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S Phiri A, Mulwafu M, Robbins Zaniku H, Banda Aron M, Kanyema J, Chibvunde S, Ndarama E, Momba G, Munyaneza F, Thambo L, Kachimanga C, Matanje B. Toward enhanced decentralized palliative care services in Neno District, Malawi: a qualitative study. BMC Palliat Care 2024; 23:132. [PMID: 38778300 PMCID: PMC11112853 DOI: 10.1186/s12904-024-01455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Palliative care remains key in assisting patients who have life-threatening conditions. In most low- and middle-income countries, it is often offered through a centralized system with limitations, including Malawi. In 2014, the World Health Organization called for improving palliative care access through primary health care and community models. Malawi and Neno District subsequently decentralized palliative care delivery to local health centers. This qualitative study explored the decentralization of palliative care services in Neno District, Malawi. METHODS The descriptive qualitative study was conducted between 2021 and 2022 in two conveniently selected health centers providing palliative care in the Neno District. Fourteen healthcare workers were purposefully selected to participate in two focus groups. Fifteen patients were conveniently selected and participated in three focus groups. Data was analyzed using deductive and inductive approaches. Focused group discussions were conducted in Chichewa (Malawi's official local language), audio recorded, transcribed, translated into English, and analyzed thematically. RESULTS Four main themes emerged from the focus groups. Patients described positive relationships with healthcare workers built on trust and holistic care over time. Accessing care included transport, social support, time constraints, and distance issues. Facilities effectively responded to needs through coordinated care and follow-up. Decentralization was perceived to benefit patients by reducing travel challenges and improving local access to efficient and inclusive palliative care services. However, challenges with resources, distance, and social support remained. Limitations in sampling and missing participant details necessitate further research with broader sampling. CONCLUSION Overall, the study provides empirical evidence that can optimize palliative care delivery in similar low-resource contexts by informing policies to address barriers through decentralized approaches.
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Affiliation(s)
- Atupere S Phiri
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi.
| | - Manuel Mulwafu
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | - Haules Robbins Zaniku
- Neno District Health Office, Ministry of Health, Neno, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Moses Banda Aron
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
- Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Judith Kanyema
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | | | - Enoch Ndarama
- Neno District Health Office, Ministry of Health, Neno, Malawi
| | - Grace Momba
- Neno District Health Office, Ministry of Health, Neno, Malawi
| | - Fabien Munyaneza
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | - Lameck Thambo
- Palliative Care Association of Malawi, Lilongwe, Malawi
| | | | - Beatrice Matanje
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
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Vitorino JV, Duarte BV, Laranjeira C. When to initiate early palliative care? Challenges faced by healthcare providers. Front Med (Lausanne) 2023; 10:1220370. [PMID: 37849489 PMCID: PMC10577203 DOI: 10.3389/fmed.2023.1220370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Joel Vieira Vitorino
- School of Health Sciences, Polytechnic of Leiria, Morro do Lena, Alto do Vieiro, Leiria, Portugal
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal
| | - Beatriz Veiga Duarte
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Morro do Lena, Alto do Vieiro, Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
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Hughes MC, Vernon E, Hainstock A. The effectiveness of community-based palliative care programme components: a systematic review. Age Ageing 2023; 52:afad175. [PMID: 37740895 PMCID: PMC10517647 DOI: 10.1093/ageing/afad175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND There is evidence that community-based palliative care programmes can improve patient outcomes and caregiver experiences cost-effectively. However, little is known about which specific components within these programmes contribute to improving the outcomes. AIM To systematically review research that evaluates the effectiveness of community-based palliative care components. DESIGN A systematic mixed studies review synthesising quantitative, qualitative and mixed-methods study findings using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PROSPERO: ID # CRD42022302305. DATA SOURCES Four databases were searched in August 2021 (CINAHL, Web of Science, ProQuest Federated and PubMed including MEDLINE) and a close review of included article references. Inclusion criteria required articles to evaluate a single, specific component of a community-based palliative care programme either within an individual programme or across several programmes. RESULTS Overall, a total of 1,674 articles were identified, with 57 meeting the inclusion criteria. Of the included studies, 21 were qualitative, 25 were quantitative and 11 had mixed methods. Outcome measures consistently examined included patient/caregiver satisfaction, hospital utilisation and home deaths. The components of standardised sessions (interdisciplinary meetings about patients), volunteer engagement and early intervention contributed to the success of community-based palliative care programmes. CONCLUSIONS Certain components of community-based palliative care programmes are effective. Such components should be implemented and tested more in low- and middle-income countries and key and vulnerable populations such as lower-income and marginalised racial or ethnic groups. In addition, more research is needed on the cost-effectiveness of individual programme components.
