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Seiça Cardoso C, Prazeres F, Oliveiros B, Nunes C, Simões P, Aires C, Rita P, Penetra J, Lopes P, Alcobia S, Baptista S, Venâncio C, Gomes B. Feasibility and effectiveness of a two-tiered intervention involving training and a new consultation model for patients with palliative care needs in primary care: A before-after study. Palliat Med 2024; 38:842-852. [PMID: 38226491 PMCID: PMC11445974 DOI: 10.1177/02692163231219682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
BACKGROUND Evidence suggests that involving General Practitioners in the care of patients with palliative care needs may improve patient outcomes. AIM To evaluate whether a two-tiered intervention involving training in palliative care and a new consultation model in primary care for patients with palliative care needs is feasible and could reduce patients' symptom burden. DESIGN Before-after study including an internal pilot. SETTING/PARTICIPANTS Nine general practitioners working in a health region in Portugal and 53 patients with palliative care needs from their patient lists were recruited. General Practitioners received training in palliative care and used a new primary palliative care consultation model, with medical consultations every 3 weeks for 12 weeks. The primary outcome was physical symptom burden, self-reported using the Integrated Palliative care Outcome Scale (IPOS) patient version (min.0-max.1000). Secondary outcomes included emotional symptoms (min.0-max.400) and communication/practical issues (min.0-max.300). RESULTS Of the 35/53 patients completed the 12-week intervention (mean age 72.53 years, SD = 13.45; 54.7% female). All had advanced disease: one third had cancer (n = 13), one third had congestive heart failure (n = 12); others had chronic kidney disease and chronic obstructive pulmonary disease. After the 12 weeks of intervention, there was a reduction in physical symptom burden [mean difference from baseline of 71.42 (95%CI 37.01-105.85) with a medium-large effect size (0.71], and in emotional symptom burden [mean difference 42.86 (95%CI 16.14-69.58), with a medium effect size (0.55)]. No difference was found for communication/practical issues. CONCLUSIONS Our intervention can be effective in reducing patients' physical and emotional symptoms. TRIAL REGISTRATION ClinicalTrials.gov ID - NCT05244590. Registration: 14th February 2022.
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Affiliation(s)
- Carlos Seiça Cardoso
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Filipe Prazeres
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
- USF Beira Ria, Gafanha da Nazaré, Portugal
| | - Bárbara Oliveiros
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Cátia Nunes
- Family Health Unit Penacova, Coimbra, Portugal
| | - Pedro Simões
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Personalized Health Care Unit Fundão, Fundão, Portugal
| | - Carolina Aires
- Family Health Unit São Martinho de Pombal, Pombal, Portugal
| | - Patrícia Rita
- Personalized Health Care Unit Castanheira de Pera, Coimbra, Portugal
| | | | - Paulo Lopes
- Family Health Unit Rainha Santa Isabel, Torres Novas, Santarém, Portugal
| | - Sara Alcobia
- Family Health Unit As Gandras, Cantanhede, Coimbra, Portugal
| | - Sara Baptista
- Personalized Health Care Unit Figueira-da-Foz Norte, Coimbra, Portugal
| | | | - Barbara Gomes
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Pires L, Rosendo I, Seiça Cardoso C. [Palliative Care Needs in Primary Health Care: Characteristics of Patients with Advanced Cancer and Dementia]. ACTA MEDICA PORT 2024; 37:90-99. [PMID: 37579749 DOI: 10.20344/amp.20049] [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: 04/15/2023] [Accepted: 05/30/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION The increase in life expectancy brought a higher prevalence of chronic diseases, with an emphasis on those who reached advanced stages and required palliative care. We aimed to characterize patients diagnosed with advanced neoplasms and/or dementia accompanied in primary health care and to test the sensitivity of two tools for identifying patients with palliative needs. METHODS We recruited three voluntary family physicians who provided data relative to 623 patients with active codification for neoplasm and/or dementia on the MIM@UF platform. We defined 'patient with palliative needs' as any patient with this codification in advanced stadium and made their clinical and sociodemographic characterization. Assuming the existence of advanced-stage disease as the gold standard, we calculated and compared the sensitivities of each of the tools under study: the surprise question, the question 'do you think this patient has palliative needs?' and an instrument that corresponded to identification by at least one of the questions. RESULTS Among the analyzed data, there were 559 (89.7%) active codifications of neoplasm and 64 (10.3%) of dementia; the prevalence of advanced neoplasm and dementia was 1.0% in the studied sample. The subgroup of patients with advanced dementia showed female sex predominance, an older age, and less access to health care. In both subgroups there was a scarcity of data related to education and income, and we observed polypharmacotherapy and multimorbidity. The sensitivity of the surprise question was 33.3% for neoplasia and 69.3% for dementia; of the new tool 50.0% for neoplasia and 92.3% for dementia; and, when used together, 55.6% for neoplasia and 92.3% for dementia. CONCLUSION Our results help characterize two subpopulations of patients in need of palliative care and advance with a possible tool for their identification, to be confirmed in a representative sample.
