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Diaz MA, Angus FC, Bickenbach JE. Perceived barriers and facilitators to good end of life care: Focusing on people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13186. [PMID: 38097500 DOI: 10.1111/jar.13186] [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: 04/17/2023] [Revised: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND People with intellectual disabilities are often left out of research on important topics. This exploratory study investigated their views on barriers and facilitators to accessing care at end of life, both at home and in a hospice setting. METHOD This qualitative study used reflexive thematic analysis. Two focus groups were held via Zoom with a total of four participants. RESULTS Three themes were produced: Unsettling Transitions, Maintaining Familiarity, and Respecting People's Wishes. Keeping things as unchanged as possible at end of life was highlighted as an ideal. Respecting people's wishes and education were highlighted as facilitators to good end of life care. CONCLUSIONS The themes identified in this study highlight the fears and wishes of this population with regards to receiving quality end of life care. Training for staff and families, as well as advanced care planning, could focus on enhancing facilitators and decreasing barriers for this population.
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Affiliation(s)
| | | | - Jerome E Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Diaz MA, Bickenbach JE, Sabariego C, Bernard RM. Qualitative methodological approaches involving participants with intellectual disabilities: Scoping review of literature exploring death and dying. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13119. [PMID: 37315942 DOI: 10.1111/jar.13119] [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: 09/07/2022] [Revised: 03/20/2023] [Accepted: 05/08/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND A paucity of qualitative research on sensitive topics that focuses on participants with intellectual disabilities leaves their views unexplored. This scoping review mainly aimed to provide an overview of qualitative data collection methods used in research involving participants with intellectual disabilities to explore death and dying. METHOD A scoping review of primary research and methodological papers published between January 2008 and March 2022 was conducted. The PRISMA-ScR checklist was followed. RESULTS We identified 25 articles utilising four data collection methods: interviews, focus groups, the Nominal Group Technique, and participant observation. Data collection trends were identified, including accommodations for participants with intellectual disabilities, visual media used as a facilitator, and reporting of distress protocols. Most participants had mild to moderate intellectual disabilities. CONCLUSIONS The included studies demonstrate a flexible approach that relies on the use of multiple methods. Future research must adequately report study characteristics to ensure transparency and reliability.
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Affiliation(s)
| | | | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, University of Lucerne, Lucerne, Switzerland
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Belperio I, Devery K, Morgan DD, Rawlings D, Raghavendra P, Walker R. Health and disability care providers' experiences and perspectives on end-of-life care needs of individuals with long-standing physical disability: A qualitative interview study. Palliat Med 2023; 37:131-139. [PMID: 36267025 DOI: 10.1177/02692163221128702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Little is known about the specific needs and experiences of individuals with long-standing physical disability at end of life. AIM To explore health and disability care providers perspectives and experiences in relation to end-of-life care needs of individuals with long-standing physical disability. DESIGN Qualitative study using reflexive thematic analysis. SETTING/PARTICIPANTS Semi-structured interviews were conducted with nine health and disability care providers from two Australian states. RESULTS Five themes were constructed from the data: (1) The significance of place. All participants described how the end-of-life care experience was significantly impacted by the place in which dying occurred. (2) Knowing the person and their needs. Knowledge and familiarity with the individual with long-standing disability were seen as invaluable in terms of providing continued high-quality care. (3) Navigating a new care landscape. For disability support workers, struggling to adapt from providing disability support to end-of-life care was difficult. (4) Complexities of family involvement. Past experiences of families within the healthcare system had resultant impacts on care received by the individual with long-standing disability. (5) Being prepared. Participants felt more was needed in terms of end-of-life planning and discussions around end of life for this cohort. CONCLUSIONS This research highlights a significant lack of continuity of care and problems at the intersection of the disability and health systems when providing end-of-life care for this cohort. Suggested areas for improvement include team approaches to enable continuity of care and dying in place, and a need for knowledge and skills in this area for all stakeholders.
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Affiliation(s)
- Irene Belperio
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Kim Devery
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Deidre D Morgan
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Deb Rawlings
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Parimala Raghavendra
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Ruth Walker
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
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Nombora O, Miguel A, Lopes L, Venâncio Â. The Intriguing Diagnosis of Lung Cancer in a Psychiatry Inpatient Unit: A Reflection Through a Case Report. Cureus 2022; 14:e29450. [PMID: 36299978 PMCID: PMC9587735 DOI: 10.7759/cureus.29450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
People with intellectual developmental disorders are vulnerable to somatic and mental illnesses, often presenting with behavioural changes. Through an intriguing and uncommon case report, we aim to provide an overview of behavioural changes in patients with an intellectual developmental disorder, emphasizing the need for screening for non-psychiatric conditions. We present a clinical case of a 57-year-old man with a personal history of intellectual developmental disorder, epilepsy, and alcohol and tobacco abuse. He had a previous acute psychiatric admission in 2017 due to behaviour disorganization and irritability. In April 2019, he was readmitted with disorganized behaviour and caregiver exhaustion. On the 58th day of hospitalization, he fell off his bed and suffered a mild traumatic brain injury. A cerebral CT scan revealed two metastatic lesions in the brain. Further investigations discovered a primary neoplastic lung lesion with metastasis to pulmonary lymph nodes. This case emphasizes that despite a long follow-up with psychiatry services, physical illness should be considered when patients with intellectual developmental disorders present with behavioural changes as they can precede image and laboratory findings. Additionally, further studies are needed in order to provide guidelines and proper medical and psychosocial care for this particular population and the caregivers.
