1
|
Lou Y, Li Y, Chen Y. The palliative care needs and experiences of patients with advanced Parkinson's disease: a qualitative scoping review. Front Med (Lausanne) 2024; 11:1362828. [PMID: 38660425 PMCID: PMC11039912 DOI: 10.3389/fmed.2024.1362828] [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: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Aim To determine the experiences and needs of palliative care in patients with advanced Parkinson's disease (PD). Methods A scoping literature review methodology, as described by the Joanna Briggs Institute, was employed to search for relevant literature. An electronic search of studies published in English was conducted across five databases from inception to 10 September 2023. Results The search yielded a total of 1,205 articles, with 20 meeting the inclusion criteria. The findings were organized into four themes: (1) unmet emotional and informational needs; (2) needs for effective coordination of care; (3) planning for the future; and (4) symptom management. This scoping review highlights the intricate nature of palliative care for patients with PD and sheds light on issues within current palliative care healthcare systems. The findings emphasize the necessity for individualized interventions and services to address the diverse unmet palliative care needs of people with PD. Conclusion The study reveals the complex landscape of palliative care for individuals with advanced PD, emphasizing the inadequacies within existing healthcare systems. The identified themes underscore the importance of tailored interventions to address the varied unmet palliative care needs of this population.
Collapse
Affiliation(s)
- Yan Lou
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
- Zhejiang Haining Health School, Haining City, Zhejiang, China
| | - Yiting Li
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yiping Chen
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| |
Collapse
|
2
|
Wongchan N, Nilmanat K, Chinnawong T. Situational Analysis of Barriers to Continuity of End-of-Life Care in Urban Areas, Bangkok. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:48-64. [PMID: 37975832 DOI: 10.1080/15524256.2023.2282354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
This qualitative study was designed to describe the continuity of end-of-life care and identify barriers to continuity in urban Bangkok. Continuity of care is considered an essential part of palliative care to promote the quality of life of patients at the end of life. The majority of studies have been conducted exploring continuity of care in rural communities. However, few studies have focused on urban areas, particularly in big cities. Twelve healthcare providers were the participants, including nurses in inpatient units, and in the Health Community and Continuity of Care Unit, a palliative care physician, and social workers. The data collection consisted of individual interviews, field notes, and observations. Content analysis was used to analyze data and identify barriers. The continuity of end-of-life care in a selected setting was fragmented. Three main barriers to the continuity of end-of-life care consisted of misunderstandings about patients who required palliative care, staff workloads, and incomplete patient information. The development of a comprehensive patient information sheet for communication among a multidisciplinary team could promote continuity of end-of-life care from hospital to home. An interprofessional training course on continuity of end-of-life care is also recommended. Finally, the staff workload should be monitored and managed.
Collapse
Affiliation(s)
- Nisa Wongchan
- Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand
| | | | | |
Collapse
|
3
|
Emanuel G, Verne J, Forbes K, Hounsome L, Henson KE. Community prescribing for cancer patients at the end of life: a national study. BMJ Support Palliat Care 2023; 13:e361-e372. [PMID: 34083319 DOI: 10.1136/bmjspcare-2021-002952] [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: 02/01/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Good end-of-life care is essential to ensure dignity and comfort in death. To our knowledge, there has not been a national population-based study in England of community prescribing of all drugs used in end-of-life care for patients with cancer. METHODS 57 632 people who died from malignant cancer in their own home or in a care home in 2017 in England were included in this study. National routinely collected data were used to examine community prescriptions dispensed for drugs for symptom control and anticipatory prescribing by key sociodemographic factors in the last 4 months of life. RESULTS 94% of people who died received drugs to control their symptoms and 65% received anticipatory prescribing. Prescribing increased for the symptom control drug group (53% to 75%) and the anticipatory prescribing group (4% to 52%) over the 4-month period to death. CONCLUSIONS Most individuals who died of cancer in their own home or a care home were dispensed drugs commonly used to control symptoms at the end of life, as recommended by best-practice guidance. Lower prescribing activity was found for those who died in a care home, highlighting a potential need for improved end-of-life service planning.
Collapse
Affiliation(s)
- Gabrielle Emanuel
- National Disease Registration Service, Public Health England, London, UK
| | - Julia Verne
- National End of Life Care Intelligence Network, Public Health England, Bristol, UK
| | - Karen Forbes
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Luke Hounsome
- National Disease Registration Service, Public Health England, London, UK
| | - Katherine E Henson
- National Disease Registration Service, Public Health England, London, UK
| |
Collapse
|
4
|
Tetzlaff B, Scherer M, Balzer K, Steyer L, Köpke S, Friede T, Maurer I, Weber CE, König HH, Konnopka A, Ruppel T, Mazur A, Hummers E, Mueller CA. Development of an interprofessional person-centred care concept for persons with care needs living in their own homes ( interprof HOME): study protocol for a mixed-methods study. BMJ Open 2023; 13:e069597. [PMID: 37451715 PMCID: PMC10351233 DOI: 10.1136/bmjopen-2022-069597] [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: 10/27/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION People receiving home care usually have complex healthcare needs requiring the involvement of informal caregivers and various health professionals. In this context, successful collaboration is an important element of person-centred care, which is often insufficiently implemented. Consequences might be found in avoidable hospitalisations. The aim of the study is to develop a care concept to improve person-centred interprofessional collaboration for people receiving home care considering the perspectives of all person groups involved. METHODS AND ANALYSIS This study uses a mixed-methods design consisting of a literature review, several qualitative inquiries, a cross-sectional quantitative study and a final structured workshop. After a literature review (work package (WP) 1), we will explore the perspectives of people receiving home care (n=20), their relatives (n=20) and representatives of statutory health insurances (n=5) in semistructured interviews (WP2). Moreover, 100 individuals of each group (people receiving home care, relatives, registered nurses, general practitioners and therapists) involved in home care will answer a survey on collaboration that will be analysed descriptively (WP3). Additionally, monoprofessional focus groups (n=9) of registered nurses, general practitioners and therapists, respectively, will discuss current practices. Data will be analysed by qualitative content analysis. Best practice cases (n=8) will be analysed by a case-based qualitative content analysis based on data of observations of home visits and interviews (WP4). The findings of WP2 will be discussed in mixed focus groups (n=4) with 10 participants each (WP5). Considering the results of joint displays of WP3, WP4 and WP5, the interprofessional care concept and its implementation will be elaborated in an expert workshop (WP6). ETHICS AND DISSEMINATION Ethical approval was obtained from all ethics committees of the project partners. Study results will be disseminated through publications, conference presentations, student education and advanced training of health professionals. TRIAL REGISTRATION NUMBER NCT05149937.
Collapse
Affiliation(s)
- Britta Tetzlaff
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Balzer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Linda Steyer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Medical Faculty & University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Indre Maurer
- Chair of Organization and Corporate Development, Faculty of Business and Economics, Georg-August-University Göttingen, Göttingen, Germany
| | - Clarissa E Weber
- Chair of Organization and Corporate Development, Faculty of Business and Economics, Georg-August-University Göttingen, Göttingen, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Ruppel
- Kanzlei für Medizinrecht und Gesundheitsrecht Dr. Dr. Thomas Ruppel, Lübeck, Germany
| | - Ana Mazur
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Christiane A Mueller
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
5
|
Payne SA, Hasselaar J. Exploring the Concept of Transitions in Advanced Cancer Care: The European Pal_Cycles Project. J Palliat Med 2023; 26:744-745. [PMID: 37276520 DOI: 10.1089/jpm.2023.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- Sheila A Payne
- International Observatory on End-of-Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| |
Collapse
|
6
|
Matthys O, Dierickx S, Deliens L, Lapeire L, Hudson P, Van Audenhove C, De Vleminck A, Cohen J. Is pre-bereavement collaboration between family caregivers and healthcare professionals associated with post-bereavement emotional well-being? A population-based survey. PATIENT EDUCATION AND COUNSELING 2023; 110:107654. [PMID: 36805930 DOI: 10.1016/j.pec.2023.107654] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To investigate pre-bereavement collaboration with healthcare professionals and its association with emotional well-being of family caregivers of people with serious illness post-bereavement. METHODS Population-based cross-sectional survey of bereaved family caregivers of people with serious illness (N = 3000) who died two to six months before the sample was drawn (November 2019), identified through three sickness funds in Belgium. RESULTS Response rate was 55%. As measured by the Positive and Negative Affect Schedule (PANAS), family caregivers scored lower on positive affect (PA) and higher on negative affect (NA) compared to a normative sample. Most family caregivers evaluated the pre-bereavement collaboration with healthcare professionals positively. Family caregivers' evaluation of collaboration with healthcare professionals pre-bereavement was positively associated with PA and negatively with NA, also when controlling for confounding effects of socio-demographic and clinical characteristics of the bereaved family caregiver and the deceased person. CONCLUSION There is a positive association between perceived quality of collaboration at the end of life between healthcare professionals and family caregivers and post-bereavement emotional well-being of family caregivers. PRACTICE IMPLICATIONS Our findings suggest the pertinence of attention from healthcare professionals to effective collaboration with family caregivers.