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Affiliation(s)
- Luís Pires
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Inês Rosendo
- Faculdade de Medicina. Universidade de Coimbra. Coimbra; Unidade de Saúde Familiar Coimbra Centro. Coimbra. Portugal
| | - Carlos Seiça Cardoso
- Faculdade de Medicina. Universidade de Coimbra. Coimbra; Unidade de Saúde Familiar Condeixa. Coimbra. Portugal
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Zhang Z, Zhang R, Peng Y, Zhai S, Zhang J, Jin Q, Zhou J, Li H, Chen J. Barriers and facilitators of family doctor contract services in caring for disabled older adults in Beijing, China: a mixed methods study. BMJ Open 2023; 13:e070130. [PMID: 37263682 DOI: 10.1136/bmjopen-2022-070130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To evaluate the current state of family doctor contract services (FDCS) in Beijing, identify the roles of family doctors who have worked with disabled older adults and investigate the barriers and facilitators faced by family doctors in providing care for them. DESIGN A convergent mixed methods study was carried out from October 2020 to January 2021 to collect and analyse both quantitative and qualitative data. The integration strategies in this study were connecting the results of the quantitative phase to data collection of the qualitative phase. SETTING A multi-stage sampling strategy was used to select 15 community health centres (CHCs) in four districts of Beijing. Of the four districts, two were from urban areas and two were from rural areas. PARTICIPANTS The inclusion criteria for participants were (1) family doctors, (2) contracted with disabled older adults, (3) engaged in related work for disabled older adults more than 6 months. METHODS A cluster sampling of 283 family doctors was used in the questionnaire. A purposive sample of 30 family doctors from the same CHCs was selected during the same period. Frequency and rank, rank-sum test, Kruskal-Wallis test were conducted in qualitative data analysis, the views of the interviewees were analysed through the thematic framework method. RESULTS Currently, family doctors provided various services to satisfy the health needs of disabled older adults, while the usage of FDCS for disabled older adults is affected by many factors. The differences of the importance of family doctors' role (p<0.001) and service satisfaction (p=0.004) were significant among four districts. Compared with contracted health senior citizens, this study has identified five unique roles of family doctors, including 'psychological consultant', 'rehabilitation physiotherapist', 'health educator', 'health manager' and 'family health guardian'. Moreover, family doctors are confronted with a myriad of barriers (including high risks in the process of home visits, a lack of supervisory and incentive mechanisms, insufficiency of time and energy, etc) and facilitators (including establishing a doctor-patient trust relationship, developing humanistic care services, etc) in the FDCS for disabled older adults. CONCLUSIONS Family doctors play a pivotal role in the FDCS for disabled older adults, while the effect and quality of FDCS in China needs to be improved. It is suggested that further research needs to focus on solving existing barriers of FDCS to optimise the health of disabled older adults and improve the quality of their lives.
