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Stiel S, Ernst A, Röwer HAA, de Jong L, Burger B, Schneider N, Damm K, Stahmeyer JT, Apolinarski B, Herbst FA. [Empirically derived recommendations for the development and expansion of day hospices in Germany - Results of a Delphi expert panel]. Z Evid Fortbild Qual Gesundhwes 2024; 185:72-82. [PMID: 38431457 DOI: 10.1016/j.zefq.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION A needs-based and patient-oriented hospice and palliative care also includes day hospices as a specialised semi-inpatient care offer. The establishment and development of these facilities in Germany has been rather unsystematic. In order to ensure quality and adequacy of these structures, research is needed. METHODS A Delphi consensus study was conducted online from November 2022 to February 2023 aiming at generating recommendations for the development and expansion of day hospices in Germany. For each recommendation, the participants indicated on a four-point verbal rating scale how much they agreed upon a) the relevance and b) the feasibility of the recommendation. Items were considered consented when 80% of the participants (strongly) agreed with the recommendation regarding both criteria. If no consensus was reached, the recommendations were revised according to the participants' free text comments and presented in the next Delphi round. Descriptive analyses were applied. RESULTS A total of 64 experts participated in the first Delphi round and 44 in the second. In round 1, 34 recommendations and in round 2 six recommendations were consented. The final set contains a total of 40 recommendations: 18 on the tasks of day hospices, 13 on cooperation, 7 on funding, and 2 on public relations. DISCUSSION Recommendations for the development and expansion of day hospices in Germany were developed. Due to their highly rated feasibility, the recommendations should be directly transferable into care practice. It remains to be seen to what extent they will be taken into account in the renegotiation of the framework agreement for day hospices. CONCLUSION The Delphi-consented recommendations provide a basis to guide action in the currently very dynamic development of hospice work and palliative care in Germany.
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Affiliation(s)
- Stephanie Stiel
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | - Alexandra Ernst
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Hanna A A Röwer
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Lea de Jong
- Institut für Versicherungsbetriebslehre, Leibniz Universität Hannover, Hannover, Deutschland
| | - Birte Burger
- Stabsbereich Versorgungsforschung, AOK - Die Gesundheitskasse für Niedersachsen, Hannover, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Kathrin Damm
- Institut für Versicherungsbetriebslehre, Leibniz Universität Hannover, Hannover, Deutschland
| | - Jona T Stahmeyer
- Stabsbereich Versorgungsforschung, AOK - Die Gesundheitskasse für Niedersachsen, Hannover, Deutschland
| | - Beate Apolinarski
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Franziska A Herbst
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
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Müller E, Vogel L, Nury E, Seibel K, Becker G. Perspectives of nursing home executives on collaboration with GPs and specialist palliative care teams. Pflege 2024; 37:19-26. [PMID: 37537993 DOI: 10.1024/1012-5302/a000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Background: Nursing home (NH) staff, general practitioners (GPs) and specialist outpatient palliative care teams are expected to cooperate to ensure adequate palliative care for NH residents in Germany. Aim: The aim of this study was to investigate the perspective of NH executives concerning collaboration with GPs and specialist outpatient palliative care teams. Methods: We conducted semi-structured telephone interviews with executives of NHs in the federal state of Baden-Wuerttemberg, Germany. Interviews were analysed by means of structured content analyses. Results: Executives of 20 NHs participated in the study, eight NHs cooperate with specialist outpatient palliative care teams. Content analysis resulted in two main categories: 'general palliative care by primary carers' and 'collaboration with SAPV in NHs', each with three first-order subcategories. The main barriers to adequate palliative care were reported to be lack of palliative care knowledge in GPs and NH staff, refusal of some GPs to cooperate with specialist outpatient palliative care teams and staff shortage in NHs. Specialist palliative care involvement was described to result in improved palliative care. Conclusion: Solutions seem obvious, e.g., further education in palliative care or round tables to discuss collaboration. However, studies show that even comprehensive educational and management interventions to implement palliative care do not always result in long-term effects and further research is needed.