Collapse
Affiliation(s)
- Orphé Matthys
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Sigrid Dierickx
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lore Lapeire
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Peter Hudson
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Centre for Palliative Care, The University of Melbourne, Melbourne, Australia
| | | | - Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
7
|
Huppertz C, Forbrig TA, Lengert-Brzozowski S, Gräske J. Associations Between Older Adults' Loneliness and Acceptance of Socially Assistive Robots: A Cross-Sectional Study. J Gerontol Nurs 2023; 49:21-26. [PMID: 36989477 DOI: 10.3928/00989134-20230309-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The use of socially assistive robots (SARs) to enable older adults (aged ≥65 years) to live independently for as long as possible has been researched for several years. Of particular interest is the way SARs can combat loneliness. A quantitative cross-sectional study was conducted with 61 older adults in living facilities in Berlin, Germany. Paper-based questionnaires were used to elicit experiences of loneliness and determine the level of acceptance of SARs. Mean score (39.3) of the loneliness scale was in the average range for this population. Mean score (56.1) of acceptance of SARs was on a moderate level. Regression analyses showed that loneliness did not influence the acceptance of SARs by older adults in the sample, which was contrary to findings in the literature. Further studies might generate more accurate data and accelerate the development of robots to make them more attractive for social purposes. [Journal of Gerontological Nursing, 49(4), 21-26.].
Collapse
|
8
|
Moon CC, Mah K, Pope A, Swami N, Hannon B, Lau J, Mak E, Al-Awamer A, Banerjee S, Dawson LA, Husain A, Rodin G, Le LW, Zimmermann C. Family physicians' involvement in palliative cancer care. Cancer Med 2023; 12:6213-6224. [PMID: 36263836 PMCID: PMC10028020 DOI: 10.1002/cam4.5371] [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] [Received: 02/17/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family physicians' (FPs) long-term relationships with their oncology patients position them ideally to provide primary palliative care, yet their involvement is variable. We examined perceptions of FP involvement among outpatients receiving palliative care at a cancer center and identified factors associated with this involvement. METHODS Patients with advanced cancer attending an oncology palliative care clinic (OPCC) completed a 25-item survey. Eligible patients had seen an FP within 5 years. Binary multivariable logistic regression analyses were conducted to identify factors associated with (1) having seen an FP for palliative care within 6 months, and (2) having a scheduled/planned FP appointment. RESULTS Of 258 patients, 35.2% (89/253) had seen an FP for palliative care within the preceding 6 months, and 51.2% (130/254) had a scheduled/planned FP appointment. Shorter travel time to FP (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.48-0.93, p = 0.02), the FP having a 24-h support service (OR = 1.96, 95% CI = 1.02-3.76, p = 0.04), and a positive perception of FP's care (OR = 1.05, 95% CI = 1.01-1.09, p = 0.01) were associated with having seen the FP for palliative care. English as a first language (OR = 2.90, 95% CI = 1.04-8.11, p = 0.04) and greater ease contacting FP after hours (OR = 1.33, 95% CI = 1.08-1.64, p = 0.008) were positively associated, and female sex of patient (OR = 0.51, 95% CI = 0.30-0.87, p = 0.01) and travel time to FP (OR = 0.66, 95% CI = 0.47-0.93, p = 0.02) negatively associated with having a scheduled/planned FP appointment. Number of OPCC visits was not associated with either outcome. CONCLUSION Most patients had not seen an FP for palliative care. Accessibility, availability, and equity are important factors to consider when planning interventions to encourage and facilitate access to FPs for palliative care.
Collapse
Affiliation(s)
- Christine C Moon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ashley Pope
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nadia Swami
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ernie Mak
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Subrata Banerjee
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura A Dawson
- Department of Radiation Oncology, University of Toronto, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Amna Husain
- Temmy Latner Centre for Palliative Care Lunenfeld Tanenbaum Research Institute, Sinai Health Division of Palliative Care, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Bowers B, Wilson E. Managing medication at the end of life: supporting family carers. Br J Community Nurs 2023; 28:34-36. [PMID: 36592094 DOI: 10.12968/bjcn.2023.28.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ben Bowers
- Post-Doctoral Research Fellow and Community Palliative Care Nurse, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge; Community Nursing Research Consultant, Queen's Nursing Institute, London
| | - Eleanor Wilson
- Senior Research Fellow, Nottingham Centre for the Advancement of Research into Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham
| |
Collapse
|
10
|
Cormican O, Dowling M. Providing Care to People Living with a Chronic Hematological Malignancy: A Qualitative Evidence Synthesis of Informal Carers' Experiences. Semin Oncol Nurs 2022; 38:151338. [PMID: 36270864 DOI: 10.1016/j.soncn.2022.151338] [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: 02/01/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Chronic hematological malignancies such as multiple myeloma, chronic lymphocytic leukemia (CLL), indolent B-cell lymphomas, and myelodysplastic syndromes (MDS) have seen significant advances in treatment. Treatment developments have resulted in patients living for many years, often between periods of being acutely unwell, relapses, and remission. Informal carers play a major role in supporting patients through the uncertain and long illness trajectory. This qualitative evidence synthesis (QES) aims to synthesize qualitative research evidence on the experiences of informal carers caring for a patient with a chronic hematological malignancy (CHM). DATA SOURCES This qualitative evidence synthesis followed the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines and adopted a "best fit" framework synthesis approach using a "redefining normal" conceptual framework. A systematic search of seven databases was undertaken. CONCLUSION Sixteen qualitative studies were synthesized in this review. Eight review findings illuminated carers' unmet information needs, challenges with caring responsibilities, end-of-life care, and changes in the dyad carer-patient relationship. IMPLICATIONS FOR NURSING PRACTICE This best-fit framework synthesis illuminates the wide-ranging challenges experienced by informal caregivers of people living with a chronic hematological malignancy. Carers' fear for the future highlights the need for interventions to support them with their fears. Carers' priority on their loved one's quality of life is impaired by late end-of-life discussions often not occurring until a sudden deterioration in the patient's condition. Early supportive relationships between carers and health care providers can promote conversations on poor prognosis and end-of-life care. Future research should focus on qualitative longitudinal studies with caregiver-patient dyads.