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Viola M, Braun RT, Luth EA, Pan CX, Lief L, Gang J, Adamou Z, Dodd P, Prigerson HG. Associations of Intellectual Disability with Cardiopulmonary Resuscitation and Endotracheal Intubation at End of Life. J Palliat Med 2022; 25:1268-1272. [PMID: 35442779 PMCID: PMC9347372 DOI: 10.1089/jpm.2021.0584] [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] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about end-of-life intensive care provided to patients with intellectual disabilities (ID). Objectives: To identify differences in receipt of end-of-life cardiopulmonary resuscitation (CPR) and endotracheal intubation among adult patients with and without ID and examine whether do-not-resuscitate orders (DNRs) mediate associations between ID and CPR. Design: Exploratory matched cohort study using medical records of inpatient decedents treated between 2012 and 2018. Results: Patients with ID (n = 37) more frequently received CPR (37.8% vs. 21.6%) and intubation (78.4% vs. 47.8%) than patients without ID (n = 74). In multivariable models, ID was associated with receiving CPR (relative risk [RR] = 2.92, 95% confidence interval = 1.26-6.78, p = 0.012), but not intubation. Patients with ID less frequently had a DNR placed (67.6% vs. 91.9%), mediating associations between ID and CPR. Conclusions: In this pilot study, ID was associated with increased likelihood of receiving end-of-life CPR, likely due to lower utilization of DNRs among patients with ID. Further research is needed to confirm these results.
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Affiliation(s)
- Martin Viola
- Center for Research on End-of-Life Care and Weill Cornell Medicine, New York, New York, USA
| | - Robert Tyler Braun
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Elizabeth A. Luth
- Department of Family Medicine and Community Health, Institute for Health, Healthcare Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
| | - Cynthia X. Pan
- Division of Palliative Medicine and Geriatrics, New York Presbyterian Queens Hospital, Flushing, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Lindsay Lief
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - James Gang
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Zara Adamou
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Philip Dodd
- University of Dublin, Trinity College, Dublin, Ireland
- Department of Psychiatry, St Michael's House Intellectual Disability Services
| | - Holly G. Prigerson
- Center for Research on End-of-Life Care and Weill Cornell Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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McGinley JM, Marsack-Topolewski CN. A Comparative Case Study of Hospice and Hospital End-of-Life Care for Aging Adults With Developmental Disabilities. Glob Qual Nurs Res 2022; 9:23333936221087626. [PMID: 35572367 PMCID: PMC9102126 DOI: 10.1177/23333936221087626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/24/2022] Open
Abstract
Greater attention is being paid to issues surrounding end-of-life care for aging adults with developmental disabilities. The purpose of this qualitative study was to explore the end-of-life experiences of two aging adults with developmental disabilities and life-limiting serious illnesses who received care in settings in the United States. Using a comparative case study design, data from three sources (records, staff, surrogates) were collected sequentially and triangulated via within and cross-case analyses. Although the setting and design limit the generalizability of these findings, the feasibility of delivering high quality care to adults with developmental disabilities as they age and experience terminal illnesses is supported. Insights are presented regarding how nurses can address barriers by adapting policies and practices to accommodate the distinct needs that arise as people with developmental disabilities age, become seriously ill, and reach life's end.