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Affiliation(s)
- Evelyn Müller
- Department of Palliative Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Lena Vogel
- Haus Katharina Egg, nursing home, Heiliggeistspitalstiftung Freiburg, Stiftungsverwaltung Freiburg, Germany
| | - Edris Nury
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Katharina Seibel
- Department of Palliative Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Gerhild Becker
- Department of Palliative Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Schwabe S, Röwer H, Kamandi N, Doctor E, Buck C, Schneider N. [Identification of regional hospice and palliative care networks in Germany - Results of a multi-method survey]. Z Evid Fortbild Qual Gesundhwes 2023; 182-183:79-88. [PMID: 37957058 DOI: 10.1016/j.zefq.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION In the course of the implementation of the German Healthcare Development Act [Gesundheitsversorgungsweiterentwicklungsgesetz] of 2021, a funding structure according to sect. 39d of the Social Code Book V [SGB V] was established to promote regional hospice and palliative care networks (RHPN). The funded networks are expected to support the multiprofessional cooperation of hospice and palliative care providers at the structural level. It is still unclear how many existing and newly established network structures are eligible for funding according to sect. 39d SGB V and where these network structures are located regionally. The proportion of actually funded networks is also unknown. METHODS Between January and March 2023, network structures of hospice and palliative care were identified in a tripartite, multi-method survey procedure, consisting of a) research of databases, literature, and internet; b) open quantitative online-survey via SoSciSurvey software, and c) telephone survey of federal offices of health insurers. The data were first documented separately. Then, the research and survey data were combined and analysed via descriptive statistics using SPSS. RESULTS Based on the aggregated data from the literature-, database- and internet research and the online survey, n=308 network structures of hospice and palliative care could be identified, of which n=37 have applied for network funding according to sect. 39d SGB V. In the survey period, n=47 applications for network funding according to sect. 39d SGB V were submitted to the health insurance funds. There is a high density of network structures in the northern, southern and western federal states, while there are only a few networks in the eastern states. According to the online-survey, 56% (n=136) of all the identified network structures with known sponsorship are organised by providers of specialised outpatient palliative care. 47% (n=29) of the networks with funding interest are organised as independent structures. Of the network structures with known funding status, 18% (n=26) plan to apply for funding according to sect. 39d SGB V in 2024 for the first time. DISCUSSION There are numerous network structures in hospice and palliative care, but they are differently distributed among the German federal states. The multi-method survey was able to provide a first nation-wide inventory of network structures as well as an assessment of networks with funding interest according to sect. 39 SGB V. A clear distinction between general network structures and structural networks according to sect. 39d SGB V is a challenge. In the next years the number of funding applications is expected to rise. CONCLUSION The identification of existing and funded network structures of hospice and palliative care in Germany can be a starting point for a deeper analysis of the structure and the activities of the networks. A quality assessment tool that takes into account both the heterogeneity of the networks and the different dimensions of networking would be helpful.
