1
|
Chen L, Sleeman KE, Bradshaw A, Sakharang W, Mo Y, Ellis-Smith C. The Use of Person-Centered Outcome Measures to Support Integrated Palliative Care for Older People: A Systematic Review. J Am Med Dir Assoc 2024; 25:105036. [PMID: 38796168 DOI: 10.1016/j.jamda.2024.105036] [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: 11/12/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES The aim was to synthesize evidence on the use of person-centered outcome measures to facilitate integrated palliative care for older people and build a logic model depicting the mechanisms through which person-centered outcome measures support integrated care. DESIGN Mixed methods systematic review using a data-based convergent synthesis design. SETTING AND PARTICIPANTS Older people aged ≥60 years who are approaching the end of their lives in multiple settings. METHODS The study was underpinned by a conceptual framework of integrated palliative care, which informed the search strategy, data extraction, analysis, and synthesis. A hybrid search strategy was implemented, with database searches (PsycINFO, MEDLINE, CINAHL, and ASSIA) complemented by snowball searches. Qualitative and quantitative data were analyzed by narrative synthesis to summarize and explain the findings. The findings informed a logic model depicting the mechanisms of using person-centered outcome measures to support integrated palliative care. RESULTS Twenty-six studies were included. Three mixed methods studies, 2 qualitative studies, and 21 quantitative studies were included. There was evidence that person-centered outcome measures could support integrated palliative care through informing palliative care policy development (n = 4), facilitating joint working across settings (n = 5), enabling close collaboration of multidisciplinary teams (n = 14), promoting joint education (n = 1), facilitating timing and specialist referral (n = 6), and enhancing patient-centered care (n = 3). CONCLUSIONS AND IMPLICATIONS This review makes an important, novel, and theoretically informed contribution to the delivery of scalable and sustainable integrated palliative care into the care of older people using person-centered outcome measures. The constructed logic model provides a conceptual framework and practical approach to how person-centered outcome measures support multilevel integration. A future area of research is the development of person-centered outcome measure interventions informed by the logic model to meet clinical needs.
Collapse
Affiliation(s)
- Linghui Chen
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Andy Bradshaw
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Wilailak Sakharang
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Yihan Mo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| |
Collapse
|
2
|
Wang L, Li Y, Zhao R, Li J, Gong X, Li H, Chi Y. Influencing factors of home hospice care needs of the older adults with chronic diseases at the end of life in China: a cross-sectional study. Front Public Health 2024; 12:1348214. [PMID: 38859895 PMCID: PMC11163093 DOI: 10.3389/fpubh.2024.1348214] [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: 12/02/2023] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Chronic diseases are becoming a serious threat to the physical and mental health of older people in China as their aging process picks up speed. Home hospice care addresses diverse needs and enhances the quality of life for older adult individuals nearing the end of life. To ensure the well-being of chronically ill older adults at the end of life, it is vital to explore and assess the multidimensional hospice needs of terminally ill older individuals in their homes. The aim of this study was to investigate the current situation of home hospice care needs of Chinese older adults with chronic diseases at the end of life, and to analyze the influencing factors (sociodemographic and disease-related factors). Methods In this cross-sectional study, 247 older adult people with chronic diseases at the end of life were selected from the communities of 4 community health service centers in Jinzhou City, Liaoning Province from June to October 2023 by random sampling method. A general information questionnaire and the home hospice care needs questionnaire developed by our research group were used to investigate. Independent samples t-test or one-way ANOVA was used to compare the differences in the scores of different characteristics, and the factors with significant differences were selected for multivariate linear regression analysis to determine the final influencing factors. Results The total score of home hospice needs of the dying older adult was 115.70 ± 12, with the mean scores for each dimension in descending order being Information Needs (3.96 ± 0.61), Social Support Needs (3.96 ± 0.44), Spiritual Needs (3.92 ± 0.43), Physical Needs (3.60 ± 0.59), Psychological Needs (3.37 ± 0.65). Status of residence, duration of illness (year), the type of disease, and self-care ability were influential factors in the total score of home hospice needs. Discussion The need for hospice care for the terminally ill older adult is high, and healthcare professionals should implement services according to the influencing factors of need to meet their multidimensional needs and improve their quality of life.