Collapse
Affiliation(s)
- Orlaith Cormican
- School of Nursing and Midwifery, University of Galway, University Road, Galway, Ireland H91 TK33.
| | - Maura Dowling
- School of Nursing and Midwifery, University of Galway, University Road, Galway, Ireland H91 TK33
| |
Collapse
|
11
|
Ania‐González N, Martín‐Martín J, Amezqueta‐Goñi P, Vázquez‐Calatayud M. The needs of families who care for individuals with kidney failure on comprehensive conservative care: A qualitative systematic review. J Ren Care 2022; 48:230-242. [PMID: 35226408 PMCID: PMC9790615 DOI: 10.1111/jorc.12415] [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: 10/25/2021] [Revised: 02/05/2022] [Accepted: 02/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Integrating the family of patients with kidney failure on comprehensive conservative care could benefit patients, families, and the health care system. However, there is a knowledge gap in this phenomenon since no systematic review has focused on the families' needs who care for individuals with kidney failure on comprehensive conservative care. OBJECTIVES To understand the primary needs of families who care for people with kidney failure on comprehensive conservative care. METHOD A systematic literature review of qualitative studies, followed by a content analysis was carried out. PubMed, CINAHL, and PsycINFO databases were used to search for articles published in English and Spanish between 2010 and 2021. The ENTREQ guideline was used for reporting. RESULTS Five relevant studies were included in this study. The analysis has allowed identifying key aspects of knowledge, psychological, social and spiritual needs of family members of patients with kidney failure on comprehensive conservative care. CONCLUSIONS This systematic review has revealed that families experience a lack of information and continuity of care by health care professionals. Added to this is the psychological burden they bear due to the feeling of indefinite care in time and uncertainty about the death of their loved one. All this, without the necessary support from their immediate family environment and social institutions. In light of these data, a paradigm shift in society and the health care received by these families is essential.
Collapse
Affiliation(s)
| | - J. Martín‐Martín
- Faculty of NursingUniversity of NavarraPamplonaSpain,Innovation for a Person‐Centred Care Research Group (ICCP‐UNAV)University of NavarraPamplonaSpain,Navarra's Health Research Institute (IdiSNA)PamplonaSpain
| | | | - M. Vázquez‐Calatayud
- Clínica Universidad de NavarraPamplonaSpain,Innovation for a Person‐Centred Care Research Group (ICCP‐UNAV)University of NavarraPamplonaSpain,Navarra's Health Research Institute (IdiSNA)PamplonaSpain,Area of Professional Development and Nursing ResearchClínica Universidad de NavarraPamplonaSpain
| |
Collapse
|
12
|
Bhadelia A, Oldfield LE, Cruz JL, Singh R, Finkelstein EA. Identifying Core Domains to Assess the "Quality of Death": A Scoping Review. J Pain Symptom Manage 2022; 63:e365-e386. [PMID: 34896278 DOI: 10.1016/j.jpainsymman.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines. OBJECTIVES Identify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems. METHODS PubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles. RESULTS A total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication. CONCLUSION The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.
Collapse
Affiliation(s)
- Afsan Bhadelia
- Department of Global Health and Population (A.B.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | | | - Jennifer L Cruz
- Department of Social and Behavioral Sciences (J.L.C.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ratna Singh
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
13
|
Robinson J, Frey R, Raphael D, Old A, Gott M. Difficulties in navigating the intersection of generalist and specialist palliative care services: A cross-sectional study of bereaved family's experiences of care at home in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:133-141. [PMID: 33894085 DOI: 10.1111/hsc.13381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
A generalist-specialist model of palliative care is well established as a framework for the provision of community care in resource-rich countries. However, evidence is lacking regarding how the model is experienced by family carers and the extent to which access to both generalist and specialist palliative care is equitable. A cross-sectional postal survey was undertaken to explore bereaved family's experiences of generalist palliative care and its intersection with hospice services in the last 3 months of life. A modified version of the Views of Informal Carers-Evaluation of Services survey was sent to 4,778 bereaved family. Data were collected between February 2017 and October 2018. Chi-square was utilised to identify factors that impacted on experiences of generalist palliative care; analysis of free text data comprising 45,823 words was undertaken using a directed content analysis approach. Eight hundred and twenty-six questionnaires were returned (response rate = 21%). Seventy per cent of people (n = 579) spent some time at home in the last 3 months prior to death. People who received support from hospice were more likely to receive support from multiple other services. Those who received no community services were less likely to feel supported by their general practitioner, less likely to spend the last 2 days of life or die at home. Feeling supported had a strong association with services working well together, being involved in decision-making and being aware of the poor prognosis. The provision of palliative care is complicated by a lack of integration with specialist palliative care and may be the basis of continuing inequities in the provision of community care at the end of life. The assumption at a policy level that "generalists" are willing and able to play a key role in palliative care provision needs to be further challenged.
Collapse
Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Deborah Raphael
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Andrew Old
- Waitemata District Health Board, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
| |
Collapse
|
14
|
Engel M, van der Padt-Pruijsten A, Huijben AMT, Kuijper TM, Leys MBL, Talsma A, van der Heide A. Quality of hospital discharge letters for patients at the end of life: A retrospective medical record review. Eur J Cancer Care (Engl) 2021; 31:e13524. [PMID: 34697850 PMCID: PMC9285046 DOI: 10.1111/ecc.13524] [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: 12/10/2020] [Revised: 06/29/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
Objective For patients who are discharged to go home after a hospitalisation, timely and adequately informing their general practitioner is important for continuity of care, especially at the end of life. We studied the quality of the hospital discharge letter for patients who were hospitalised in their last year of life. Methods A retrospective medical record review was performed. Included patients had been admitted to the hospital during the period 1 January to 1 July 2017 and had died within a year after discharge. Results Data were collected from records of 108 patients with cancer or other diseases. For 57 patients (53%), the discharge letter included information that related to their limited life expectancy (e.g., agreements about treatment limitations), whereas the patient's limited life expectancy was addressed in the medical record in 76 cases (70%). We found related information in discharge letters for 36 patients (66%) who died <3 months compared to 21 patients (40%) who died 3–12 months after hospitalisation (p < 0.01). Conclusion For patients with a limited life expectancy going home after a hospitalisation, one out of two hospital discharge letters lacked any information addressing their limited life expectancy. Specific guidelines for medical information exchange between care settings are needed.
Collapse
Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Auke M T Huijben
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Maria B L Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
15
|
Leysen B, Schmitz O, Aujoulat I, Karam M, Van den Eynden B, Wens J. Implementation of Primary Palliative Care in five Belgian regions: A qualitative study on early identification of palliative care needs by general practitioners. Eur J Gen Pract 2021; 26:146-153. [PMID: 33078644 PMCID: PMC7592891 DOI: 10.1080/13814788.2020.1825675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background To deliver optimal palliative care, a Care Pathway for Primary Palliative Care (CPPPC) was developed. This CPPPC was implemented by general practitioners (GPs) in territories of five Belgian palliative care networks (2014–2016). Belgian doctors have much therapeutic freedom, and do not commonly follow guidelines. Objectives To assess how palliative care was provided by GPs before the CPPPC and its implementation project were presented publicly. Methods Between 2013 and 2015, seven focus groups with GPs were conducted. Participants included 15 GPs in three French-speaking focus groups and 26 GPs in four Dutch-speaking focus groups, with diversity for age, gender, palliative care experience and practice context. Some GPs implemented the CPPPC later. Results GPs considered each palliative care case unique and disliked strict protocols. However, they expressed a need for peer review and reflective frameworks. GPs felt it is important to identify palliative care patients ‘timely’, but found this difficult. Screening methods help, but are not widely used. GPs struggled most with identifying palliative care needs in non-oncological patients. Bad news breaking was considered difficult. Continuity of care was considered very important. However, advance care planning seemed more widely practised by Dutch-speaking GPs than by French-speaking GPs. The taboo of palliative care provoked emotional discussions. Conclusion Palliative care frameworks which help GPs to deliver ‘tailor-made’ care have more chance to be adopted than strict protocols. GPs should be given education for bad news breaking. Palliative care and advance care planning practices differ locally: guideline dissemination plans should respect these local differences.
Collapse
Affiliation(s)
- Bert Leysen
- Primary and Interdisciplinary Care, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - Olivier Schmitz
- Institute of Health & Society (IRSS), Université catholique de Louvain Secteur des sciences de la santé, Bruxelles, Belgium
| | - Isabelle Aujoulat
- Institute of Health & Society (IRSS), Université catholique de Louvain Secteur des sciences de la santé, Bruxelles, Belgium
| | - Marlène Karam
- Institute of Health & Society (IRSS), Université catholique de Louvain Secteur des sciences de la santé, Bruxelles, Belgium
| | - Bart Van den Eynden
- Primary and Interdisciplinary Care, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium.,Multidisciplinary Pain Centre, University Hospital Antwerp, Edegem, Belgium
| | - Johan Wens
- Primary and Interdisciplinary Care, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium.,Multidisciplinary Pain Centre, University Hospital Antwerp, Edegem, Belgium
| |
Collapse
|
16
|
Pollock K, Wilson E, Caswell G, Latif A, Caswell A, Avery A, Anderson C, Crosby V, Faull C. Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services.