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Affiliation(s)
- Sven Schwabe
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | - Hanna Röwer
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Nilab Kamandi
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Eileen Doctor
- Forschungsinstitut für Informationsmanagement, Institutsteil Wirtschaftsinformatik des Fraunhofer FIT, Universität Bayreuth, Bayreuth, Deutschland
| | - Christoph Buck
- Forschungsinstitut für Informationsmanagement, Institutsteil Wirtschaftsinformatik des Fraunhofer FIT, Fakultät für Informatik, Technische Hochschule Augsburg, Augsburg, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
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Bußmann A, Pomorin N. [Implications for improving health care quality and patient safety of palliative residents in nursing homes: A qualitative study]. Z Evid Fortbild Qual Gesundhwes 2023; 181:1-9. [PMID: 37438168 DOI: 10.1016/j.zefq.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 12/21/2022] [Accepted: 04/18/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Despite the increasing importance of palliative care, the implementation of professional and ethical quality standards appears to be challenging for nursing homes, leading to different levels of palliative care between facilities. This study aims to examine the concrete problem areas of palliative care in everyday practice and to discover what is needed to improve health care quality and patient safety of palliative residents in nursing homes from different perspectives. METHODS Semi-structured interviews with 14 employees and managers of two nursing homes in urban and rural areas in North Rhine-Westphalia were conducted and analyzed according to Mayring's qualitative content analysis. Additionally, characteristics of ideal-typical palliative care in nursing homes were identified from different perspectives through interdisciplinary focus groups of various involved professions. RESULTS Due to a lack of structural and organizational guidelines, processes of palliative care are based on subjective actions of the staff, which leads to uncertainties and differences in the management of palliative care for nursing home residents. Besides limited time resources for care and support of residents at their end of life, this represents a major stress factor for employees. In the focus groups, characteristics of ideal-typical palliative care in the everyday practice of palliative care were identified. In terms of potential for optimization, palliative care pathways are seen as one way to contribute to creating a framework for palliative processes which at the same time leaves room for professional decisions in individual cases. DISCUSSION It seems likely that inconsistencies in the management of palliative care processes can also be found in other nursing homes. Indications of this include the low proportion of residents with identified palliative care needs and the lack of use of assessments to identify palliative needs and to monitor typical palliative symptoms. At the same time, it must be taken into account that the last phase of life is characterised by individuality, which cannot and should not be standardised. In palliative care practice, professional perceptions and empirical knowledge are well needed. Nevertheless, in terms of quality of care, these should not be the sole basis for palliative action. CONCLUSION Different levels of palliative care and employees' uncertainties indicate that palliative care practice in nursing homes requires a framework that helps staff to act more confidently and yet leaves room for professional action and decision-making in individual cases.
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Affiliation(s)
- Anna Bußmann
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Deutschland.
| | - Natalie Pomorin
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Deutschland; FOM Hochschule für Oekonomie & Management gemeinnützige Gesellschaft mbH, Düsseldorf, Deutschland
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Martina D, Witjaksono MA, Putranto R. Advance Care Planning in Indonesia: Current state and future prospects. Z Evid Fortbild Qual Gesundhwes 2023; 180:94-98. [PMID: 37394335 DOI: 10.1016/j.zefq.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 07/04/2023]
Abstract
Indonesia is a low-middle income country in Southeast Asia, as well as the world's fourth most populous and largest archipelagic nation. Indonesia has approximately 1,300 ethnic groups that speak 800 different languages and are typically collectivist and religiously devout. With an aging population and an increasing number of cancer patients, palliative care in the country remains scarcely available, disproportionally distributed, and underfunded. All of these factors (economic level, geographical and cultural landscapes, and palliative care level of development) pose a considerable impact on the adoption of advance care planning in Indonesia. Nonetheless, recent advocacy initiatives promise some hopes in advance care planning in Indonesia. Furthermore, local studies suggested opportunities to implement advance care planning, particularly through capacity building and a culturally sensitive approach to it. This article describes the present situation of advance care planning in Indonesia, including its challenges and opportunities.