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Affiliation(s)
- M Courtney Hughes
- Department of Public Health, Northern Illinois University, DeKalb, IL 60115, USA
| | - Erin Vernon
- Department of Economics, Seattle University, Seattle, WA 98122, USA
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Afshar K, van Baal K, Wiese B, Schleef T, Stiel S, Müller-Mundt G, Schneider N. Structured implementation of the Supportive and Palliative Care Indicators Tool in general practice - A prospective interventional study with follow-up. Palliat Care 2022; 21:214. [PMID: 36451172 PMCID: PMC9714240 DOI: 10.1186/s12904-022-01107-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/15/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND General practitioners (GPs) play a key role in the provision of primary palliative care (PC). The identification of patients who might benefit from PC and the timely initiation of patient-centred PC measures at the end of life are essential, yet challenging. Although different tools exist to support these key tasks, a structured approach is often missing. OBJECTIVE The study aimed at implementing the German version of the Supportive and Palliative Care Indicators Tool (SPICT-DE™) in general practices, following a structured and regional approach, in order to evaluate the effects of this tool on the identification of patients with potential PC needs and the initiation of patient-centred PC measures. METHODS The intervention of this mixed-methods study comprised a standardised training of 52 GPs from 34 general practices in two counties in Lower Saxony, Germany, on the use of the SPICT-DE™. The SPICT-DE™ is a clinical tool which supports the identification of patients with potential PC needs. Subsequently, over a period of 12 months, GPs applied the SPICT-DE™ in daily practice with adult patients with chronic, progressive diseases, and completed a follow-up survey 6 months after the initial patient assessment. The outcome parameters were alterations in the patient's clinical situation, and the type and number of initiated patient-centred PC measures during the follow-up interval. Additionally, 12 months after the standardised training, GPs provided feedback on their application of the SPICT-DE™. RESULTS A total of 43 GPs (n = 15 female, median age 53 years) out of an initial sample of 52 trained GPs assessed 580 patients (n = 345 female, median age 84 years) with mainly cardiovascular (47%) and cancer (33%) diseases. Follow-up of 412 patients revealed that 231 (56%) experienced at least one critical incident in their disease progression (e.g. acute crisis), 151 (37%) had at least one hospital admission, and 141 (34%) died. A review of current treatment/medication (76%) and a clarification of treatment goals (53%) were the most frequently initiated patient-centred PC measures. The majority of GPs deemed the SPICT-DE™ practical (85%) and stated an intention to continue applying the tool in daily practice (66%). CONCLUSIONS The SPICT-DE™ is a practical tool that supports the identification of patients at risk of deterioration or dying and promotes the initiation of patient-centred PC measures. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (N° DRKS00015108; 22/01/2019).
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Affiliation(s)
- Kambiz Afshar
- grid.10423.340000 0000 9529 9877Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Katharina van Baal
- grid.10423.340000 0000 9529 9877Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Birgitt Wiese
- grid.10423.340000 0000 9529 9877Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tanja Schleef
- grid.10423.340000 0000 9529 9877Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Stephanie Stiel
- grid.10423.340000 0000 9529 9877Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Gabriele Müller-Mundt
- grid.10423.340000 0000 9529 9877Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Nils Schneider
- grid.10423.340000 0000 9529 9877Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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What do we know about experiencing end-of-life in burn intensive care units? A scoping review. Palliat Support Care 2022:1-17. [PMID: 36254708 DOI: 10.1017/s1478951522001389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this article is to review and synthesize the evidence on end-of-life in burn intensive care units. METHODS Systematic scoping review: Preferred Reporting Items for Systemic Reviews extension for Scoping Reviews was used as a reporting guideline. Searches were performed in 3 databases, with no time restriction and up to September 2021. RESULTS A total of 16,287 documents were identified; 18 were selected for analysis and synthesis. Three key themes emerged: (i) characteristics of the end-of-life in burn intensive care units, including end-of-life decisions, decision-making processes, causes, and trajectories of death; (ii) symptom control at the end-of-life in burn intensive care units focusing on patients' comfort; and (iii) concepts, models, and designs of the care provided to burned patients at the end-of-life, mainly care approaches, provision of care, and palliative care. SIGNIFICANCE OF RESULTS End-of-life care is a major step in the care provided to critically ill burned patients. Dying and death in burn intensive care units are often preceded by end-of-life decisions, namely forgoing treatment and do-not-attempt to resuscitate. Different dying trajectories were described, suggesting the possibility to develop further studies to identify triggers for palliative care referral. Symptom control was not described in detail. Palliative care was rarely involved in end-of-life care for these patients. This review highlights the need for early and high-quality palliative and end-of-life care in the trajectories of critically ill burned patients, leading to an improved perception of end-of-life in burn intensive care units. Further research is needed to study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units.