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Ghanouni P, Hood G, Weisbrot A, McNeil K. Utilization of health services among adults with autism spectrum disorders: Stakeholders' experiences. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104120. [PMID: 34736105 DOI: 10.1016/j.ridd.2021.104120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/01/2021] [Accepted: 10/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a lifelong disorder, beginning in early childhood, which often accompanies with several healthcare challenges. There is a need for consistent and continued healthcare services throughout the life of an individual with ASD. The majority of previous studies have examined healthcare services in children with ASD and there is limited evidence about healthcare needs of adults with ASD. OBJECTIVE The aim of this project was to capture the experiences of stakeholders including adults with ASD in receiving healthcare services. METHOD We interviewed 22 stakeholders, including adults with ASD (n = 13), parents of adults with ASD (n = 5), and service providers (n = 4). Open-ended questions were used to explore their experiences with the healthcare system. We analysed the data thematically to develop the overarching themes. RESULTS Three themes emerged from interviews including a) availability and accessibility of healthcare services, b) provision of quality healthcare and service delivery, and c) striving for better health outcomes. CONCLUSION This study found that many adults with ASD can experience a continued lack of access to services and the care they receive is often of limited quality. The unmet healthcare needs lead stakeholders to feel stress, frustration, exhaustion, and possible burnout. The detrimental cost of limited services not only impacts adults with ASD but also their caregivers.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Graham Hood
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Abby Weisbrot
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Karen McNeil
- Department of Family Medicine, Dalhousie University, Halifax, Canada
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Voss H, Loxton A, Anderson J, Watson J. "It was one of those complicated cases": health practitioners' perspectives and practices of providing end-of-life care for people with profound intellectual and multiple disability. BMC Palliat Care 2021; 20:177. [PMID: 34772382 PMCID: PMC8586595 DOI: 10.1186/s12904-021-00873-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Due to developments in health and social care, people with profound intellectual and multiple disability (PIMD) are living longer than ever before, meaning they are increasingly experiencing life-threatening health conditions requiring palliative care. Little is known about providing end-of-life care for people with PIMD. The aim of this study was to explore health practitioners’ perspectives and practices relating to end-of-life decision-making and planning for people with PIMD. Methods Seven in-depth semi-structured interviews were conducted with health practitioners employed in a range of hospital and community services throughout Melbourne, Australia. Questions were designed to gather information about their experience, perceptions, and attitudes relating to people with PIMD during and at the end of their life. Each interview, ranging from 40 to 60 min in length, was audio recorded and transcribed. Inductive thematic analysis was used to analyse the data. Results Four main themes emerged: limited participation, bias, dignity, and quality of death. Health practitioners indicated that people with PIMD are frequently excluded from participating in decision-making related to end-of-life care. Participants discussed reasons for this exclusion including challenges with communication and cognition. Participants reported a need for additional support and guidance in providing care for people with PIMD at the end of life. Professional and family bias played a role in end-of-life decision-making for people with PIMD. Participants reported a disproportional focus by palliative care practitioners on physical as opposed to emotional and spiritual well-being for patients with PIMD at the end of life. Finally, participants reported that people with PIMD generally did not die in specialised palliative care settings, but in segregated supported living environments. Conclusions Due to negative perceptions of a person with PIMD’s decision-making capacity, people with PIMD are likely to be assessed as unable to express choice and preference regarding end-of-life care and are offered limited opportunity to be involved in their own end-of-life care. This research provides guidance for the development of training and professional development relating to people with PIMD at the end of life. It is hoped that this will increase the accessibility of end-of-life services for people with PIMD, ensuring that a respectful and dignified death can be a reality for all humankind regardless of disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00873-5.
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Affiliation(s)
- Hille Voss
- Netherlands Institute for Health Services Research (Nivel), Otterstraat 118, Utrecht, 3513 CR, The Netherlands.
| | - April Loxton
- Deakin University's School of Health and Social Development, Faculty of Health, 221 Burwood Hwy, Burwood, Melbourne, VIC, 3125, Australia
| | - Julie Anderson
- Deakin University's School of Health and Social Development, Faculty of Health, 221 Burwood Hwy, Burwood, Melbourne, VIC, 3125, Australia
| | - Joanne Watson
- Deakin University's School of Health and Social Development, Faculty of Health, 221 Burwood Hwy, Burwood, Melbourne, VIC, 3125, Australia
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Foo B, Wiese M, Curryer B, Stancliffe RJ, Wilson NJ, Clayton JM. Specialist palliative care staff's varying experiences of talking with people with intellectual disability about their dying and death: A thematic analysis of in-depth interviews. Palliat Med 2021; 35:738-749. [PMID: 33730929 DOI: 10.1177/0269216321998207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The cognitive and communication challenges experienced by people with intellectual disability present difficulties for health professionals, particularly in the face of illness and dying. AIM To explore the experiences of specialist palliative care staff in talking with people with intellectual disability about their dying and death, and factors that influence these conversations. DESIGN An inductive thematic analysis was conducted on data from a larger qualitative semi-structured interview study. SETTING/PARTICIPANTS Twenty palliative care staff from health services across Australia were interviewed. Participants were employed in multidisciplinary specialist palliative care teams and had provided palliative care to dying persons with intellectual disability. RESULTS Specialist palliative care staff did not consistently talk with people with intellectual disability about their dying and death. Conversations were influenced by (a) the perceived capacity of the person with intellectual disability, (b) experience and expertise of palliative care staff, (c) the relationship between palliative care staff and dying person and (d) values of palliative care staff and other caregivers (namely family members and paid carers). CONCLUSIONS Specialist palliative care staff experience difficulties in talking with people with intellectual disability about their dying. Development of communication guidelines, resources and training for palliative care teams are urgently required to improve palliative care for this patient group. A more comprehensive research agenda on the needs of people with intellectual disability and their caregivers in palliative care is needed, with a particular focus on strategies to effectively communicate about dying and death.