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Affiliation(s)
- Diah Martina
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | | | - Rudi Putranto
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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van der Steen JT, Engels Y, Touwen DP, Kars MC, Reyners AKL, van der Linden YM, Korfage IJ. Advance Care Planning in the Netherlands. Z Evid Fortbild Qual Gesundhwes 2023; 180:133-138. [PMID: 37482528 DOI: 10.1016/j.zefq.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/25/2023]
Abstract
The Dutch health care system fosters a strong public health sector offering accessible generalist care including generalist palliative care. General practitioners are well positioned to conduct ACP, for example, to continue or initiate conversations after hospitalization. However, research shows that ACP conversations are often ad hoc and in frail patients, ACP is often only initiated when admitted to a nursing home by elderly care physicians who are on the staff. Tools that raise awareness of triggers to initiate ACP, screening tools, information brochures, checklists and training have been developed and implemented with funding by national programs which currently focus on implementation projects rather than or in addition to, research. The programs commonly require educational deliverables, patient and public involvement and addressing diversity in patient groups. A major challenge is how to implement ACP systematically and continuously across sectors and disciplines in a way that supports a proactive yet person-centered approach rather than an approach with an exclusive focus on medical procedures. Digital solutions can support continuity of care and communication about care plans. Solutions should fit a culture that prefers trust-based, informal deliberative approaches. This may be supported by involving disciplines other than medicine, such as nursing and spiritual caregiving, and public health approaches.
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Affiliation(s)
- Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Primary and Community Care and Radboudumc Alzheimer center, Radboud university medical center, Nijmegen, the Netherlands.
| | - Yvonne Engels
- Department of anesthesiology, pain and palliative medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Dorothea P Touwen
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, the Netherlands
| | - Marijke C Kars
- Center of Expertise of Palliative Care, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anna K L Reyners
- Center of Expertise of Palliative Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yvette M van der Linden
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, the Netherlands/Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Toczek-Wasiak A, Kubiak R, Dzierżanowski T. Practices to overcome the inexistence of Advance Care Planning in Poland. Z Evid Fortbild Qual Gesundhwes 2023; 180:139-142. [PMID: 37482529 DOI: 10.1016/j.zefq.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/25/2023] [Indexed: 07/25/2023]
Abstract
Although the first Advance Care Planning (ACP) models were developed decades ago, Poland is still a country where ACP has not yet been implemented, despite its apparent benefits for both patients and the health care system. This article presents the legal and cultural context, main impediments, and opportunities for implementing ACP in Poland. Legal regulations are mandatory to ensure respect for the patient's will. Raising public awareness seems to be a cornerstone of the shift of paradigm. We strongly believe that the support of experienced countries is indispensable.
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Affiliation(s)
| | - Rafał Kubiak
- Katedra Prawa Karnego, Uniwersytet Łódzki, Poland
| | - Tomasz Dzierżanowski
- Laboratory of Palliative Medicine, Department of Social Medicine and Public Health, Medical University of Warsaw, Poland.
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Tripodoro VA, Di Gennaro S, Fila J, Veloso VI, Quiroga C, Varela C, Francia L. How should Argentina raise Advance Care Planning awareness? Introduction of the Shared Care Planning Group. Z Evid Fortbild Qual Gesundhwes 2023; 180:50-55. [PMID: 37380547 DOI: 10.1016/j.zefq.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/30/2023]
Abstract
The WHO Concept Model of Palliative Care emphasises empowering people and communities with Advance Care Planning (ACP). In Latin America, a more relational approach involving family members is suited to ACP. Improvements in doctor-patient-family relationships are needed. Policy efforts have been made to foster ACP in Argentina's healthcare system, but implementation barriers include a need for more communication skills and coordination between healthcare providers. The Shared Care Planning Group Argentina aims to promote ACP through research and training programs. It has sensitised and trained 236 healthcare providers in short courses to introduce basic information and skills. However, there needs to be specific documentation for ACP in Argentina. Research found obstacles to ACP implementation, such as the inability to converse with patients and the lack of coordination between healthcare teams. A new project will assess the self-efficacy of healthcare professionals who assist patients with Sclerosis Lateral Amyotrophic in ACP and evaluate a specific training program. Patient and public involvement in ACP remains limited in Argentina, with paternalistic medical culture and a need for more awareness and training among healthcare professionals as significant barriers. Collaborative research projects with Spain and Ecuador aim to train healthcare professionals and evaluate ACP implementation in other Latin American countries.