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Wu A, Ugiliweneza B, Wang D, Hsin G, Boakye M, Skirboll S. Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: A SEER-Medicare retrospective study. Neurooncol Pract 2022; 9:299-309. [PMID: 35859543 PMCID: PMC9290893 DOI: 10.1093/nop/npac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Glioblastoma (GBM) carries a poor prognosis despite standard of care. Early palliative care (PC) has been shown to enhance survival and quality of life while reducing healthcare costs for other cancers. This study investigates differences in PC timing on outcomes for patients with GBM. Methods This study used Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1997 to 2016. Based on ICD codes, three groups were defined: (1) early PC within 10 weeks of diagnosis, (2) late PC, and (3) no PC. Outcomes were compared between the three groups. Results Out of 10 812 patients with GBM, 1648 (15.24%) patients had PC consultation with an overall positive trend over time. There were no significant differences in patient characteristics. The late PC group had significantly higher number of hospice claims (1.06 ± 0.69) compared to those without PC, in the last month of life. There were significant differences in survival among the three groups (P < .0001), with late PC patients with the longest mean time to death from diagnosis (11.72 ± 13.20 months). Conclusion We present the first investigation of PC consultation prevalence and outcomes, stratified by early versus late timing, for adult GBM patients. Despite an overall increase in PC consultations, only a minority of GBM patients receive PC. Patients with late PC had the longest survival times and had greater hospice use in the last month of life compared to other subgroups. Prospective studies can provide additional valuable information about this unique population of patients with GBM.
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Affiliation(s)
- Adela Wu
- Department of Neurosurgery, Stanford University, Palo Alto, California, USA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Dengzhi Wang
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Gary Hsin
- Department of Extended Care and Palliative Medicine Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Maxwell Boakye
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Stephen Skirboll
- Department of Neurosurgery, Stanford University, Palo Alto, California, USA
- Section of Neurosurgery, VA Palo Alto Health Care System, Palo Alto, California, USA
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Alquati S, Peruselli C, Turrà C, Tanzi S. Lesson Learned From Hospital Palliative Care Service in a Cancer Research Center in Italy: Results of 5 Years of Experience. Front Oncol 2022; 12:936795. [PMID: 35832554 PMCID: PMC9271826 DOI: 10.3389/fonc.2022.936795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundInternational studies have documented that over a third of all hospital beds are occupied by patients with palliative care needs in their last year of life. Experiences of Palliative Care Services that take place prevalently or exclusively in hospital settings are very few in Italy.ObjectiveDescribe clinical, educational and research activities performed by a hospital PCS and discussing opportunities and critical issues encountered in an Italian Cancer Center.MethodRetrospective data regarding adults with advanced stage diseases referred from January 2015 to December 2019.ResultsClinical activity - The PCS performed 2422 initial consultations with an average of 484 initial consultations per year. A majority of patients had advanced cancer, from 85% to 72%, with an average of 2583 total consultations per year and an average of 4.63 consultations per patient. The penetrance has increased over time from 6.3% to 15.75%. Educational and research activity - Since 2015, PCS has provided training to health professionals (HPs) of different departments of our hospital. Most of the educational projects for HPs were part of research projects, for example the communication training program, management of pain and end-of-life symptoms and the training program for PC-based skills.ConclusionOur data suggests that a PCS able to provide palliative care to inpatients and outpatient and continuous training support to other hospital specialists can relatively quickly improve the level of its penetrance in hospital activities.
