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Eaton TL, Lincoln TE, Lewis A, Davis BC, Sevin CM, Valley TS, Donovan HS, Seaman J, Iwashyna TJ, Alexander S, Scheunemann LP. Palliative Care in Survivors of Critical Illness: A Qualitative Study of Post-Intensive Care Unit Program Clinicians. J Palliat Med 2023; 26:1644-1653. [PMID: 37831930 PMCID: PMC10771886 DOI: 10.1089/jpm.2023.0034] [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: 06/27/2023] [Indexed: 10/15/2023] Open
Abstract
Background: Survivors of critical illness experience high rates of serious health-related suffering. The delivery of palliative care may assist in decreasing this burden for survivors and their families. Objectives: To understand beliefs, attitudes, and experiences of post-intensive care unit (ICU) program clinicians regarding palliative care and explore barriers and facilitators to incorporating palliative care into critical illness survivorship care. Design: Qualitative inquiry using semistructured interviews and framework analysis. Results were mapped using the Consolidated Framework for Implementation Research. Setting/Subjects: We interviewed 29 international members (United States, United Kingdom, Canada) of the Critical and Acute Illness Recovery Organization post-ICU clinic collaborative. Results: All interprofessional clinicians described components of palliative care as essential to post-ICU clinic practice, including symptom management, patient/family support, facilitation of goal-concordant care, expectation management and anticipatory guidance, spiritual support, and discussion of future health care wishes and advance care planning. Facilitators promoting palliative care strategies were clinician level, including first-hand experience, perceived value, and a positive attitude regarding palliative care. Clinician-level barriers were reciprocals and included insufficient palliative care knowledge, lack of self-efficacy, and a perceived need to protect ICU survivors from interventions the clinician felt may adversely affect recovery or change the care trajectory. System-level barriers included time constraints, cost, and lack of specialty palliative care services. Conclusion: Palliative care may be an essential element of post-ICU clinic care. Implementation efforts focused on tailoring strategies to improve post-ICU program clinicians' palliative care knowledge and self-efficacy could be a key to enhanced care delivery for survivors of critical illness.
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Affiliation(s)
- Tammy L. Eaton
- National Clinician Scholars Program (NCSP), VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
- Department of Acute and Tertiary Care, and School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Taylor E. Lincoln
- Department of Critical Care Medicine, and Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anna Lewis
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Clinical Care Coordination and Discharge Planning, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania, USA
| | - Brian C. Davis
- Kline School of Law, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Carla M. Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas S. Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Heidi S. Donovan
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Seaman
- Department of Acute and Tertiary Care, and School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Theodore J. Iwashyna
- Department of Medicine, Division of Pulmonary and Critical Care, School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sheila Alexander
- Department of Acute and Tertiary Care, and School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, and Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Leslie P. Scheunemann
- Division of Geriatric Medicine and Gerontology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Marques P, Rêgo F, Nunes R. Palliative Care in Portugal-From Intention to Reality, What Is Yet to Be Accomplished. NURSING REPORTS 2023; 13:1477-1485. [PMID: 37873831 PMCID: PMC10594488 DOI: 10.3390/nursrep13040124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES This article focuses on exploring the evolution of palliative care in Portugal. Ten years after the approval of its Basic Law, the aim was to investigate the quality of the path followed and the guidelines that could promote its development. Thus, this study sought to identify (a) the goals of the current members of parliament concerning palliative care, (b) the major priorities that should guide the development of palliative care in the coming decade, (c) the facilitating or hindering factors to accelerating the process, and (d) to propose consensually agreed measures for the integral development of palliative care within the health system. METHODS The qualitative data analysis was performed through the reading of the literature and interviews conducted via Zoom with several intentionally chosen participants. The data extracted from the previous studies were analyzed in a focus group. The NVivo® 10 was used for the data processing and categorization. RESULTS Three key themes emerged concerning the current status of palliative care: the policymakers, the health professionals, and the society. This first line of structuring is explained by a second set of categories, namely, (a) the knowledge about palliative care; and (b) palliative care organization from the policymakers' perspective. In the health professionals' domain: (a) knowledge about palliative care, (b) clinical training, and (c) medical specialty. Finally, in society: (a) knowledge about palliative care. SIGNIFICANCE OF THE RESULTS Advancing general education, increasing the qualitative training for different health professionals, reformulating the laws supporting them, promoting the flexibility of the implementation methodologies, and establishing a medical specialty are crucial to achieving the proposed goal. This study was not registered.