Objective
To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting.
Design
A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops.
Setting
This took place in Nottinghamshire and Leicestershire, UK.
Results
As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care.
Limitations
The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned.
Conclusions
The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life.
Future work
Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alan Caswell
- Patient and Public Involvement Representative, Dementia, Frail Older and Palliative Care Patient and Public Involvement Advisory Group, University of Nottingham, Nottingham, UK
| | - Anthony Avery
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Anderson
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Vincent Crosby
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | |
Collapse
|
17
|
Engel M, van der Ark A, Tamerus R, van der Heide A. Quality of collaboration and information handovers in palliative care: a survey study on the perspectives of nurses in the Southwest Region of the Netherlands. Eur J Public Health 2021; 30:720-727. [PMID: 32221585 PMCID: PMC7445043 DOI: 10.1093/eurpub/ckaa046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background When patients receiving palliative care are transferred between care settings, adequate collaboration and information exchange between health care professionals is necessary to ensure continuity, efficiency and safety of care. Several studies identified deficits in communication and information exchange between care settings. Aim of this study was to get insight in the quality of collaboration and information exchange in palliative care from the perspectives of nurses. Methods We performed a cross-sectional regional survey study among nurses working in different care settings. Nurses were approached via professional networks and media. Respondents were asked questions about collaboration in palliative care in general and about their last deceased patient. Potential associations between quality scores for collaboration and information handovers and characteristics of respondents or patients were tested with Pearson’s chi-square test. Results A total of 933 nurses filled in the questionnaire. Nurses working in nursing homes were least positive about inter-organizational collaboration. Forty-six per cent of all nurses had actively searched for such collaboration in the last year. For their last deceased patient, 10% of all nurses had not received the information handover in time, 33% missed information they needed. An adequate information handover was positively associated with timeliness and completeness of the information and the patient being well-informed, not with procedural characteristics. Conclusion Nurses report that collaboration between care settings and information exchange in palliative care is suboptimal. This study suggests that health care organizations should give more attention to shared professionalization towards inter-organizational collaboration among nurses in order to facilitate high-quality palliative care.
Collapse
Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrée van der Ark
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rosanne Tamerus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
18
|
Abstract
BACKGROUND The policy several countries is to provide people with a terminal illness the choice of dying at home; this is supported by surveys that indicate that the general public and people with a terminal illness would prefer to receive end-of-life care at home. This is the fifth update of the original review. OBJECTIVES To determine if providing home-based end-of-life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs and caregivers compared with inpatient hospital or hospice care. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE(R), Embase, CINAHL, and clinical trials registries to 18 March 2020. We checked the reference lists of systematic reviews. For included studies, we checked the reference lists and performed a forward search using ISI Web of Science. We handsearched palliative care journals indexed by ISI Web of Science for online first references. SELECTION CRITERIA Randomised controlled trials evaluating the effectiveness of home-based end-of-life care with inpatient hospital or hospice care for people aged 18 years and older. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed study quality. When appropriate, we combined published data for dichotomous outcomes using a fixed-effect Mantel-Haenszel meta-analysis to calculate risk ratios (RR) with 95% confidence intervals (CI). When combining outcome data was not possible, we reported the results from individual studies. MAIN RESULTS We included four randomised trials and found no new studies from the search in March 2020. Home-based end-of-life care increased the likelihood of dying at home compared with usual care (RR 1.31, 95% CI 1.12 to 1.52; 2 trials, 539 participants; I2 = 25%; high-certainty evidence). Admission to hospital varied among the trials (range of RR 0.62, 95% CI 0.48 to 0.79, to RR 2.61, 95% CI 1.50 to 4.55). The effect on patient outcomes and control of symptoms was uncertain. Home-based end-of-life care may slightly improve patient satisfaction at one-month follow-up, with little or no difference at six-month follow-up (2 trials; low-certainty evidence). The effect on caregivers (2 trials; very low-certainty evidence), staff (1 trial; very low-certainty evidence) and health service costs was uncertain (2 trials, very low-certainty evidence). AUTHORS' CONCLUSIONS The evidence included in this review supports the use of home-based end-of-life care programmes for increasing the number of people who will die at home. Research that assesses the impact of home-based end-of-life care on caregivers and admissions to hospital would be a useful addition to the evidence base, and might inform the delivery of these services.
Collapse
Affiliation(s)
- Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Bee Wee
- Nuffield Department of Medicine and Sir Michael Sobell House, Churchill Hospital, Oxford, UK
| |
Collapse
|
19
|
Engel M, van Zuylen L, van der Ark A, van der Heide A. Palliative care nurse champions' views on their role and impact: a qualitative interview study among hospital and home care nurses. BMC Palliat Care 2021; 20:34. [PMID: 33602177 PMCID: PMC7893717 DOI: 10.1186/s12904-021-00726-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background One of the strategies to promote the quality of palliative care in non-specialised settings is the appointment of palliative care nurse champions. It is unclear what the most effective model to implement the concept of nurse champions is and little is known about palliative care nurse champions’ own views on their role and responsibilities. This paper aims to describe views of palliative care nurse champions in hospitals and home care on their role, responsibilities and added value. Methods In 2018, a qualitative interview study was conducted with 16 palliative care nurse champions in two hospitals and four home care organisations in the southwest of the Netherlands. The framework approach was used to analyse the data. Results Most palliative care nurse champions described their role by explaining concrete tasks or activities. Most nurse champions perceive their main task as disseminating information about palliative care to colleagues. A few nurses mentioned activities aimed at raising awareness of palliative care among colleagues. Most nurses were to a limited extent involved in collaboration with the palliative care expert team. Hospital nurse champions suggested that more support from the palliative care expert team would be helpful. Most nurse champions feel little responsibility for organisational tasks and inter-organisational collaboration. Especially hospital nurses found it difficult to describe their role. Conclusion The role of palliative care nurse champions in hospital and home care varies a lot and nurses have diverging views on palliative care in these settings. Comprehensively fulfilling the role of palliative care nurse champion is a challenge. Careful selection, training, support and task descriptions for nurse champions are needed to make the concept of nurse champions work in palliative care. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00726-1.
Collapse
Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Andrée van der Ark
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| |
Collapse
|
20
|
Pepin E, Hébert J. Besoins des proches aidants qui accompagnent une personne en soins palliatifs et de fin de vie à domicile. Can Oncol Nurs J 2020; 30:141-146. [PMID: 33118984 DOI: 10.5737/23688076302141146] [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: 11/05/2022] Open
Abstract
Le maintien à domicile d'une personne en soins palliatifs et de fin de vie (SPFV) dépend grandement de la présence quotidienne de proches aidants (PA) et de leur implication dans les soins. Or, les besoins des PA tout au long de la trajectoire d'accompagnement d'un proche en SPFV à domicile sont encore relativement méconnus. Objectifs et méthode Cette étude qualitative descriptive s'intéresse au rôle des PA qui ont accompagné une personne recevant des SPFV à domicile dans le but de décrire leurs besoins tout au long de la trajectoire d'accompagnement. Ainsi, 20 PA ont participé à des entrevues semi-dirigées. Résultats et discussion L'étude met en lumière les besoins multiples des PA qui accompagnent un proche en SPFV à domicile. Les besoins informationnels, émotionnels et psychosociaux démontrent que les PA connaissent des changements dans leur rôle auprès de la personne malade. Les besoins spirituels ont été rapportés en termes de sens donné à l'expérience d'accompagnement. Enfin, les besoins pratiques mettent de l'avant l'importance d'avoir accès aux services de SPFV 24 h/24 et le caractère essentiel du soutien de l'infirmière. Conclusion Les besoins des PA qui accompagnent une personne en SPFV à domicile sont peu satisfaits. Il importe d'en tenir compte dans la trajectoire de soins, parallèlement aux besoins de la personne malade, afin d'améliorer l'expérience d'accompagnement qui précède la période de deuil.