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Affiliation(s)
- Sara Alquati
- Palliative Care Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
- *Correspondence: Sara Alquati, ; orcid.org/0000-0001-8696-9602
| | | | - Caterina Turrà
- Department of Hospital Pharmacy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Pereira J, Meadows L, Kljujic D, Strudsholm T, Parsons H, Riordan B, Faulkner J, Fisher K. Learner Experiences Matter in Interprofessional Palliative Care Education: A Mixed Methods Study. J Pain Symptom Manage 2022; 63:698-710. [PMID: 34998952 DOI: 10.1016/j.jpainsymman.2021.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/09/2021] [Accepted: 12/31/2021] [Indexed: 12/17/2022]
Abstract
CONTEXT Interprofessional collaboration is needed in palliative care and many other areas in health care. Pallium Canada's two-day interprofessional Learning Essential Approaches to Palliative care Core courses aim to equip primary care providers from different professions with core palliative care skills. OBJECTIVES Explore the learning experience of learners from different professions who participated in Learning Essential Approaches to Palliative care Core courses from April 2015 to March 2017. METHODS This mixed methods study was designed as a secondary analysis of existing data. Learners had completed a standardized course evaluation survey online immediately post-course. The survey explored the learning experience across several domains and consisted of seven closed ended (Likert Scales; 1 = "Total Disagree", 5 = "Totally Agree") and three open-ended questions. Quantitative data were analyzed using descriptive statistics and Kruskal-Wallis non-parametric test tests, and qualitative data underwent thematic analysis. RESULTS During the study period, 244 courses were delivered; 3045 of 4636 participants responded (response rate 66%); physicians (662), nurses (1973), pharmacists (74), social workers (80), and other professions (256). Overall, a large majority of learners (96%) selected "Totally Agree" or "Agree" for the statement "the course was relevant to my practice". A significant difference was noted across profession groups; X2 (4) = 138; p < 0.001. Post-hoc analysis found the differences to exist between physicians and pharmacists (X2 = -4.75; p < 0.001), and physicians and social workers (X2 = -6.63; p < 0.001). No significant differences were found between physicians and nurses (X2 = 1.31; p = 1.00), and pharmacists and social workers (X2 = -1.25; p = 1.00). Similar results were noted for five of the other statements. CONCLUSION Learners from across profession groups reported this interprofessional course highly across several learning experience parameters, including relevancy for their respective professions. Ongoing curriculum design is needed to fully accommodate the specific learning needs of some of the professions.
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Affiliation(s)
- José Pereira
- Pallium (J.P., B.R., J.F.), Ontario, Canada; Division of Palliative Care, Department of Family Medicine (J.P.), McMaster University, Hamilton, Canada; Institute for Culture and Society (ICS) (J.P.), University of Navara, Pamplona, Spain.
| | - Lynn Meadows
- Department of Community Health Sciences (L.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dragan Kljujic
- Database Manager and Analyst (D.K.), Independent Consultant, Brampton, Canada
| | - Tina Strudsholm
- School of Health Sciences (T.S.), University of Northern British Columbia, Prince George, Canada
| | - Henrique Parsons
- Division of Palliative Care (H.P.), Department of Medicine, University of Ottawa; The Ottawa Hospital Research Institute Clinical Epidemiology Program; Bruyere Research Institute, Ontario, Canada
| | | | | | - Kathryn Fisher
- School of Nursing, Faculty of Health Sciences (K.F.), McMaster University, Hamilton, Canada
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Timely Palliative Care: Personalizing the Process of Referral. Cancers (Basel) 2022; 14:cancers14041047. [PMID: 35205793 PMCID: PMC8870673 DOI: 10.3390/cancers14041047] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
Timely palliative care is a systematic process to identify patients with high supportive care needs and to refer these individuals to specialist palliative care in a timely manner based on standardized referral criteria. It requires four components: (1) routine screening of supportive care needs at oncology clinics, (2) establishment of institution-specific consensual criteria for referral, (3) a system in place to trigger a referral when patients meet criteria, and (4) availability of outpatient palliative care resources to deliver personalized, timely patient-centered care aimed at improving patient and caregiver outcomes. In this review, we discuss the conceptual underpinnings, rationale, barriers and facilitators for timely palliative care referral. Timely palliative care provides a more rational use of the scarce palliative care resource and maximizes the impact on patients who are offered the intervention. Several sets of referral criteria have been proposed to date for outpatient palliative care referral. Studies examining the use of these referral criteria consistently found that timely palliative care can lead to a greater number of referrals and earlier palliative care access than routine referral. Implementation of timely palliative care at each institution requires oncology leadership support, adequate palliative care infrastructure, integration of electronic health record and customization of referral criteria.