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Affiliation(s)
- Zhiying Zhang
- School of Medical Humanities, Capital Medical University, Beijing, China
| | - Ruyi Zhang
- Ethics Committee Office, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yingchun Peng
- School of Medical Humanities, Capital Medical University, Beijing, China
| | - Shaoqi Zhai
- School of Medical Humanities, Capital Medical University, Beijing, China
| | - Jiaying Zhang
- School of Medical Humanities, Capital Medical University, Beijing, China
| | - Qilin Jin
- Cardiac Surgery Department, People's Hospital of Beijing Daxing District, Beijing, China
| | - Jiaojiao Zhou
- Medical Department, Fengtai District Xiluoyuan Community Health Service Center, Beijing, China
| | - Hanlin Li
- School of Basic Medical Science, Capital Medical University, Beijing, China
| | - Jingjing Chen
- Administrative Office, Huairou District Liulimiao Community Health Service Center, Beijing, China
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Balasundram S, Holm A, Benthien KS, Waldorff FB, Reventlow S, Overbeck G. Increasing the chance of dying at home: roles, tasks and approaches of general practitioners enabling palliative care: a systematic review of qualitative literature. BMC PRIMARY CARE 2023; 24:77. [PMID: 36959553 PMCID: PMC10035229 DOI: 10.1186/s12875-023-02038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Many elderly people wish to die at home but end up dying at the hospital. If the patient wishes to die at home, palliative care provided by General Practitioners (GPs) may increase the chance of dying at home, however, there is a lack of knowledge on how GPs should provide palliative care. We aimed to identify roles, tasks and approaches of GPs enabling palliative care, by exploring the experiences of GPs, other healthcare professionals, patients, and relatives through a systematic review of the qualitative literature. METHODS We searched PubMed, EMBASE, PsycINFO, Web of Science, and CINAHL in March 2022. Thematic analysis was used for synthesizing the results. RESULTS Four thousand five hundred sixty three unique records were retrieved, and 12 studies were included for review. Of these, ten were interview or focus group studies and two were survey studies with additional open-ended questions. Only qualitative findings from the studies were used in synthesizing the results. Thematic analysis produced four main themes describing the roles, tasks and approaches of GPs enabling palliative care to increase the chance for patients to die at home. GPs can support patients in the final phases of life by applying a holistic, patient-centred, and proactive approach to palliative care and by having sufficient education and training. Furthermore, the palliative care consultation should include symptom management, handling psychosocial and spiritual needs, maintaining a fragile balance, and proper communication with the patient. Lastly, GPs must address several palliative care elements surrounding the consultation including initiating the palliative care, being available, being the team coordinator/collaborator, providing continuous care and having sufficient knowledge about the patient. CONCLUSIONS The roles, tasks and approaches of the GPs enabling palliative care include being aware of elements in the palliative care consultation and elements surrounding the consultation and by having sufficient education and training and a broad, proactive, and patient-centred approach.
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Affiliation(s)
- Shangavi Balasundram
- The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark.
| | - Anne Holm
- The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark
| | | | - Frans Boch Waldorff
- The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Gritt Overbeck
- The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark
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Evaluation of a Spiritual History with Elderly Multi-Morbid Patients in General Practice-A Mixed-Methods Study within the Project HoPES3. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010538. [PMID: 35010797 PMCID: PMC8744880 DOI: 10.3390/ijerph19010538] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 02/01/2023]
Abstract
Background: The “Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity and Self-Care into Disease Management in Primary Care” (HoPES3) examines the implementation of a spiritual history (SH) as part of a multifaceted intervention in German general practices. While the effectiveness of the interventions was evaluated in a cluster-randomized trial, this article investigates the patients’ views concerning the acceptability of the SH and its effects. Methods: A mixed-methods study was conducted in which 133 patients of the intervention group filled in a standardized questionnaire after the intervention. Later, 29 of these patients took part in qualitative semi-standardized interviews. Results: According to the survey, 63% (n = 77) of patients found the SH helpful. In the interviews, however, many indicated that they either kept the conversation brief or declined the offer to talk about spirituality. Contents of longer conversations referred to difficult life events, personal sources of strength, and experiences with religious institutions. Many patients who had a longer conversation about spirituality reported that their relationship with their general practitioner (GP) had improved. Almost all patients recommended integrating a personal conversation of this kind into primary care. Conclusions: The SH seems to be a possible ‘door opener’ for a trusting doctor-patient relationship, which can then be built upon.
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Implementation and Knowledge of the Clinical Practice Guide for Palliative Care in the Ecuadorian Primary Care Level. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111573. [PMID: 34770088 PMCID: PMC8583406 DOI: 10.3390/ijerph182111573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022]
Abstract
Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals’ knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium; 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel’s knowledge must be implemented in Zone 7 centers.
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