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Affiliation(s)
- Baby Foo
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Michele Wiese
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Bernadette Curryer
- Centre for Disability Research and Policy, The University of Sydney, Sydney, NSW, Australia
| | - Roger J Stancliffe
- Centre for Disability Research and Policy, The University of Sydney, Sydney, NSW, Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Hawkesbury, NSW, Australia
| | - Josephine M Clayton
- Centre for Learning & Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, Australia; Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
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Voss H, Vogel AGFM, Wagemans AMA, Francke AL, Metsemakers JFM, Courtens AM, de Veer AJE. Development, Implementation, and Evaluation of an Advance Care Planning Program for Professionals in Palliative Care of People With Intellectual Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:39-54. [PMID: 33543280 DOI: 10.1352/1934-9556-59.1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 11/22/2019] [Indexed: 06/12/2023]
Abstract
In this article we describe how an advance care planning (ACP) program was developed, implemented, and evaluated. Our aim was to improve ACP in palliative care for people with intellectual disability (ID). The program was based on 10 competencies needed for ACP and was developed in a co-design process with people with ID, relatives, and professionals. The program was implemented in six ID care organizations in the Netherlands and consisted of an information pack, a training course, and an implementation interview about implementing ACP. Professionals indicated that their competencies had improved, particularly regarding communication and the application of ACP as a standard element in palliative care practice. This program therefore seems helpful in training ID care professionals in the competencies needed for ACP.
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Affiliation(s)
- Hille Voss
- Hille Voss*, Netherlands Institute of Health Services Research (Nivel), Utrecht, the Netherlands
| | | | - Annemieke M A Wagemans
- Annemieke M.A. Wagemans, Maasveld, Koraal, Maastricht, the Netherlands; Expertise Centre for Palliative Care, Maastricht University Medical Centre, Maastricht, the Netherlands; and Department of Family Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands
| | - Anneke L Francke
- Anneke L. Francke, Netherlands Institute of Health Services Research (Nivel), Utrecht, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health; Expertise Centre for Palliative Care, Amsterdam, the Netherlands
| | - Job F M Metsemakers
- Job F.M. Metsemakers, Department of Family Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands
| | - Annemie M Courtens
- Annemie M. Courtens, Expertise Centre for Palliative Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Anke J E de Veer
- Anke J.E. de Veer, Netherlands Institute of Health Services Research (Nivel), Utrecht, the Netherlands
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Kluger BM, Drees C, Wodushek TR, Frey L, Strom L, Brown MG, Bainbridge JL, Fischer SN, Shrestha A, Spitz M. Would people living with epilepsy benefit from palliative care? Epilepsy Behav 2021; 114:107618. [PMID: 33246892 PMCID: PMC9326903 DOI: 10.1016/j.yebeh.2020.107618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022]
Abstract
Palliative care (PC) is an approach to the care of persons living with serious illness and their families that focuses on improving quality of life and reducing suffering by addressing complex medical symptoms, psychosocial needs, spiritual well-being, and advance care planning. While PC has traditionally been associated with hospice care for persons with cancer, there is now recognition that PC is relevant to many noncancer diagnoses, including neurologic illness, and at multiple points along the illness journey, not just end of life. Despite the recent growth of the field of neuropalliative care there has been scant attention paid to the relevance of PC principles in epilepsy or the potential for PC approaches to improve outcomes for persons living with epilepsy and their families. We believe this has been a significant oversight and that PC may provide a useful framework for addressing the many sources of suffering facing persons living with epilepsy, for engaging patients and families in challenging conversations, and to focus efforts to improve models of care for this population. In this manuscript we review areas of significant unmet needs where a PC approach may improve patient and family-centered outcomes, including complex symptom management, goals of care, advance care planning, psychosocial support for patient and family and spiritual well-being. When relevant we highlight areas where epilepsy patients may have unique PC needs compared to other patient populations and conclude with suggestions for future research, clinical, and educational efforts.
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Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Cornelia Drees
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas R Wodushek
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren Frey
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Strom
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacquelyn L Bainbridge
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah N Fischer
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Archana Shrestha
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark Spitz
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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McNamara B, Same A, Rosenwax L. Creating person-centred support for people with intellectual disabilities at the end of life: An Australian qualitative study of unmet needs and strategies. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:543-558. [PMID: 30727802 DOI: 10.1177/1744629518823887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND People with intellectual disabilities at the end of life are at risk of receiving inadequate and inequitable end-of-life care. This study explores their unmet needs, opportunities for person-centred care and experiences of health service use. METHODS Qualitative interviews with 26 experienced health professionals and carers were used to explore their patients' and residents' unmet needs and end-of-life care options and to outline strategies to support them. RESULTS A range of challenges and unmet needs experienced by people with intellectual disabilities are presented in themes: (1) accommodation setting at the end of life: dying 'at home'; (2) personal factors and networks: a circle of support; (3) end-of-life medical care and decision-making. Strategies to facilitate good end-of-life care and a model of care are presented. CONCLUSIONS Well-prepared and collaborative disability and health service workforces are needed, together with flexible and adequate end-of-life funding to ensure compassionate and person-centred care.