Collapse
Affiliation(s)
- Lei Wang
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yaru Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Rui Zhao
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Jiangxu Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Xiangru Gong
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Hongyu Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yuan Chi
- Department of Science and Technology, Jinzhou Medical University, Jinzhou, China
| |
Collapse
|
3
|
Disler R, Pascoe A, Chen XE, Lawson E, Cahyadi M, Paalendra A, Hickson H, Wright J, Phillips B, Subramaniam S, Glenister K, Philip J, Donesky D, Smallwood N. Palliative Approach Remains Lacking in Terminal Hospital Admissions for Chronic Disease Across Rural Settings: Multisite Retrospective Medical Record Audit. J Pain Symptom Manage 2024; 67:453-462. [PMID: 38365070 DOI: 10.1016/j.jpainsymman.2024.02.009] [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] [Received: 09/13/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION/AIM Despite clear benefit from palliative care in end-stage chronic diseases, access is often limited, and rural access largely undescribed. This study sought to determine if a palliative approach is provided to people with chronic disease in their terminal hospital admission. METHODS Multisite, retrospective medical record audit, of decedents with a primary diagnosis of chronic lung, heart, or renal failure, or multimorbidity of these conditions over 2019. RESULTS Of 241 decedents, across five clinical sites, 143 (59.3%) were men, with mean age 80.47 years (SD 11.509), and diagnoses of chronic lung (n = 56, 23.2%), heart (n = 56, 23.2%), renal (n = 24, 10.0%) or multimorbidity disease (n = 105, 43.6%), and had 2.88 (3.04SD) admissions within 12 months. Outpatient chronic disease care was evident (n = 171, 73.7%), however, contact with a private physician (n = 91, 37.8%), chronic disease program (n = 61, 25.3%), or specialist nurse (n = 17, 7.1%) were less apparent. "Not-for-resuscitation" orders were common (n = 139, 57.7%), however, advance care planning (n = 71, 29.5%), preferred place of death (n = 18, 7.9%), and spiritual support (n = 18, 7.5%) were rarely documented. Referral to and input from palliative services were low (n = 74, 30.7% and n = 49, 20.3%), as was review of nonessential medications or blood tests (n = 86, 35.7%, and n = 78, 32.4%). Opioids were prescribed in 45.2% (n = 109). Hospital site and diagnosis were significantly associated with outpatient care and palliative approach (P<0.001). CONCLUSIONS End-of-life planning and specialist palliative care involvement occurred infrequently for people with chronic disease who died in rural hospitals. Targeted strategies are necessary to improve care for these prevalent and high needs rural populations.
Collapse
Affiliation(s)
- Rebecca Disler
- Respiratory Research@Alfred, Department of Immunology and Pathology (R.D., A.Y.P., N.S.), Central Clinical School, Monash University, Melbourne, Australia; Department of Rural Health (R.D., E.L., H.H., J.W., S.S., K.G.), The University of Melbourne, Shepparton, VIC, Australia.
| | - Amy Pascoe
- Respiratory Research@Alfred, Department of Immunology and Pathology (R.D., A.Y.P., N.S.), Central Clinical School, Monash University, Melbourne, Australia
| | | | - Emily Lawson
- Department of Rural Health (R.D., E.L., H.H., J.W., S.S., K.G.), The University of Melbourne, Shepparton, VIC, Australia
| | | | | | - Helen Hickson
- Department of Rural Health (R.D., E.L., H.H., J.W., S.S., K.G.), The University of Melbourne, Shepparton, VIC, Australia
| | - Julian Wright
- Department of Rural Health (R.D., E.L., H.H., J.W., S.S., K.G.), The University of Melbourne, Shepparton, VIC, Australia; Goulburn Valley Health (J.W., S.S.), Shepparton, VIC, Australia
| | | | - Sivakumar Subramaniam
- Department of Rural Health (R.D., E.L., H.H., J.W., S.S., K.G.), The University of Melbourne, Shepparton, VIC, Australia; Goulburn Valley Health (J.W., S.S.), Shepparton, VIC, Australia
| | - Kristen Glenister
- Department of Rural Health (R.D., E.L., H.H., J.W., S.S., K.G.), The University of Melbourne, Shepparton, VIC, Australia
| | - Jennifer Philip
- The University of Melbourne (J.P.), Parkville, VIC, Australia
| | - Doranne Donesky
- Department of Physiological Nursing (D.D.), University of California San Francisco, San Francisco, USA
| | - Natasha Smallwood
- Respiratory Research@Alfred, Department of Immunology and Pathology (R.D., A.Y.P., N.S.), Central Clinical School, Monash University, Melbourne, Australia; Department of Respiratory and Sleep Medicine (N.S.), The Alfred Hospital, Melbourne, Australia