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Williams N, Hermans K, Stevens T, Hirdes JP, Declercq A, Cohen J, Guthrie DM. Prognosis does not change the landscape: palliative home care clients experience high rates of pain and nausea, regardless of prognosis. BMC Palliat Care 2021; 20:165. [PMID: 34666732 PMCID: PMC8527809 DOI: 10.1186/s12904-021-00851-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Most individuals who typically receive palliative care (PC) tend to have cancer and a relatively short prognosis (< 6 months). People with other life-limiting illnesses can also benefit from a palliative care approach. However, little is known about those who receive palliative home care in Ontario, Canada's largest province. To address this gap, the goal of this project was to understand the needs, symptoms and potential differences between those with a shorter (< 6 months) and longer prognosis (6+ months) for individuals receiving PC in the community. METHODS A cross-sectional analysis was conducted using interRAI Palliative Care (interRAI PC) assessment data collected between 2011 and 2018. Individuals with a shorter prognosis (< 6 months; n = 48,019 or 64.1%) were compared to those with a longer prognosis (6+ months; n = 26,945) across several clinical symptoms. The standardized difference (stdiff), between proportions, was calculated to identify statistically meaningful differences between those with a shorter and longer prognosis. Values of the stdiff of 0.2 or higher (absolute value) indicated a statistically significant difference. RESULTS Overall, cancer was the most prevalent diagnosis (83.2%). Those with a shorter prognosis were significantly more likely to experience fatigue (75.3% vs. 59.5%; stdiff = 0.34) and shortness of breath at rest (22.1% vs. 13.4%; stdiff = 0.23). However, the two groups were similar in terms of severe pain (73.5% vs. 66.5%; stdiff = - 0.15), depressive symptoms (13.2% vs. 10.7%; stdiff = 0.08) and nausea (35.7% vs. 29.4%; stdiff = 0.13). CONCLUSIONS These results highlight the importance of earlier identification of individuals who could benefit from a palliative approach to their care as individuals with a longer prognosis also experience high rates of symptoms such as pain and nausea. Providing PC earlier in the illness trajectory has the potential to improve an individual's overall quality of life throughout the duration of their illness.
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Affiliation(s)
- Nicole Williams
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, Canada.
| | - Kirsten Hermans
- End-of-life Care Research Group, University of Brussels (VUB) and Ghent University (UGent), Laarbeeklaan 103, 1090, Brussels, Belgium
- University of Leuven (KU Leuven), LUCAS, Minderbroedersstraat 8 box 5310, 3000, Leuven, Belgium
| | - Tara Stevens
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada
| | - Anja Declercq
- University of Leuven (KU Leuven), LUCAS, Minderbroedersstraat 8 box 5310, 3000, Leuven, Belgium
- University of Leuven (KU Leuven), CESO, Minderbroedersstraat 8 box 5310, 3000, Leuven, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, University of Brussels (VUB) and Ghent University (UGent), Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, Canada
- Department of Health Sciences, Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, Canada
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Pereira J, Giddings G, Sauls R, Harle I, Antifeau E, Faulkner J. Navigating Design Options for Large-Scale Interprofessional Continuing Palliative Care Education: Pallium Canada's Experience. Palliat Med Rep 2021; 2:226-236. [PMID: 34927146 PMCID: PMC8675227 DOI: 10.1089/pmr.2021.0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 12/17/2022] Open
Abstract
To be effective, palliative care education interventions need to be informed, among others, by evidence and best practices related to curriculum development and design. Designing palliative care continuing professional development (CPD) courses for large-scale, national deployment requires decisions about various design elements, including competencies and learning objectives to be addressed, overall learning approaches, content, and courseware material. Designing for interprofessional education (IPE) adds additional design complexity. Several design elements present themselves in the form of polarities, resulting in educators having to make choices or compromises between the various options. This article describes the learning design decisions that underpin Pallium Canada's interprofessional Learning Essential Approaches to Palliative Care (LEAP) courses. Social constructivism provides a foundational starting point for LEAP course design, as it lends itself well to both CPD and IPE. We then explore design polarities that apply to the LEAP courseware development. These include, among others, which professions to target and how to best support interprofessional learning, class sizes, course length and content volume, courseware flexibility, regional adaptations, facilitator criteria, and learning methods. In some cases, compromises have had to be made between optimal perfect design and pragmatism.