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Affiliation(s)
- Paulo Marques
- CINTESIS (NursID)—RISE, Nursing School of Porto (ESEP), Rua Dr. Antº Bernardino de Almeida, nº830, 4200-072 Porto, Portugal
| | - Francisca Rêgo
- Department of Community Medicine, Health Information and Decision, Porto Faculty of Medicine (FMUP), 4200-319 Porto, Portugal; (F.R.); (R.N.)
| | - Rui Nunes
- Department of Community Medicine, Health Information and Decision, Porto Faculty of Medicine (FMUP), 4200-319 Porto, Portugal; (F.R.); (R.N.)
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van Doorne I, Mokkenstorm K, Willems D, Buurman B, van Rijn M. The perspectives of in-hospital healthcare professionals on the timing and collaboration in advance care planning: A survey study. Heliyon 2023; 9:e14772. [PMID: 37095949 PMCID: PMC10121622 DOI: 10.1016/j.heliyon.2023.e14772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 04/26/2023] Open
Abstract
Background Hospital admissions are common in the last phase of life. However, palliative care and advance care planning (ACP) are provided late or not at all during hospital admission. Aim To provide insight into the perceptions of in-hospital healthcare professionals concerning current and ideal practice and roles of in-hospital palliative care and advance care planning. Methods An electronic cross-sectional survey was send 398 in-hospital healthcare professionals in five hospitals in the Netherlands. The survey contained 48 items on perceptions of palliative care and ACP. Results We included non-specialists who completed the questions of interest, resulting in analysis of 96 questionnaires. Most respondents were nurses (74%). We found that current practice for initiating palliative care and ACP was different to what is considered ideal practice. Ideally, ACP should be initiated for almost every patient for whom no treatment options are available (96.2%), and in case of progression and severe symptoms (94.2%). The largest differences between current and ideal practice were found for patients with functional decline (Current 15.2% versus Ideal 78.5%), and patients with an estimated life expectancy <1 year (Current 32.6% versus ideal 86.1%). Respondents noted that providing palliative care requires collaboration, however, especially nurses noted barriers like a lack of inter-professional consensus. Conclusions The differences between current and ideal practice demonstrate that healthcare professionals are willing to improve palliative care. To do this, nurses need to increase their voice, a shared vision of palliative care and recognition of the added value of working together is needed.
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Affiliation(s)
- I. van Doorne
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Corresponding author. Amsterdam University Medical Center, University of Amsterdam Department of Internal Medicine, Section of Geriatric Medicine, Room D3-335 Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - K. Mokkenstorm
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - D.L. Willems
- Amsterdam UMC Location University of Amsterdam, General Practice, Section of Medical Ethics, Meibergdreef 9, Amsterdam, the Netherlands
| | - B.M. Buurman
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Boelelaan 1117, Amsterdam, the Netherlands
| | - M. van Rijn
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Boelelaan 1117, Amsterdam, the Netherlands
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Hamdan N, Yaacob LH, Idris NS, Abdul Majid MS. Primary Care Physicians' Knowledge and Attitudes Regarding Palliative Care in Northeast Malaysia. Healthcare (Basel) 2023; 11:healthcare11040550. [PMID: 36833084 PMCID: PMC9956221 DOI: 10.3390/healthcare11040550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Palliative care in Malaysia has progressed steadily since its inception in 1991, and it has been integrated gradually into primary health care in the past decade. This study aims to assess the level of knowledge and the attitudes towards palliative care and its associated factors among primary care physicians. A cross-sectional study was conducted among primary care physicians using two validated questionnaires: the Palliative Care Knowledge Test (PCKT) and Frommelt's Attitude Toward Care of the Dying (FATCOD). The data were analysed using descriptive and linear regression statistics. A total of 241 primary care physicians from 27 different health clinics participated in the study. The mean PCKT score was 8.68 (2.94), whereas the mean FATCOD score was 106.8 (9.14). The maximum score for each questionnaire was 20 and 150, respectively. There was a significant positive relationship between knowledge and attitudes toward palliative care, with a p-value of 0.003 (CI 0.22-1.04) and an r-value of 0.42. Palliative care knowledge among primary care physicians is still low despite their overall positive attitude towards the service. This finding suggests the urgent need for more education and training on palliative care for primary care physicians in Malaysia.