| |
Collapse
|
4
|
García-Navarro EB, Garcia Navarro S, Cáceres-Titos MJ. How to Manage the Suffering of the Patient and the Family in the Final Stage of Life: A Qualitative Study. NURSING REPORTS 2023; 13:1706-1720. [PMID: 38133117 PMCID: PMC10745957 DOI: 10.3390/nursrep13040141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/01/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The end of life and death have changed from being issues managed within the family, assumed as part of life, to occur within health institutions for the majority of patients. The amount of patients dying at home has decreased, and the roles of families and communities in death and dying have become involuted, threatening related traditions and knowledge. As a result, a need to promote the end of life at home in this new self-serving society has arisen. In that context, the main objective of this study was to find out what patients and their families need during the end-of-life process in order to feel effectively accompanied at this time. METHODS With that objective, a descriptive qualitative study was conducted via the content analysis of data from semi-structured interviews and focus groups. This research adhered to the COREQ guidelines. The sample consisted of 36 informants selected via intentional sampling of family members and patients integrated into the Comprehensive Palliative Care Process (PAI Paliativos). RESULTS The results suggest the existence of several common needs such as communication and presence, including the conspiracy of silence as an important factor generating suffering for both. However, there are specific needs such as autonomy, dignity, and respect for patients, which must be taken into account. CONCLUSIONS The results of this study will allow us to establish intervention strategies for effective accompaniment of patients' family members at the end of life and the avoidance of ethnocentrism in this process. This study was retrospectively registered with the (nursrep-1194226) on the (21 April 2023).
Collapse
Affiliation(s)
- E. Begoña García-Navarro
- Department of Nursing, University of Huelva, 21007 Huelva, Spain; (S.G.N.); (M.J.C.-T.)
- Research Group ESEIS, Research Center COIDESO, University of Huelva, 21007 Huelva, Spain
| | - Sonia Garcia Navarro
- Department of Nursing, University of Huelva, 21007 Huelva, Spain; (S.G.N.); (M.J.C.-T.)
- Huelva Costa Health District, Junta de Andalucía, 21003 Huelva, Spain
| | | |
Collapse
|
5
|
Bowers SP, Black P, McCheyne L, Wilson D, Mills SEE, Agrawal U, Williams L, Quirk F, Bowden J. Current definitions of advanced multimorbidity: a protocol for a scoping review. BMJ Open 2023; 13:e076903. [PMID: 38035744 PMCID: PMC10689385 DOI: 10.1136/bmjopen-2023-076903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION People living with and dying from multimorbidity are increasing in number, and ensuring quality care for this population is one of the major challenges facing healthcare providers. People with multimorbidity often have a high burden of palliative and end-of-life care needs, though they do not always access specialist palliative care services. A key reason for this is that they are often not identified as being in the last stages of their life by current healthcare providers and systems.This scoping review aims to identify and present the available evidence on how people with multimorbidity are currently included in research, policy and clinical practice. METHODS AND ANALYSIS Scoping review methodology, based on Arksey and O'Malley's framework, will be undertaken and presented using the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. Search terms have been generated using the key themes of 'multimorbidity', 'end of life' and 'palliative care'. Peer-reviewed research will be obtained through systematic searching of Medline, EMBASE, CINAHL, Scopus and PsycINFO. Grey literature will be searched in a systematic manner. Literature containing a definition for adults with multimorbidity in a terminal phase of their illness experience will be included. After screening studies for eligibility, included studies will be described in terms of setting and characteristics as well as using inductive content analysis to highlight the commonalities in definitions. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review. The findings of the scoping review will be used internally as part of SPB's PhD thesis at the University of St Andrews through the Multimorbidity Doctoral Training Programme for Health Professionals, which is supported by the Wellcome Trust (223499/Z/21/Z) and published in an open access, peer-reviewed journal for wider dissemination.