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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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Segerlantz M, Axmon A, Ahlström G. End-of-life care among older cancer patients with intellectual disability in comparison with the general population: a national register study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:317-330. [PMID: 32067284 DOI: 10.1111/jir.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/13/2019] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Increasing life expectancy for people with an intellectual disability (ID) is resulting in more persons with cancer and a greater need for end-of-life (EoL) care. There is a need for knowledge of health care utilisation over the last year of life to plan for resources that support a high quality of care for cancer patients with ID. Therefore, the aims of the study were to compare (1) health care utilisation during the last year of life among cancer patients with ID and cancer patients without ID and (2) the place of death in these two groups. METHODS The populations were defined using national data from the period 2002-2015, one with ID (n = 15 319) and one matched 5:1 from the general population (n = 72 511). Cancer was identified in the Cause of Death Register, resulting in two study cohorts with 775 cancer patients with ID (ID cohort) and 2968 cancer patients from the general population (gPop cohort). RESULTS Cancer patients with ID were less likely than those without ID to have at least one visit in specialist inpatient (relative risk 0.90, 95% confidence interval 0.87-0.93) and outpatient (0.88, 0.85-0.91) health care, during their last year of life. Those with ID were more likely to have no or fewer return visits than the patients in the gPop cohort (5 vs. 11, P < 0.001), also when stratifying on sex and median age at death. Most cancer patients with ID died in group homes or in their own homes and fewer in hospital (31%) as compared with cancer patients in the gPop cohort (55%, 0.57, 0.51-0.64). CONCLUSIONS Older cancer patients with ID were less likely to be assessed or treated by a specialist. This may suggest that people with ID have unaddressed or untreated distressing symptoms, which strongly contributes to a decreased quality of EoL care and a poor quality of life. There is a need to acquire further knowledge of the EoL care and to focus on adapting and evaluating quality indicators for older cancer patients with ID.
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Affiliation(s)
- M Segerlantz
- Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Region Skåne, Lund, Sweden
| | - A Axmon
- EPI@LUND (Epidemiology, Population studies, and Infrastructures at Lund University), Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - G Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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A scoping review to characterize bridging tasks in the literature on aging with disability. BMC Health Serv Res 2020; 20:170. [PMID: 32131826 PMCID: PMC7057667 DOI: 10.1186/s12913-020-5046-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/26/2020] [Indexed: 01/16/2023] Open
Abstract
Background Bridging involves improving knowledge sharing and collaboration across different fields, such as aging and disability. The objectives of this review were to describe: 1) the contexts where bridging has occurred in relation to delivery of health services for adults aging with neurological or developmental conditions; and 2) characterize and map bridging tasks, stakeholders involved, and outcomes discussed in peer-reviewed literature. Methods Seven databases were searched around the core concepts of “bridging,” “aging,” and “disability.” In total, 10,819 articles were screened with 49 meeting the inclusion criteria of discussing aging with developmental or neurological disability, explicitly describing bridging tasks, published in English and a peer-reviewed publication. Bibliographic information, sample characteristics, and data on bridging was extracted and included in the qualitative synthesis. Results Intellectual and/or Developmental disabilities were the most studied population (76% of articles), and most articles were published in the United States (57%). Twenty-two bridging tasks were identified, and categorized into three domains: health and social service delivery (e.g., care coordination tasks), policy (e.g., policy change), and research and training (e.g., mentoring). Stakeholders involved ranged from health care professionals to policy makers and organizations in aging and disability services. Conclusions The resulting matrix will assist in the specification of bridging in research and practice. Future work should evaluate specific models of bridging and their effects on health service delivery.
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Tuffrey-Wijne I, Davidson J. Excellence in palliative and end-of-life care provision for people with intellectual disability. Int J Palliat Nurs 2018; 24:598-610. [PMID: 30571253 DOI: 10.12968/ijpn.2018.24.12.598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND: People with an intellectual disability experience significant inequalities in end-of-life and palliative care provision. AIMS: To identify the key characteristics of practice initiatives and case reports that have won a UK award for the outstanding provision of end-of-life care for people with ID (2008-2018). METHODS: Thematic content analysis of the written nominations for award winners and those highly commended (n=25). FINDINGS: Four themes were identified: (1) Good practice was dependent on 'champions' with drive, enthusiasm and determination, supported by committed organisations and managers. (2) Collaboration was essential, including collaboration with families. (3) Care was highly individualised, putting the person's story at the centre. (4) There was a focus on staff training and use of specifically designed or adapted tools. CONCLUSION: The good practice examples are encouraging. Focus is now needed on ensuring that good practice is sustained, replicated and embedded within policies and organisational cultures. Currently, it remains over-dependent on committed individuals within organisations.