Collapse
Affiliation(s)
- Elizabeth Pepin
- Infirmière clinicienne, étudiante à la maîtrise, Université du Québec à Rimouski, campus de Lévis, Maison Michel-Sarrazin,
| | - Johanne Hébert
- Directrice de recherche, Université du Québec à Rimouski, campus de Lévis, Maison Michel-Sarrazin, Centre intégré de santé et de services sociaux de Chaudière-Appalaches,
| |
Collapse
|
21
|
Physicians' perspectives on estimating and communicating prognosis in palliative care: a cross-sectional survey. BJGP Open 2020; 4:bjgpopen20X101078. [PMID: 32967841 PMCID: PMC7606137 DOI: 10.3399/bjgpopen20x101078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background Advance care planning (ACP) can help to enhance the care of patients with limited life expectancy. Despite physicians’ key role in ACP, the ways in which physicians estimate and communicate prognosis can be improved. Aim To determine how physicians in different care settings self-assess their performance in estimating and communicating prognosis to patients in palliative care, and how they perceive their communication with other physicians about patients’ poor prognosis. Design & setting A survey study was performed among a random sample of GPs, hospital physicians (HPs), and nursing home physicians (NHPs) in the southwest of the Netherlands (n = 2212). Method A questionnaire was developed that had three versions for GPs, HPs, and NHPs. Each specialism filled in an appropriate version. Results A total of 547 physicians participated: 259 GPs, 205 HPs, and 83 NHPs. In the study, 61.1% of physicians indicated being able to adequately estimate whether a patient will die within 1 year, which was associated with use of the Surprise Question (odds ratio [OR] = 1.65, P = 0.042). In the case of a prognosis of <1 year, 75.0% of physicians indicated that they communicate with patients about preferences regarding treatment and care, which was associated with physicians being trained in palliative care (OR = 2.02, P=0.007). In cases where patients with poor prognosis are discharged after hospital admission, 83.4% of HPs indicated that they inform GPs about these patients’ preferences compared with 29.0% of GPs, and 21.7% of NHPs, who indicated that they are usually adequately informed about the preferences. Conclusion The majority of physicians indicated that they believe they can adequately estimate patients’ limited life expectancy and that they discuss patients’ preferences for care. However, more physicians should be trained in communicating about patients’ poor prognosis and care preferences.
Collapse
|
22
|
Pepin E, Hébert J. Needs of caregivers of patients receiving in-home palliative and end-of-life care. Can Oncol Nurs J 2020; 30:147-152. [PMID: 33118991 DOI: 10.5737/23688076302147152] [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: 11/05/2022] Open
Abstract
Home support for patients receiving in-home palliative and end-of-life care (PELC) is greatly dependent on the daily presence of caregivers and their involvement in care delivery. However, the needs of caregivers throughout the care trajectory of a loved one receiving in-home PELC are still relatively unknown. Objectives and methodology This descriptive qualitative study focuses on the role of caregivers who have cared for a person receiving in-home PELC with the goal of describing their needs throughout the care trajectory. As part of this process, 20 caregivers took part in semi-directed interviews. Results and discussion This study sheds light on the multiple needs of caregivers of loved ones receiving in-home PELC. These informational, emotional, and psychosocial needs show that caregivers experience changes in their relationship with their loved one. Spiritual needs were expressed through the meaning ascribed to the home support experience. And the practical needs expressed by participants highlight the importance of round-the-clock access to PELC services and the essential importance of nursing support. Conclusion The needs of caregivers of loved ones receiving in-home PELC are not being met to a satisfactory degree. It is important to consider these needs in the care trajectory, alongside the needs of the patients themselves, in order to improve the support experience leading up to the bereavement period.
Collapse
Affiliation(s)
- Elizabeth Pepin
- Nurse Clinician, Master's Student, Université du Québec à Rimouski, Lévis Campus, Maison Michel-Sarrazin,
| | - Johanne Hébert
- Research Director, Université du Québec à Rimouski, Lévis Campus, Maison Michel-Sarrazin, Centre intégré de santé et de services sociaux de Chaudière-Appalaches,
| |
Collapse
|
23
|
The Lived Experiences of Family Caregivers of Persons Dying in Home Hospice: Support, Advocacy, and Information Urgently Needed. J Hosp Palliat Nurs 2020; 22:145-151. [PMID: 32011356 DOI: 10.1097/njh.0000000000000632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Death in America is changing from hospital to home, which demands complex skills by family caregivers. However, information from family members about the challenges of providing home hospice care until death is scant. To understand the challenges a family caregiver confronts when he/she decides to deliver hospice care and during the actual delivery of the hospice care, we used descriptive phenomenology methods to document the experience of 18 family caregivers as they delivered home hospice care. We learned the decision to begin home hospice was made by a physician, followed frequently by family resistance and refusal to assist. Family caregiver burden is enormous, compounded by fatigue, sleeplessness, and confusion on issues such as morphine dosage and administration. The stages and process of dying, such as transition, baffled family caregivers. All family caregivers agree financial and emotion support, empathic advocacy, and affirmation of their worth are needed to sustain them to care for the dying. The peacefulness following offering a home death comes at a high price to family caregivers. Evidence is needed from a randomized controlled trial as to effectiveness of advocacy support for family caregivers to increase their resiliency and higher probability of a good death for the dying.
Collapse
|
24
|
Pleschberger S, Reitinger E, Trukeschitz B, Wosko P. Older people living alone (OPLA) - non-kin-carers' support towards the end of life: qualitative longitudinal study protocol. BMC Geriatr 2019; 19:219. [PMID: 31409280 PMCID: PMC6692935 DOI: 10.1186/s12877-019-1243-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND A growing number of older people, mainly women, live in single households. They represent a vulnerable group as staying at home may turn out challenging when care needs increase, particularly at the end of life. Non-kin-carers can play an essential role in supporting individuals' preferences to stay at home. In research little attention has been paid to non-kin-carers, such as friends and neighbors, yet. Thus, the Older People Living Alone (OPLA) study will evaluate whether non-kin support is robust enough to enable care dependent people to stay at home even at the end of life. This paper aims to introduce the research protocol. METHODS We plan to apply a qualitative longitudinal study to better understand how older people living alone and their non-kin-carers manage to face the challenges with increased care needs towards the end-of-life. We will conduct serial interviews with the older persons living alone and their non-kin-carers. A total of 20-25 complete data sets and up to 200 personal interviews were planned. These will be complemented by regular telephone contacts. All interviews will be analysed following the grounded theory approach and strategies for reconstructing case trajectories, supported by MAXQDA software. In the course of the study, inter- and transdisciplinary workshops shall assure quality and support knowledge transfer. DISCUSSION This study protocol aims to guide research in a field that is difficult to approach, with regard to its topic, methodology and the interdisciplinary approach. As this study introduces longitudinal qualitative research methodology in the field of home care in Austria, a deeper understanding of (end-of-life-) care trajectories will be enhanced, which is of major relevance for future care planning. With investment in additional reflexivity and communication procedures innovative results and robust knowledge are expected outcomes.