Collapse
Affiliation(s)
- Sarah P Bowers
- University of St Andrews School of Medicine, St Andrews, UK
| | - Polly Black
- University of St Andrews School of Medicine, St Andrews, UK
| | | | | | - Sarah E E Mills
- University of St Andrews School of Medicine, St Andrews, UK
- NHS Fife, Kirkcaldy, UK
| | - Utkarsh Agrawal
- University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | | | - Frances Quirk
- University of St Andrews School of Medicine, St Andrews, UK
- NHS Fife, Kirkcaldy, UK
| | - Jo Bowden
- University of St Andrews School of Medicine, St Andrews, UK
- NHS Fife, Kirkcaldy, UK
| |
Collapse
|
6
|
Godfrey S, Peng Y, Lorusso N, Sulistio M, Mentz RJ, Pandey A, Warraich H. Palliative Care for Patients With Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2023; 16:e010802. [PMID: 37869880 DOI: 10.1161/circheartfailure.123.010802] [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] [Received: 05/03/2023] [Accepted: 08/31/2023] [Indexed: 10/24/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) has become the leading form of heart failure worldwide, particularly among elderly patient populations. HFpEF is associated with significant morbidity and mortality that may benefit from incorporation of palliative care (PC). Patients with HFpEF have similarly high mortality rates to patients with heart failure with reduced ejection fraction. PC trials for heart failure have shown improvement in quality of life, quality of death, and health care utilization, although most trials defined heart failure clinically without differentiating between HFpEF and heart failure with reduced ejection fraction. As such, the timing and role of PC for HFpEF care remains uncertain, and PC referral rates for HFpEF are very low despite potential improvements in important patient-centered outcomes. Specific barriers to referral include limited data, prognostic uncertainty, provider misconceptions about PC, inadequate specialty PC workforce, complexities of treating multimorbidity, and limited home care options for patients with heart failure. While there are many barriers to integration of PC into HFpEF care, there are multiple potential benefits to patients with HFpEF throughout their disease course. As this population continues to grow, targeted efforts to study and implement PC interventions are needed to improve patient quality of life and death.
Collapse
Affiliation(s)
- Sarah Godfrey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.G., M.S., A.P.)
| | | | - Nicholas Lorusso
- Department of Natural Sciences, University of North Texas at Dallas (N.L.)
| | - Melanie Sulistio
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.G., M.S., A.P.)
| | - Robert J Mentz
- Duke University Medical Center, Division of Cardiology, Durham, NC (R.J.M.)
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.G., M.S., A.P.)
| | - Haider Warraich
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA (H.W.)
| |
Collapse
|
7
|
Tagliafico L, Maizza G, Marani C, Della Rovere F, Schiavetti I, Signori A, Petrocchi L, Ottaviani S, Muzyka M, Nencioni A, Monacelli F. Prevalence of Palliative Care Needs in Older Adults With Multimorbidity: A Multicentric Point Prevalence Study. J Am Med Dir Assoc 2023; 24:1278-1281. [PMID: 37353204 DOI: 10.1016/j.jamda.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Luca Tagliafico
- IRCCS Policlinico San Martino Hospital, Genoa, Italy; Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Giada Maizza
- IRCCS Policlinico San Martino Hospital, Genoa, Italy; Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Carlo Marani
- Home Palliative Care, Fondazione Gigi Ghirotti ETS, Genoa, Italy
| | | | - Irene Schiavetti
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Lorena Petrocchi
- Medicina Interna, Ospedale degli Infermi, ASL Biella, Biella, Italy
| | - Silvia Ottaviani
- IRCCS Policlinico San Martino Hospital, Genoa, Italy; Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Mariya Muzyka
- IRCCS Policlinico San Martino Hospital, Genoa, Italy; Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Alessio Nencioni
- IRCCS Policlinico San Martino Hospital, Genoa, Italy; Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Policlinico San Martino Hospital, Genoa, Italy; Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy.
| |
Collapse
|
8
|
Blanes-Selva V, Asensio-Cuesta S, Doñate-Martínez A, Pereira Mesquita F, García-Gómez JM. User-centred design of a clinical decision support system for palliative care: Insights from healthcare professionals. Digit Health 2023; 9:20552076221150735. [PMID: 36644661 PMCID: PMC9837281 DOI: 10.1177/20552076221150735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
Objective Although clinical decision support systems (CDSS) have many benefits for clinical practice, they also have several barriers to their acceptance by professionals. Our objective in this study was to design and validate The Aleph palliative care (PC) CDSS through a user-centred method, considering the predictions of the artificial intelligence (AI) core, usability and user experience (UX). Methods We performed two rounds of individual evaluation sessions with potential users. Each session included a model evaluation, a task test and a usability and UX assessment. Results The machine learning (ML) predictive models outperformed the participants in the three predictive tasks. System Usability Scale (SUS) reported 62.7 ± 14.1 and 65 ± 26.2 on a 100-point rating scale for both rounds, respectively, while User Experience Questionnaire - Short Version (UEQ-S) scores were 1.42 and 1.5 on the -3 to 3 scale. Conclusions The think-aloud method and including the UX dimension helped us to identify most of the workflow implementation issues. The system has good UX hedonic qualities; participants were interested in the tool and responded positively to it. Performance regarding usability was modest but acceptable.