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Affiliation(s)
- Norhazura Hamdan
- Department of Family Medicine, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Lili Husniati Yaacob
- Department of Family Medicine, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Correspondence: (L.H.Y.); (N.S.I.)
| | - Nur Suhaila Idris
- Department of Family Medicine, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Correspondence: (L.H.Y.); (N.S.I.)
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Snijders R, Raijmakers N, Firouzian A, Kodde A, Kazimier H, Bols F, Zerstegen C, Brom L. Trends in Palliative Care Telephone Consultation Support for Health Care Professionals: A Dutch Nationwide Registry between 2004 and 2019. J Palliat Med 2023; 26:87-93. [PMID: 35994009 DOI: 10.1089/jpm.2022.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Regional palliative care consultation (PCC) teams aim to support health care professionals by telephone in providing quality palliative care (PC) in the Netherlands. Objectives: The study aims to assess trends in the number and characteristics of PC telephone consultations in the Netherlands between 2004 and 2019. Design: A retrospective observational study reviewed data from the Dutch national register for PC consultations by telephone (PRADO). To assess trends in the number of consultations, three time periods were defined: 2004-2008, 2009-2013, and 2014-2019. All analyses were conducted using STATA. Results: A total of 83,554 PC telephone consultations were analyzed. There was a slight decrease in the number of consultations since 2014, from 5811 (2014) to 4914 (2019). The Dutch PCC telephone helpdesk was mainly consulted by general practitioners, with pharmacological issues (65%) and pain (44%) being the main concerns. The data included 73,833 patients, of whom 63% were 65 years or older (18-109) and 51% were male. The proportion of noncancer patients increased during the selected time periods, 2004-2008 (11%), 2009-2013 (16%), and 2014-2019 (22%). The proportion of consultations requested for hospitalized patients was higher in 2014-2019 (7.9%) than in 2009-2013 (4.5%). Conclusion: Dutch PC telephone consultations have changed over time. More PC telephone consultations were held for hospitalized patients and noncancer diseases over the past years. These trends are in line with the shift toward more integrated PC in which different services collaborate.