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Tromans S, Andrews H, Wani A, Ganghadaran S. The ELCIDD Project: An Audit of End-of-Life Care in Persons with Intellectual Disabilities and Dementia. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Hayley Andrews
- General Adult Psychiatry Service; Leicestershire Partnership NHS Trust; Leicester UK
| | - Anu Wani
- Learning Disabilities Service; Leicestershire Partnership NHS Trust; Leicester UK
| | - Satheesh Ganghadaran
- Learning Disabilities Service; Leicestershire Partnership NHS Trust; Leicester UK
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Pentaris P, Papadatou D, Jones A, Hosang GM. Palliative care professional's perceptions of barriers and challenges to accessing children's hospice and palliative care services in South East London: A preliminary study. DEATH STUDIES 2018; 42:649-657. [PMID: 29393840 DOI: 10.1080/07481187.2018.1430081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Several barriers have been identified as preventing or delaying access to children's palliative care services. The aim of this study is to further explore such barriers from palliative care professionals' perspective from two London boroughs. METHODS Qualitative-five children's palliative care professionals' perceptions were obtained from semi-structured interviews. RESULTS Three themes emerged: availability and adequacy of child palliative care (e.g., unreliability of services), obstacles to accessing palliative care (e.g., logistical challenges), and cultural values and family priorities. CONCLUSION These findings contribute to the equal opportunities dialogue in this sector and the need for future research to address the challenges identified.
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Affiliation(s)
- Panagiotis Pentaris
- a Department of Psychology, Social Work and Counselling , University of Greenwich , London , UK
- b Faiths and Civil Society Unit, Goldsmiths , University of London , London , UK
| | - Danai Papadatou
- c Department of Nursing , National and Kapodistrian University of Athens , Athens , Greece
| | - Alice Jones
- d Department of Psychology, Goldsmiths , University of London , London , UK
| | - Georgina M Hosang
- e Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary , University of London , London , UK
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Williamson HJ, Contreras GM, Rodriguez ES, Smith JM, Perkins EA. Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 37:227-236. [PMID: 28703641 DOI: 10.1177/1539449217714148] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.
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Moro TT, Savage TA, Gehlert S. Agency, social and healthcare supports for adults with intellectual disability at the end of life in out-of-home, non-institutional community residences in Western nations: A literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30:1045-1056. [PMID: 28585240 DOI: 10.1111/jar.12374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The nature and quality of end-of-life care received by adults with intellectual disabilities in out-of-home, non-institutional community agency residences in Western nations is not well understood. METHOD A range of databases and search engines were used to locate conceptual, clinical and research articles from relevant peer-reviewed journals. RESULTS The present authors present a literature review of the agency, social and healthcare supports that impact end-of-life care for adults with intellectual disabilities. More information is needed about where people with intellectual disabilities are living at the very end of life and where they die. CONCLUSIONS The support needs for adults with intellectual disabilities will change over time, particularly at the end of life. There are some areas, such as removing barriers to providing services, staff training, partnerships between agencies and palliative care providers, and advocacy, where further research may help to improve the end-of-life care for adults with intellectual disabilities.
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Affiliation(s)
- Teresa T Moro
- College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Teresa A Savage
- Department of Women, Children, and Family Health Science, College of Nursing, Chicago, IL, USA
| | - Sarah Gehlert
- E. Desmond Lee Professor of Racial and Ethnic Diversity, George Warren Brown School of Social Work, St. Louis, MO, USA
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Tedder T, Elliott L, Lewis K. Analysis of common barriers to rural patients utilizing hospice and palliative care services: An integrated literature review. J Am Assoc Nurse Pract 2017; 29:356-362. [PMID: 28560759 DOI: 10.1002/2327-6924.12475] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 04/21/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this literature review is to explore barriers and potential solutions related to hospice (HC) and palliative care (PC) services among rural residents. Although the healthcare system is continually advancing, healthcare providers may not be optimizing HC and PC referrals for the growing rural population who underutilize these services. Suggested methods to close the utilization gap between HC and PC services among rural patients appear feasible, but universal effectiveness cannot be determined. METHODS An integrative literature review was conducted to evaluate diverse sources of literature. An electronic literature search was carried out using databases MEDLINE, CINAHL, Cochrane, PsycINFO, and Pubmed. The search was limited to English only, full text, peer reviewed, and published between 2010 and 2016. Search terms included rural, hospice, palliative, care access, and barriers. CONCLUSION There are several barriers that interrelate to decreased utilization of PC and HC for rural populations and there are many options for overcoming them to equalize care. IMPLICATIONS FOR PRACTICE Although advances to the general healthcare system are expediently rising, the rural patient population seems to fall short of these important life-changing services, especially in the realm of PC/HC. Beginning in primary care, this patient population can be affected and included in a positive manner.