Collapse
Affiliation(s)
- Sabine Pleschberger
- 0000 0004 0437 2768grid.502403.0Gesundheit Österreich GmbH (GÖG, Austrian Public Health Institute), Vienna, Austria
| | - Elisabeth Reitinger
- 0000 0001 2286 1424grid.10420.37Department of Nursing Science, University of Vienna, Vienna, Austria
| | - Birgit Trukeschitz
- 0000 0001 1177 4763grid.15788.33Research Institute for Economics of Aging, Vienna University of Economics and Business, Vienna, Austria
| | - Paulina Wosko
- 0000 0004 0437 2768grid.502403.0Gesundheit Österreich GmbH (GÖG, Austrian Public Health Institute), Vienna, Austria
| |
Collapse
|
25
|
Røen I, Stifoss-Hanssen H, Grande G, Kaasa S, Sand K, Knudsen AK. Supporting carers: health care professionals in need of system improvements and education - a qualitative study. BMC Palliat Care 2019; 18:58. [PMID: 31311536 PMCID: PMC6636145 DOI: 10.1186/s12904-019-0444-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 07/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background Health care professionals should prevent and relieve suffering in carers of patients with advanced cancer. Despite known positive effects of systematic carer support, carers still do not receive sufficient support. Carers have reported to be less satisfied with coordination of care and involvement of the family in treatment and care decisions than patients. In a rural district of Mid-Norway, cancer palliative care services across specialist and community care were developed. Participants’ experiences and opinions were investigated as part of this development process. Methods The aim of this qualitative study was to explore and describe health care professionals’ experiences with carer support from their own perspective. Data were collected in focus groups. Purposeful sampling guided the inclusion. Six groups were formed with 21 professionals. The discussions were audio-recorded, transcribed, and analyzed using systematic text condensation. Results In the analyzis of the focus group discussions, ten categories emerged from the exploration of health care professionals’ carer support, assessment of needs, and factors hampering carer support: 1) dependent on profession, role, and context, 2) personal relationship, 3) personal skills and competence, 4) adjusted to the stage of the disease, 5) informal assessment of carers’ needs, 6) lack of education 7) lack of systems for carer consultations, 8) lack of systems for documentation, 9) lack of systems for involving GPs, and 10) lack of systematic spiritual care. Conclusions Health care professionals built a personal relationship with the carers as early as possible, to facilitate carer support throughout the disease trajectory. Systematic carer support was hampered by lack of education and system insufficiencies. Organizational changes were needed, including 1) education in carer support, communication, and spiritual care, 2) use of standardized care pathways, including systematic carer needs assessment, 3) systematic involvement of general practitioners, and 4) a system for documentation of clinical work with carers.
Collapse
Affiliation(s)
- Ingebrigt Røen
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 4. etg. Kunnskapssenteret vest, St. Olavs hospital, 7006, Trondheim, Norway. .,St. Olavs hospital HF, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs hospital, 7006, Trondheim, Norway.
| | - Hans Stifoss-Hanssen
- Center of diakonia and professional practice, VID Specialized University, Oslo, Norway
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, England
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Kari Sand
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 4. etg. Kunnskapssenteret vest, St. Olavs hospital, 7006, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
26
|
Hudson BF, Best S, Stone P, Noble T(B. Impact of informational and relational continuity for people with palliative care needs: a mixed methods rapid review. BMJ Open 2019; 9:e027323. [PMID: 31147362 PMCID: PMC6549611 DOI: 10.1136/bmjopen-2018-027323] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To identify and synthesise existing literature exploring the impact of relational and informational continuity of care on preferred place of death, hospital admissions and satisfaction for palliative care patients in qualitative, quantitative and mixed methods literature. DESIGN A mixed methods rapid review. METHODS PUBMED, PsychINFO, CINAHL were searched from June 2008 to June 2018 in order to identify original peer reviewed, primary qualitative, quantitative or mixed methods research exploring the impact of continuity of care for people receiving palliative care. Synthesis methods as outlined by the Cochrane Qualitative and Implementation Methods Group were applied to qualitative studies while meta-analyses for quantitative data were planned. OUTCOMES The impact of interventions designed to promote continuity of care for people receiving palliative care on the following outcomes was explored: achieving preferred place of death, satisfaction with care and avoidable hospital admissions. RESULTS 18 eligible papers were identified (11 qualitative, 6 quantitative and 1 mixed methods papers). In all, 1951 patients and 190 family caregivers were recruited across included studies. Meta-analyses were not possible due to heterogeneity in outcome measures and tools used. Two studies described positive impact on facilitating preferred place of death. Four described a reduction in avoidable hospital admissions. No negative impacts of interventions designed to promote continuity were reported. Patient satisfaction was not assessed in quantitative studies. Participants described a significant impact on their experiences as a result of the lack of informational and relational continuity. CONCLUSIONS This rapid review highlights the impact that continuity of care can have on the experiences of patients receiving palliative care. The evidence for the impact of continuity on place of death and hospital admissions is limited. Methods for enhancing, and recording continuity should be considered in the design and development of future healthcare interventions to support people receiving palliative care.
Collapse
Affiliation(s)
- Briony F Hudson
- Marie Curie, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | |
Collapse
|
27
|
McCaughan D, Roman E, Smith AG, Garry AC, Johnson MJ, Patmore RD, Howard MR, Howell DA. Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study. Eur J Oncol Nurs 2019; 39:70-80. [PMID: 30850141 PMCID: PMC6417764 DOI: 10.1016/j.ejon.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/04/2018] [Accepted: 02/06/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Patients with haematological malignancies are more likely to die in hospital, and less likely to access palliative care than people with other cancers, though the reasons for this are not well understood. The purpose of our study was to explore haematology nurses' perspectives of their patients' places of care and death. METHOD Qualitative description, based on thematic content analysis. Eight haematology nurses working in secondary and tertiary hospital settings were purposively selected and interviewed. Transcriptions were coded and analysed for themes using a mainly inductive, cross-comparative approach. RESULTS Five inter-related factors were identified as contributing to the likelihood of patients' receiving end of life care/dying in hospital: the complex nature of haematological diseases and their treatment; close clinician-patient bonds; delays to end of life discussions; lack of integration between haematology and palliative care services; and barriers to death at home. CONCLUSIONS Hospital death is often determined by the characteristics of the cancer and type of treatment. Prognostication is complex across subtypes and hospital death perceived as unavoidable, and sometimes the preferred option. Earlier, frank conversations that focus on realistic outcomes, closer integration of palliative care and haematology services, better communication across the secondary/primary care interface, and an increase in out-of-hours nursing support could improve end of life care and facilitate death at home or in hospice, when preferred.
Collapse
Affiliation(s)
- Dorothy McCaughan
- Epidemiology & Cancer Statistics Group, University of York, York, YO10 5DD, UK.
| | - Eve Roman
- Epidemiology & Cancer Statistics Group, University of York, York, YO10 5DD, UK.
| | - Alexandra G Smith
- Epidemiology & Cancer Statistics Group, University of York, York, YO10 5DD, UK.
| | - Anne C Garry
- Department of Palliative Care, York Hospital, York, YO31 8HE, UK.
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK.
| | - Russell D Patmore
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull, HU16 5JQ, UK.
| | - Martin R Howard
- Department of Haematology, York Hospital, York, YO31 8HE, UK.
| | - Debra A Howell
- Epidemiology & Cancer Statistics Group, University of York, York, YO10 5DD, UK.
| |
Collapse
|
28
|
Teamwork in primary palliative care: general practitioners' and specialised oncology nurses' complementary competencies. BMC Health Serv Res 2018. [PMID: 29514681 PMCID: PMC5842567 DOI: 10.1186/s12913-018-2955-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generalists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. There is little research on their contribution. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care. METHODS A qualitative focus group and interview study in rural Northern Norway, involving 52 health professionals. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically. RESULTS The ideal cooperation between GPs and ONs was as a "meeting of experts" with complementary competencies. GPs drew on their generalist backgrounds, including their often long-term relationship with and knowledge of the patient. The ONs contributed longitudinal clinical observations and used their specialised knowledge to make treatment suggestions. While ONs were often experienced and many had developed a form of pattern recognition, they needed GPs' competencies for complex clinical judgements. However, ONs sometimes lacked timely advice from GPs, and could feel left alone with sick patients. To avoid this, some ONs bypassed GPs and contacted palliative specialists directly. While traditional professional hierarchies were not a barrier, we found that organization, funding and remuneration were significant barriers to cooperation. GPs often did not have time to meet with ONs to discuss shared patients. We also found that ONs and GPs had different strategies for learning. While ONs belonged to a networking nursing collective aiming for continuous quality improvement, GPs learned mostly from their individual experience of caring for patients. CONCLUSIONS The complementary competences and autonomous roles of a specialised nurse and a general practitioner represented a good match for primary palliative care. When planning high-quality teamwork in primary care, organizational barriers to cooperation and different cultures for learning need consideration.