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Affiliation(s)
- Rolf Snijders
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, the Netherlands
| | - Natasja Raijmakers
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, the Netherlands
| | - Azadeh Firouzian
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Astrid Kodde
- Netherlands Association for Palliative Care, Utrecht, the Netherlands.,Stichting PaTz, Utrecht, the Netherlands
| | - Hetty Kazimier
- Netherlands Association for Palliative Care, Utrecht, the Netherlands
| | - Floor Bols
- Department of Palliative Care, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | - Linda Brom
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, the Netherlands
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Pérez-Ros P, Cauli O, Julián-Rochina I, Long CO, Chover-Sierra E. Level of knowledge and attitudes towards palliative care for people with advanced dementia in Spain: role of professional and academic factors. Curr Alzheimer Res 2022; 19:CAR-EPUB-128370. [PMID: 36545733 DOI: 10.2174/1567205020666221221145259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Providing quality end-of-life care to individuals with advanced dementia is crucial. To date, little attention has been paid to palliative care knowledge and attitudes toward palliative care for people with advanced dementia in Spain Objectives: To investigate the knowledge of and attitudes toward palliative care for advanced dementia among registered nurses and physicians in Spain. DESIGN AND METHODS A descriptive, cross-sectional survey design was used. This study included a convenience sample of 402 nurses (n = 290) and physicians (n = 112). Two instruments were administered: demographic characteristics and Spanish version of the Questionnaire of Palliative Care for Advanced Dementia (qPAD-SV). Descriptive statistics and multiple regression were used for data analysis. RESULTS Overall, the nurses and physicians had moderate mean scores for both knowledge of and attitudes regarding palliative care for advanced dementia. Physicians had a higher level of knowledge (p<0.05) compared to nurses. Additionally, physicians and nursing staff who had professional experience/education in geriatrics and those who had received palliative care and hospice training had greater (p<0.01) knowledge of palliative care. In addition, healthcare professionals who had received dementia care training and who had worked in nursing homes had higher levels (p<0.05) of knowledge and attitudes toward palliative care. CONCLUSION This study indicates the need to provide nurses and physicians with more education for select groups of professionals who have had limited education and experience in caring for older adults with advanced dementia.
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Affiliation(s)
- Pilar Pérez-Ros
- Nursing Department, Facultat d'Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Omar Cauli
- Nursing Department, Facultat d'Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Iván Julián-Rochina
- Nursing Department, Facultat d'Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Carol O Long
- Nursing Care and Education Research Group (GRIECE), University of Valencia, 46010 Valencia, Spain
| | - Elena Chover-Sierra
- Nursing Department, Facultat d'Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain
- Palliative Care Essentials, Fredericksburg, Virginia, USA
- Nursing Care and Education Research Group (GRIECE), University of Valencia, 46010 Valencia, Spain
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Wake AD. Knowledge and associated factors towards palliative care among nurses in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2022; 10:20503121221092338. [PMID: 35509954 PMCID: PMC9058338 DOI: 10.1177/20503121221092338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/10/2022] [Indexed: 12/01/2022] Open
Abstract
Palliative care is a holistic care that emphasises on relieving pain and other symptoms of a critical illness, irrespective of age, diagnosis, or stage of illness. It improves the quality of life of the individual. Since nurses spend the longest time with patients, they are the heart of the palliative care team who deliver high standards of care. This study was intended to assess the pooled prevalence of knowledge and associated factors towards palliative care among nurses in Ethiopia. During this study, a comprehensive search was performed by using different databases. A funnel plot and Egger’s test were used to evaluate a publication bias. I2 statistic was used to check the heterogeneity between the studies. The subgroup analysis was also conducted for this study. A total of 11 studies with 3330 study participants were included in this systematic review and meta-analysis. The systematic review and meta-analysis showed that the pooled prevalence of knowledge towards palliative care among nurses in Ethiopia was 42.31% (95% confidence interval = [32.41, 52.21]). Educational status (adjusted odds ratio = 2.69, 95% confidence interval = [1.11, 4.25]), experience of caring for a dying patient (adjusted odds ratio = 3.15, 95% confidence interval = [1.17, 5.13]), and training on palliative care (adjusted odds ratio = 2.53, 95% confidence interval = [1.42, 3.64]) were factors significantly associated with the knowledge of nurses towards palliative care. This study indicated that the pooled prevalence of knowledge towards palliative care among nurses in Ethiopia was low. Educational status, experience of caring for a dying patient, and training on palliative care were factors significantly associated with the knowledge of nurses towards palliative care. Thus, training on palliative care and education is suggested for nurses to improve their knowledge towards palliative care. Systematic review registration: PROSPERO CRD42021247590
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Affiliation(s)
- Addisu Dabi Wake
- Nursing Department, College of Health Sciences, Arsi University, Asella, Ethiopia
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Nair S. We need a paradigm shift in oncology nursing. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_366_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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