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Affiliation(s)
- Tara Tedder
- MS(N) Program, Western Carolina University, Asheville, North Carolina
| | - Lydia Elliott
- MS(N) Program, Western Carolina University, Asheville, North Carolina
| | - Karen Lewis
- MS(N) Program, Western Carolina University, Asheville, North Carolina
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Grindrod A, Rumbold B. Providing end‐of‐life care in disability community living services: An organizational capacity‐building model using a public health approach. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30:1125-1137. [DOI: 10.1111/jar.12372] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Grindrod
- Palliative Care UnitSchool of Psychology and Public HealthCollege of ScienceHealth and EngineeringLa Trobe University Melbourne VIC Australia
| | - Bruce Rumbold
- Palliative Care UnitSchool of Psychology and Public HealthCollege of ScienceHealth and EngineeringLa Trobe University Melbourne VIC Australia
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Kirkendall A, Linton K, Farris S. Intellectual Disabilities and Decision Making at End of Life: A Literature Review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:982-994. [DOI: 10.1111/jar.12270] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Abbie Kirkendall
- Greenspun College of Urban Affairs School of Social Work University of Nevada at Las Vegas Las Vegas NV USA
| | - Kristen Linton
- Health Sciences Program California State University Channel Islands Camarillo CA USA
| | - Saritha Farris
- Beacon Pointe 2810 W. Charleston Blvd. Las Vegas NV 89102
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Tuffrey-Wijne I, McLaughlin D, Curfs L, Dusart A, Hoenger C, McEnhill L, Read S, Ryan K, Satgé D, Straßer B, Westergård BE, Oliver D. Defining consensus norms for palliative care of people with intellectual disabilities in Europe, using Delphi methods: A White Paper from the European Association of Palliative Care. Palliat Med 2016; 30:446-55. [PMID: 26346181 PMCID: PMC4838171 DOI: 10.1177/0269216315600993] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with intellectual disabilities often present with unique challenges that make it more difficult to meet their palliative care needs. AIM To define consensus norms for palliative care of people with intellectual disabilities in Europe. DESIGN Delphi study in four rounds: (1) a taskforce of 12 experts from seven European countries drafted the norms, based on available empirical knowledge and regional/national guidelines; (2) using an online survey, 34 experts from 18 European countries evaluated the draft norms, provided feedback and distributed the survey within their professional networks. Criteria for consensus were clearly defined; (3) modifications and recommendations were made by the taskforce; and (4) the European Association for Palliative Care reviewed and approved the final version. SETTING AND PARTICIPANTS Taskforce members: identified through international networking strategies. Expert panel: a purposive sample identified through taskforce members' networks. RESULTS A total of 80 experts from 15 European countries evaluated 52 items within the following 13 norms: equity of access, communication, recognising the need for palliative care, assessment of total needs, symptom management, end-of-life decision making, involving those who matter, collaboration, support for family/carers, preparing for death, bereavement support, education/training and developing/managing services. None of the items scored less than 86% agreement, making a further round unnecessary. In light of respondents' comments, several items were modified and one item was deleted. CONCLUSION This White Paper presents the first guidance for clinical practice, policy and research related to palliative care for people with intellectual disabilities based on evidence and European consensus, setting a benchmark for changes in policy and practice.
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Affiliation(s)
- Irene Tuffrey-Wijne
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | | | - Leopold Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | | | - Karen Ryan
- Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | | | | | | | - David Oliver
- Tizard Centre, University of Kent, Canterbury, UK
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25
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Tuffrey-Wijne I, Wicki M, Heslop P, McCarron M, Todd S, Oliver D, de Veer A, Ahlström G, Schäper S, Hynes G, O'Farrell J, Adler J, Riese F, Curfs L. Developing research priorities for palliative care of people with intellectual disabilities in Europe: a consultation process using nominal group technique. BMC Palliat Care 2016; 15:36. [PMID: 27009550 PMCID: PMC4806426 DOI: 10.1186/s12904-016-0108-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 03/17/2016] [Indexed: 11/20/2022] Open
Abstract
Background Empirical knowledge around palliative care provision and needs of people with intellectual disabilities is extremely limited, as is the availability of research resources, including expertise and funding. This paper describes a consultation process that sought to develop an agenda for research priorities for palliative care of people with intellectual disabilities in Europe. Methods A two-day workshop was convened, attended by 16 academics and clinicians in the field of palliative care and intellectual disability from six European countries. The first day consisted of round-table presentations and discussions about the current state of the art, research challenges and knowledge gaps. The second day was focused on developing consensus research priorities with 12 of the workshop participants using nominal group technique, a structured method which involved generating a list of research priorities and ranking them in order of importance. Results A total of 40 research priorities were proposed and collapsed into eleven research themes. The four most important research themes were: investigating issues around end of life decision making; mapping the scale and scope of the issue; investigating the quality of palliative care for people with intellectual disabilities, including the challenges in achieving best practice; and developing outcome measures and instruments for palliative care of people with intellectual disabilities. Conclusions The proposal of four major priority areas and a range of minor themes for future research in intellectual disability, death, dying and palliative care will help researchers to focus limited resources and research expertise on areas where it is most needed and support the building of collaborations. The next steps are to cross-validate these research priorities with people with intellectual disabilities, carers, clinicians, researchers and other stakeholders across Europe; to validate them with local and national policy makers to determine how they could best be incorporated in policy and programmes; and to translate them into actual research studies by setting up European collaborations for specific studies that require such collaboration, develop research proposals and attract research funding.