Collapse
|
29
|
Wahid AS, Sayma M, Jamshaid S, Kerwat D, Oyewole F, Saleh D, Ahmed A, Cox B, Perry C, Payne S. Barriers and facilitators influencing death at home: A meta-ethnography. Palliat Med 2018; 32:314-328. [PMID: 28604232 DOI: 10.1177/0269216317713427] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In many countries, achieving a home death represents a successful outcome from both a patient welfare and commissioning viewpoint. Significant variation exists in the proportion of home deaths achieved internationally, with many countries unable to meet the wishes of a large number of patients. This review builds on previous literature investigating factors influencing home death, synthesising qualitative research to supplement evidence that quantitative research in this field may have been unable to reach. AIM To identify and understand the barriers and facilitators influencing death at home. DESIGN Meta-ethnography. DATA SOURCES The review adhered to the PRISMA guidelines. A systematic literature search was conducted using five databases: PubMed, EMBASE, Ovid, CINAHL and PsycINFO. Databases were searched from 2006 to 2016. Empirical, UK-based qualitative studies were included for analysis. RESULTS A total of 38 articles were included for analysis. Seven overarching barriers were identified: lack of knowledge, skills and support among informal carers and healthcare professionals; informal carer and family burden; recognising death; inadequacy of processes such as advance care planning and discharge; as well as inherent patient difficulties, either due to the condition or social circumstances. Four overarching facilitators were observed: support for patients and healthcare professionals, skilled staff, coordination and effective communication. CONCLUSION Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.
Collapse
Affiliation(s)
- Abdul Samad Wahid
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Meelad Sayma
- 2 Imperial College Business School, London, UK.,3 Peninsula College of Medicine & Dentistry, Plymouth, UK
| | - Shiraz Jamshaid
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Doa'a Kerwat
- 2 Imperial College Business School, London, UK.,4 Bart's and the London School of Medicine and Dentistry, London, UK
| | - Folashade Oyewole
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Dina Saleh
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Aaniya Ahmed
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Benita Cox
- 2 Imperial College Business School, London, UK
| | | | | |
Collapse
|
30
|
den Herder-van der Eerden M, Hasselaar J, Payne S, Varey S, Schwabe S, Radbruch L, Van Beek K, Menten J, Busa C, Csikos A, Vissers K, Groot M. How continuity of care is experienced within the context of integrated palliative care: A qualitative study with patients and family caregivers in five European countries. Palliat Med 2017; 31:946-955. [PMID: 28659022 DOI: 10.1177/0269216317697898] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with advanced diseases often experience deficient continuity of care. Although integrated palliative care promotes continuity of care, it is not clear how it can be optimized to improve continuity of care experiences. AIM To examine how relational, informational and management continuity of care are experienced by patients with advanced diseases and their family caregivers receiving care from several integrated palliative care initiatives in five European countries. DESIGN We adopted a longitudinal qualitative study design including two interviews (interval 3 months) with patients and family caregivers focusing on how health care professionals responded to their needs. Interviews were audio-recorded and transcribed verbatim. Analysis involved a two-step qualitative content approach. SETTING/PARTICIPANTS A total of 22 integrated palliative care initiatives (established local palliative care collaborations) were selected in Belgium, Germany, Hungary, the Netherlands and the United Kingdom. We recruited 152 patients (63% cancer, 24% chronic obstructive pulmonary disease, 13% heart failure; life expectancy <1 year; mean age 68 years, 56% female) and 92 family caregivers (mean age 61 years, 66% female). RESULTS Trusted relationships with a small number of key health care professionals to receive tailored care and easily access help were essential. Relational continuity was often deficient, especially with general practitioners. Although informational and management continuity was often lacking in care provision, collaborative integrated palliative care initiatives were related to consistent and coherent care. CONCLUSION Patients and family caregivers most likely experience continuity of care by having a small number of trusted health care professionals who are available, provide multidisciplinary care and regularly transfer information to all health care professionals involved. Optimizing continuity of care requires further integration of integrated palliative care initiatives with other health care professionals involved in the patients' care networks.
Collapse
Affiliation(s)
| | - Jeroen Hasselaar
- 1 Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sheila Payne
- 2 Division of Health Research, International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sandra Varey
- 2 Division of Health Research, International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sven Schwabe
- 3 Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Lukas Radbruch
- 3 Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Karen Van Beek
- 4 Department of Radiation Oncology and Palliative Care, University Hospital Leuven, Leuven, Belgium
| | - Johan Menten
- 4 Department of Radiation Oncology and Palliative Care, University Hospital Leuven, Leuven, Belgium
| | - Csilla Busa
- 5 Department of Primary Health Care, Medical School, University of Pecs (UP), Pécs, Hungary
| | - Agnes Csikos
- 5 Department of Primary Health Care, Medical School, University of Pecs (UP), Pécs, Hungary
| | - Kris Vissers
- 1 Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Groot
- 1 Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
31
|
Payne S, Eastham R, Hughes S, Varey S, Hasselaar J, Preston N. Enhancing integrated palliative care: what models are appropriate? A cross-case analysis. BMC Palliat Care 2017; 16:64. [PMID: 29179710 PMCID: PMC5704425 DOI: 10.1186/s12904-017-0250-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background Effective integration between hospices, palliative care services and other local health care services to support patients with palliative care needs is an important international priority. A previous model suggests that integration involves a cumulative stepped process of engagement with other organisations labelled as ‘support, supplant or supplement’, but the extent to which this model currently applies in the United Kingdom is unknown. We aimed to investigate accounts of hospice integration with local health care providers, using the framework provided by the model, to determine how service users and healthcare professionals perceived palliative care services and the extent of integration experienced. Methods Longitudinal organisational case study methods were employed using qualitative serial interviews (interval 3 months) with patients and family carers focusing on how services responded to their needs; and group interviews with health professionals. Data were audio-recorded, transcribed verbatim, and analysed by qualitative content analysis and combined across data sources. Results The study focused on four hospices in northern England, including 34 patients (diagnosis: 17 cancer, 10 COPD, 7 heart failure), 65% female, mean age 66 (range 44–89), 13 family carers of these patients (48% partners), and 23 health care professionals. While some care fell short of expectations, all patients reported high levels of satisfaction and valued continuity of care and efficient information sharing. All hospices supported and supplemented local providers, with three hospices also supplanting local provision by providing in-patient facilities. Conclusion UK hospices predominantly operate in ways that support and supplement other providers. In addition, some also supplant local services, taking over direct responsibility and funding in-patient care. They all contributed to integration with local services, with greater blurring of boundaries than defined by the original model. Integrated care offers the necessary flexibility to respond to changes in patient needs, however, constraints from funding drivers and a lack of clear responsibilities in the UK can result in shortfalls in optimal service delivery. Integrating hospice care with local healthcare services can help to address demographic changes, predominantly more frail older people, and disease factors, including the needs of those with non-malignant conditions. This model, tested in the UK, could serve as an example for other countries.