Collapse
Affiliation(s)
- Vicent Blanes-Selva
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain,Vicent Blanes-Selva, Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, 46022, Spain.
| | - Sabina Asensio-Cuesta
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain
| | | | - Felipe Pereira Mesquita
- Divisão de Hematologia, departamento de Clínica Médica, da Universidade Federal de Juiz de Fora, Minas Gerais, Brasil
| | - Juan M. García-Gómez
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain
| |
Collapse
|
9
|
The Experiences and Views on Palliative Care of Older People with Multimorbidities, Their Family Caregivers and Professionals in a Spanish Hospital. Healthcare (Basel) 2022; 10:healthcare10122489. [PMID: 36554013 PMCID: PMC9778218 DOI: 10.3390/healthcare10122489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The increasing prevalence of complex chronic diseases in the population over 65 years of age is causing a major impact on health systems. This study aims to explore the needs and preferences of the multimorbid patient and carers to improve the palliative care received. The perspective of professionals who work with this profile of patients was also taken into account. A qualitative study was conducted using semi-structured interviews with open-ended questions. Separate topic guides were developed for patients, careers and health professionals. We included 12 patients, 11 caregivers and 16 health professionals in Spain. The results showed multiple unmet needs of patients and families/caregivers, including feelings of uncertainty, a sense of fear, low awareness and knowledge about palliative care in non-malignant settings, and a desire to improve physical, psychosocial and financial status. A consistent lack of specialized psychosocial care for both patients and caregivers was expressed and professionals highlighted the need for holistic needs assessment and effective and early referral pathways to palliative care. There is a lack of institutional support for multimorbid older patients in need of palliative care and important barriers need to be addressed by health systems to face the significant increase in these patients.
Collapse
|
10
|
Loosen SH, Krieg S, Eschrich J, Luedde M, Krieg A, Schallenburger M, Schwartz J, Neukirchen M, Luedde T, Kostev K, Roderburg C. The Landscape of Outpatient Palliative Care in Germany: Results from a Retrospective Analysis of 14,792 Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14885. [PMID: 36429604 PMCID: PMC9691170 DOI: 10.3390/ijerph192214885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Palliative care comprises multiprofessional, integrated, person-centered healthcare services for patients and their families facing problems related to progressive or advanced diseases and limited life expectancy. Although non-oncology patients' needs are similar to those of tumor patients, they are often underestimated. The purpose of our study was to investigate the actual utilization of palliative care services in Germany, especially in the outpatient setting. METHODS Using the IQVIA Disease Analyzer database, a total of 14,792 outpatients from 805 primary care practices in Germany with documented palliative care and related diagnosis between 2018 and 2021 were analyzed. Proportions of different diagnoses among patients receiving outpatient palliative care were stratified by gender and different age groups. RESULTS The most common underlying diagnosis for outpatient palliative care was cancer (55%), followed by heart failure (16%) and dementia (8%), with age- and sex-specific differences found in the proportion of diagnoses for utilization. While the relative proportions of cancers decreased with age (87% in the 18- to 50-year-old age group versus 37% in the 80-plus age group), the proportion of palliative care related to heart failure increased in the older population (2% in the 18- to 50-year-old age group versus 25% in the 80-plus age group). CONCLUSIONS This study provides an overview of the situation of outpatient palliative care in Germany and shows age- and gender-specific trends regarding the underlying medical diagnoses. Based on these data, palliative care should be adapted to current demographic developments.
Collapse
Affiliation(s)
- Sven H. Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | - Sarah Krieg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | - Johannes Eschrich
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | | | - Andreas Krieg
- Department of Surgery (A), University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | - Manuela Schallenburger
- Interdisciplinary Center of Palliative Medicine, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | - Jacqueline Schwartz
- Interdisciplinary Center of Palliative Medicine, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | - Martin Neukirchen
- Interdisciplinary Center of Palliative Medicine, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
- Department of Anesthesiology, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Duesseldorf, Germany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | | | - Christoph Roderburg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| |
Collapse
|