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Affiliation(s)
- José Pereira
- Pallium Canada, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Institute of Culture and Society (ICS), University of Navarra, Navarra, Spain
| | - Gordon Giddings
- Pallium Canada, Ottawa, Ontario, Canada
- College of Physicians and Surgeons of Alberta, Edmonton, Alberta, Canada
| | - Robert Sauls
- Pallium Canada, Ottawa, Ontario, Canada
- Mississauga, Ontario (retired), Canada
| | | | - Elisabeth Antifeau
- Palliative Care End of Life Services, Interior Health, Vancouver, British Columbia, Canada
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Pereira J, Chary S, Faulkner J, Tompkins B, Moat JB. Primary-level palliative care national capacity: Pallium Canada. BMJ Support Palliat Care 2021:bmjspcare-2021-003036. [PMID: 34315718 DOI: 10.1136/bmjspcare-2021-003036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/11/2021] [Indexed: 01/29/2023]
Abstract
The need to improve access to palliative care across many settings of care for patients with cancer and non-cancer illnesses is recognised. This requires primary-level palliative care capacity, but many healthcare professionals lack core competencies in this area. Pallium Canada, a non-profit organisation, has been building primary-level palliative care at a national level since 2000, largely through its Learning Essential Approaches to Palliative Care (LEAP) education programme and its compassionate communities efforts. From 2015 to 2019, 1603 LEAP course sessions were delivered across Canada, reaching 28 123 learners from different professions, including nurses, physicians, social workers and pharmacists. This paper describes the factors that have accelerated and impeded spread and scale-up of these programmes. The need for partnerships with local, provincial and federal governments and organisations is highlighted. A social enterprise model, that involves diversifying sources of revenue to augment government funding, enhances long-term sustainability. Barriers have included Canada's geopolitical realities, including large geographical area and thirteen different healthcare systems. Some of the lessons learned and strategies that have evolved are potentially transferrable to other jurisdictions.
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Affiliation(s)
- Jose Pereira
- Family Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Pallium Canada, Ottawa, Ontario, Canada
| | - Srini Chary
- Pallium Canada, Ottawa, Ontario, Canada
- Division of Palliative Medicine, Foothills Hospital, Calgary, Alberta Health Services, Edmonton, Alberta, Canada
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Meghani SH, Levoy K, Magan KC, Starr LT, Yocavitch L, Barg FK. "I'm Dealing With That": Illness Concerns of African American and White Cancer Patients While Undergoing Active Cancer Treatments. Am J Hosp Palliat Care 2021; 38:830-841. [PMID: 33107324 PMCID: PMC8424597 DOI: 10.1177/1049909120969121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND National oncology guidelines recommend early integration of palliative care for patients with cancer. However, drivers for this integration remain understudied. Understanding illness concerns at the time of cancer treatment may help facilitate integration earlier in the cancer illness trajectory. OBJECTIVE To describe cancer patients' concerns while undergoing cancer treatment, and determine if concerns differ among African Americans and Whites. METHODS A 1-time, semi-structured qualitative interview was conducted with a purposive subsample of cancer patients participating in a larger study of illness concerns. Eligible patients were undergoing cancer treatments and had self-reported moderate-to-severe pain in the last week. Analysis encompassed a qualitative descriptive approach with inductive thematic analysis. RESULTS Participants (16 African American, 16 White) had a median age of 53 and were predominantly females (72%) with stage III/IV cancer (53%). Illness concerns were largely consistent across participants and converged on 3 themes: symptom experience (pain, options to manage pain), cancer care delivery (communication, care coordination and care transitions), and practical concerns (access to community and health system resources, financial toxicity). CONCLUSIONS The findings extend the scope of factors that could be utilized to integrate palliative care earlier in the cancer illness trajectory, moving beyond the symptoms- and prognosis-based triggers that typify current referrals to also consider diverse logistical concerns. Using this larger set of concerns aids anticipatory risk mitigation and planning (e.g. care transitions, financial toxicity), helps patients receive a larger complement of support services, and builds cancer patients' capacity toward a more patient-centered treatment and care experience.