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Affiliation(s)
- I Tuffrey-Wijne
- Kingston University & St George's University of London, Faculty of Health, Social Care and Education, Cranmer Terrace, London, SW17 0RE, UK.
| | - M Wicki
- Internationale Hochschule für Heilpädagogik Zürich, Zürich, Switzerland
| | - P Heslop
- Norah Fry Research Centre, School for Policy Studies, University of Bristol, Bristol, UK
| | - M McCarron
- Trinity College, University of Dublin, Dublin, Ireland
| | - S Todd
- Faculty of Life Sciences and Education, University of South Wales, Cardiff, Newport, UK
| | - D Oliver
- Tizard Centre, University of Kent, Kent, UK
| | - A de Veer
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | | | - S Schäper
- Department Muenster, Catholic University of Applied Sciences, Muenster, Germany
| | - G Hynes
- Trinity College, University of Dublin, Dublin, Ireland
| | - J O'Farrell
- Trinity College, University of Dublin, Dublin, Ireland
| | - J Adler
- University of Applied Sciences of Special Needs Education, Zürich, Switzerland
| | - F Riese
- Division of Psychiatry Research and Psychogeriatric Medicine, Zurich, Switzerland
| | - L Curfs
- Maastricht University Medical Centre, Governor Kremers Centre, Maastricht, The Netherlands
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Wagemans AMA, van Schrojenstein Lantman-de Valk HMJ, Proot IM, Metsemakers J, Tuffrey-Wijne I, Curfs LMG. End-of-Life Decision-Making for People With Intellectual Disability From the Perspective of Nurses. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2015. [DOI: 10.1111/jppi.12140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. M. A. Wagemans
- Maasveld, Koraalgroep; Maastricht the Netherlands
- Maastricht University Medical Centre; Maastricht the Netherlands
| | | | - I. M. Proot
- Maastricht University Medical Centre; Maastricht the Netherlands
| | - J. Metsemakers
- Maastricht University Medical Centre; Maastricht the Netherlands
| | - I. Tuffrey-Wijne
- Maastricht University Medical Centre; Maastricht the Netherlands
- St George's University of London; London UK
| | - L. M. G. Curfs
- Maastricht University Medical Centre; Maastricht the Netherlands
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Capri C, Buckle C. ‘We have to be Satisfied with the Scraps’: South African Nurses' Experiences of Care on Adult Psychiatric Intellectual Disability Inpatient Wards. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2014; 28:167-81. [DOI: 10.1111/jar.12118] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Charlotte Capri
- Psychology; University of Stellenbosch; Stellenbosch South Africa
| | - Chanellé Buckle
- Psychology; University of Stellenbosch; Stellenbosch South Africa
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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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Anderson LL, Humphries K, McDermott S, Marks B, Sisarak J, Larson S. The state of the science of health and wellness for adults with intellectual and developmental disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2013; 51:385-98. [PMID: 24303825 PMCID: PMC4677669 DOI: 10.1352/1934-9556-51.5.385] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Historically, people with intellectual and developmental disabilities (IDD) have experienced health disparities related to several factors including: a lack of access to high quality medical care, inadequate preparation of health care providers to meet their needs, the social determinants of health (e.g., poverty, race and gender), and the failure to include people with IDD in public health efforts and other prevention activities. Over the past decade, a greater effort has been made to both identify and begin to address myriad health disparities experienced by people with IDD through a variety of activities including programs that address health lifestyles and greater attention to the training of health care providers. Gaps in the literature include the lack of intervention trials, replications of successful approaches, and data that allow for better comparisons between people with IDD and without IDD living in the same communities. Implications for future research needed to reduce health disparities for people with IDD include: better monitoring and treatment for chronic conditions common in the general population that are also experienced by people with IDD, an enhanced understanding of how to promote health among those in the IDD population who are aging, addressing the health needs of people with IDD who are not part of the disability service system, developing a better understanding of how to include people with IDD in health and wellness programs, and improving methods for addressing the health care needs of members of this group in an efficient and cost-effective manner, either through better access to general medical care or specialized programs.
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Affiliation(s)
| | - Kathy Humphries
- Montana Disability and Health Program, University of Montana Rural Institute
| | - Suzanne McDermott
- Department of Family and Preventive Medicine, University of South Carolina
| | - Beth Marks
- Department of Disability and Human Development, University of Illinois at Chicago
| | - Jasmina Sisarak
- University of Illinois-Chicago Department of Disability and Human Development, University of Illinois at Chicago
| | - Sheryl Larson
- Research and Training Center on Community Living, University of Minnesota
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