Collapse
Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Rachael Eastham
- Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
| | - Sean Hughes
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
| | - Sandra Varey
- Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
| |
Collapse
|
32
|
Sun Z, Laporte A, Guerriere DN, Coyte PC. Utilisation of home-based physician, nurse and personal support worker services within a palliative care programme in Ontario, Canada: trends over 2005-2015. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1127-1138. [PMID: 28024313 DOI: 10.1111/hsc.12413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 06/06/2023]
Abstract
With health system restructuring in Canada and a general preference by care recipients and their families to receive palliative care at home, attention to home-based palliative care continues to increase. A multidisciplinary team of health professionals is the most common delivery model for home-based palliative care in Canada. However, little is known about the changing temporal trends in the propensity and intensity of home-based palliative care. The purpose of this study was to assess the propensity to use home-based palliative care services, and once used, the intensity of that use for three main service categories: physician visits, nurse visits and care by personal support workers (PSWs) over the last decade. Three prospective cohort data sets were used to track changes in service use over the period 2005 to 2015. Service use for each category was assessed using a two-part model, and a Heckit regression was performed to assess the presence of selectivity bias. Service propensity was modelled using multivariate logistic regression analysis and service intensity was modelled using log-transformed ordinary least squares regression analysis. Both the propensity and intensity to use home-based physician visits and PSWs increased over the last decade, while service propensity and the intensity of nurse visits decreased. Meanwhile, there was a general tendency for service propensity and intensity to increase as the end of life approached. These findings demonstrate temporal changes towards increased use of home-based palliative care, and a shift to substitute care away from nursing to less expensive forms of care, specifically PSWs. These findings may provide a general idea of the types of services that are used more intensely and require more resources from multidisciplinary teams, as increased use of home-based palliative care has placed dramatic pressures on the budgets of local home and community care organisations.
Collapse
Affiliation(s)
- Zhuolu Sun
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
| | - Denise N Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
| |
Collapse
|
33
|
Götze H, Brähler E, Gansera L, Schnabel A, Gottschalk-Fleischer A, Köhler N. Anxiety, depression and quality of life in family caregivers of palliative cancer patients during home care and after the patient's death. Eur J Cancer Care (Engl) 2016; 27:e12606. [PMID: 27859889 DOI: 10.1111/ecc.12606] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/27/2022]
Abstract
We examined psychological parameters in family caregivers of palliative cancer patients before and after the death of the patients. Caregivers' data about depression and anxiety (Hospital Anxiety and Depression Scale), quality-of-life (Short Form-8 Health Survey), and social support (Oslo Social Support Scale) were collected at the beginning of home care (t1) and 2 months after the patient had died (t2). Regression models were employed to examine factors related to depression and anxiety in the bereaved caregivers. We interviewed 72 relatives, who were the primary caregiver of a patient. One-third (31.9%) of caregivers had high anxiety levels and 29.2% had high depression levels (t1, cut-off = 10). At t2, anxiety and depression had decreased significantly. There were no changes in quality-of-life over time. At both points of assessments, quality-of-life was lower than in the general population. Relevant factors for higher anxiety and depression in the bereaved caregivers were high levels of distress at t1, insufficient social support and low physical function. Bereaved caregivers were particularly depressed when they had been the spouse of the patient. Healthcare professionals should consider social isolation of caring relatives both during homecare and afterwards. Thus, it seems to be important to routinely offer support to spouses.
Collapse
Affiliation(s)
- H Götze
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - E Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Germany
| | - L Gansera
- Department of Psychiatry, Psychosomatics and Psychotherapy, HELIOS Park-Klinikum Leipzig, Leipzig, Germany
| | - A Schnabel
- Leipziger Palliativgesellschaft, Palliative Care Service (SAPV), Leipzig, Germany
| | - A Gottschalk-Fleischer
- Department of Internal Medicine, Muldentalkliniken, Medical Hospital Wurzen, Wurzen, Germany
| | - N Köhler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| |
Collapse
|
34
|
Turner M, King C, Milligan C, Thomas C, Brearley SG, Seamark D, Wang X, Blake S, Payne S. Caring for a dying spouse at the end of life: 'It's one of the things you volunteer for when you get married': a qualitative study of the oldest carers' experiences. Age Ageing 2016; 45:421-6. [PMID: 27055880 DOI: 10.1093/ageing/afw047] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 02/03/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND older people aged 80 and over are increasingly providing end-of-life care to spouses at home and often do so for long periods of time, while also trying to manage their own illnesses and disabilities. Little of the research on older spousal carers has focussed on the oldest carers; hence, the needs of this particular population are not fully known. OBJECTIVE to explore the experiences of the 'oldest carers' in caring for a dying spouse at home. METHODS secondary analysis was undertaken on a subset of data from a larger qualitative interview study; this dataset comprised 17 interviews from participants aged 80 or over. Framework analysis methods were used, with items derived from the thematic analysis of the main study. RESULTS the oldest carers in this subset demonstrated high levels of resilience and the ability to adapt to their caring role. Caring until death was accepted as an integral part of the commitment made to their partner as part of the 'wedding contract'. Carers felt they benefitted from the support provided by family, friends and care services; however, their own care needs were not always recognised by health and social care services. CONCLUSIONS these findings underscore the complexity of the oldest carers' experiences and challenges in times of illness and end of life. Healthcare professionals should be alerted to the myriad ways caregiving is enacted in serious illness and seek opportunities for developing supportive interventions specifically for older carers.
Collapse
Affiliation(s)
- Mary Turner
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College Lancaster University, Lancaster LA1 4YG, UK
| | - Claire King
- Health and Care Directorate, Cumbria County Council, Carlisle, UK
| | - Christine Milligan
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College Lancaster University, Lancaster LA1 4YG, UK
| | - Carol Thomas
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College Lancaster University, Lancaster LA1 4YG, UK
| | - Sarah G Brearley
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College Lancaster University, Lancaster LA1 4YG, UK
| | | | - Xu Wang
- School of Social, Psychological and Communication Sciences, Leeds Metropolitan University, Leeds, UK
| | | | - Sheila Payne
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College Lancaster University, Lancaster LA1 4YG, UK
| |
Collapse
|
35
|
Abstract
BACKGROUND The policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating that the general public and people with a terminal illness would prefer to receive end-of-life care at home. This is the fourth update of the original review. OBJECTIVES To determine if providing home-based end-of-life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs, and caregivers, compared with inpatient hospital or hospice care. SEARCH METHODS We searched the following databases until April 2015: Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), Ovid MEDLINE(R) (from 1950), EMBASE (from 1980), CINAHL (from 1982), and EconLit (from 1969). We checked the reference lists of potentially relevant articles identified and handsearched palliative care publications, clinical trials registries, and a database of systematic reviews for related trials (PDQ-Evidence 2015). SELECTION CRITERIA Randomised controlled trials, interrupted time series, or controlled before and after studies evaluating the effectiveness of home-based end-of-life care with inpatient hospital or hospice care for people aged 18 years and older. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible, we reported the results from individual studies. MAIN RESULTS We included four trials in this review and did not identify new studies from the search in April 2015. Home-based end-of-life care increased the likelihood of dying at home compared with usual care (risk ratio (RR) 1.33, 95% confidence interval (CI) 1.14 to 1.55, P = 0.0002; Chi(2) = 1.72, df = 2, P = 0.42, I(2) = 0%; 3 trials; N = 652; high quality evidence). Admission to hospital while receiving home-based end-of-life care varied between trials, and this was reflected by a high level of statistical heterogeneity in this analysis (range RR 0.62 to RR 2.61; 4 trials; N = 823; moderate quality evidence). Home-based end-of-life care may slightly improve patient satisfaction at one-month follow-up and reduce it at six-month follow-up (2 trials; low quality evidence). The effect on caregivers is uncertain (2 trials; low quality evidence). The intervention may slightly reduce healthcare costs (2 trials, low quality evidence). No trial reported costs to patients and caregivers. AUTHORS' CONCLUSIONS The evidence included in this review supports the use of home-based end-of-life care programmes for increasing the number of people who will die at home, although the numbers of people admitted to hospital while receiving end-of-life care should be monitored. Future research should systematically assess the impact of home-based end-of-life care on caregivers.
Collapse
Affiliation(s)
- Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordOxfordshireUKOX3 7LF
| | - Daniela C. Gonçalves‐Bradley
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordOxfordshireUKOX3 7LF
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of TorontoKnowledge Translation Program30 Bond StreetTorontoONCanadaM5B 1W8
| | - Bee Wee
- Churchill HospitalNuffield Department of Medicine and Sir Michael Sobell HouseOld RoadHeadingtonOxfordUKOX3 7LJ
| | | |
Collapse
|