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Affiliation(s)
- Salimah H. Meghani
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing; Philadelphia, Pennsylvania
| | - Kristin Levoy
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing; Philadelphia, Pennsylvania
| | | | - Lauren T. Starr
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing; Philadelphia, Pennsylvania
| | | | - Frances K. Barg
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania
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Wegier P, Kurahashi A, Saunders S, Lokuge B, Steinberg L, Myers J, Koo E, van Walraven C, Downar J. mHOMR: a prospective observational study of an automated mortality prediction model to identify patients with unmet palliative needs. BMJ Support Palliat Care 2021:bmjspcare-2020-002870. [PMID: 33941574 DOI: 10.1136/bmjspcare-2020-002870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Identification of patients with shortened life expectancy is a major obstacle to delivering palliative/end-of-life care. We previously developed the modified Hospitalised-patient One-year Mortality Risk (mHOMR) model for the automated identification of patients with an elevated 1-year mortality risk. Our goal was to investigate whether patients identified by mHOMR at high risk for mortality in the next year also have unmet palliative needs. METHOD We conducted a prospective observational study at two quaternary healthcare facilities in Toronto, Canada, with patients admitted to general internal medicine service and identified by mHOMR to have an expected 1-year mortality risk of 10% or more. We measured patients' unmet palliative needs-a severe uncontrolled symptom on the Edmonton Symptom Assessment Scale or readiness to engage in advance care planning (ACP) based on Sudore's ACP Engagement Survey. RESULTS Of 518 patients identified by mHOMR, 403 (78%) patients consented to participate; 87% of those had either a severe uncontrolled symptom or readiness to engage in ACP, and 44% had both. Patients represented frailty (38%), cancer (28%) and organ failure (28%) trajectories were admitted for a median of 6 days, and 94% survived to discharge. CONCLUSIONS A large majority of hospitalised patients identified by mHOMR have unmet palliative needs, regardless of disease, and are identified early enough in their disease course that they may benefit from a palliative approach to their care. Adoption of such a model could improve the timely introduction of a palliative approach for patients, especially those with non-cancer illness.
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Affiliation(s)
- Pete Wegier
- Humber River Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management, & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allison Kurahashi
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
| | | | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
| | - Leah Steinberg
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
| | - Jeff Myers
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
- Albert and Temmy Latner Family Palliative Care Unit, Bridgepoint Active Healthcare, Toronto, Ontario, Canada
| | - Ellen Koo
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Carl van Walraven
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - James Downar
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Palliative Care, Ottawa Hospital, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
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Look Hong NJ, Liu N, Wright FC, MacKinnon M, Seung SJ, Earle CC, Gradin S, Sati S, Buchman S, Mittmann N. Assessing the Impact of Early Identification of Patients Appropriate for Palliative Care on Resource Use and Costs in the Final Month of Life. JCO Oncol Pract 2020; 16:e688-e702. [DOI: 10.1200/jop.19.00397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE:This study evaluates whether an intervention to identify Canadian patients eligible for a palliative approach changes the use of health care resources and costs within the final month of life.METHODS:Between 2014 and 2017, physicians identified 1,187 patients in family practice units and cancer centers who were likely to die within 1 year based on diagnosis, symptom assessment, and performance status. A multidisciplinary intervention that included activation of community resources and initiation of palliative planning was started. By using propensity-score matching, patients in the intervention group were matched 1:1 with nonintervention controls selected from provincial administrative data. We compared health care use and costs (using 2017 Canadian dollars) for 30 days before death between patients who died within the 1-year follow-up and matched controls.RESULTS:Groups (n = 629 in each group) were well-balanced in sociodemographic characteristics, comorbidities, and previous health care use. In the last 30 days, there was no differences in proportions between the two groups of patients regarding emergency department visits, intensive care unit admissions, or inpatient hospitalizations. However, patients in the intervention group had greater use of palliative physician encounters, community home care visits, and/or physician home visits (92.8% v 88.4%; P = .007). In the 507 pairs with cancer, more patients in the intervention group underwent chemotherapy (44% v 33%; P < .001) and radiation (18.7% v 3.2%; P = .043) in the last 30 days. Mean cost per patient was similar for the intervention group (mean, $17,231; 95% CI, $16,027 to $18,436) and for the control group (mean, $16,951; 95% CI, $15,899 to $18,004).CONCLUSION:Even with the limitations in our observational study design, identification of palliative patients did not significantly change overall costs but may shift resources toward palliative services.
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Affiliation(s)
- Nicole J. Look Hong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Frances C. Wright
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Soo Jin Seung
- Health Outcomes and PharmacoEconomic Research Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Craig C. Earle
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sharon Gradin
- British Columbia Renal Agency, Toronto, Ontario, Canada
| | | | | | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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