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Affiliation(s)
- Vilma A Tripodoro
- SCP-Group Argentina, Instituto Pallium Latinoamérica, Buenos Aires City, Argentina; Instituto de Investigaciones Médicas A. Lanari, Universidad de Buenos Aires. Argentina; Atlantes Global Observatory of Palliative Care, University of Navarra, Spain.
| | - Stella Di Gennaro
- SCP-Group Argentina, Instituto Pallium Latinoamérica, Buenos Aires City, Argentina; Clínica Universitaria Reina Fabiola, Córdoba City, Argentina
| | - Julia Fila
- SCP-Group Argentina, Instituto Pallium Latinoamérica, Buenos Aires City, Argentina; National University of La Plata, Buenos Aires, Argentina
| | - Verónica I Veloso
- SCP-Group Argentina, Instituto Pallium Latinoamérica, Buenos Aires City, Argentina; Instituto de Investigaciones Médicas A. Lanari, Universidad de Buenos Aires. Argentina
| | - Celeste Quiroga
- SCP-Group Argentina, Instituto Pallium Latinoamérica, Buenos Aires City, Argentina; Hospital Argerich, Buenos Aires City, Argentina
| | - Constanza Varela
- SCP-Group Argentina, Instituto Pallium Latinoamérica, Buenos Aires City, Argentina; Hospital Argerich, Buenos Aires City, Argentina
| | - Lucrecia Francia
- SCP-Group Argentina, Instituto Pallium Latinoamérica, Buenos Aires City, Argentina; Hospital José María Cullen Santa Fe, Argentina
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Alparaque-Corvera R, Aguirre-Pedro D, Phillip E Francisco E, Ang AE. Advance Care Planning in the Philippines: A continuing narrative of advocacy. Z Evid Fortbild Qual Gesundhwes 2023; 180:74-77. [PMID: 37517968 DOI: 10.1016/j.zefq.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 08/01/2023]
Abstract
This article discusses the current state of Advance Care Planning (ACP) in the Philippines, where the health system operates within a fragmented environment, with mixed private and public provisions. Despite some attempts to introduce legislation to foster ACP implementation, patient autonomy remains subordinate to family values and physician authority within the Southeast Asian culture. The article also highlights how the COVID-19 pandemic has challenged the norms of the global healthcare force and pushed Palliative Medicine specialists to take on stronger roles in the battle lines against health-related suffering. The Palliative Care Consultants, advocates along with Philippine Society of Hospice and Palliative Medicine (PSHPM) and Hospice Philippines Inc. have been playing a significant role in promoting and supporting ACP through education and training, advocacy, research and development, networking and collaboration.
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Affiliation(s)
| | | | | | - Andrew E Ang
- Department of Family and Community Medicine, Philippine General Hospital, Manila, Metro Manila, Philippines
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van Baal K, Frerichs H, Stahmeyer JT, Hemmerling M, Schulze C, Schneider N, Stiel S. [Advancement of an intermediate level of outpatient palliative care - A Delphi study]. Z Evid Fortbild Qual Gesundhwes 2023:S1865-9217(23)00055-7. [PMID: 37173274 DOI: 10.1016/j.zefq.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/10/2023] [Accepted: 03/22/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION In the course of the further development of palliative care in Germany, an agreement on an intermediate level of outpatient palliative care, the so-called BQKPMV (specially qualified and coordinated palliative homecare) was realised in 2017. Family physicians play a central role in the BQKPMV; among other things, they are responsible for the coordination of care. There are indications that barriers exist in the practical implementation of the BQKPMV and that an adjustment may be necessary. This work is part of the Polite project (analysis of the implementation of an intermediate level of outpatient palliative care in the reality of care and recommendations for further development) and aims at building consensus on recommendations for the further development of the BQKPMV. METHODS Between June and October 2022, an online Delphi survey was conducted among experts for outpatient palliative care from all over Germany (providers, professional associations, funders, science, self-government). The content of the recommendations, which were voted on as part of the Delphi survey, was based on the results of both the first project phase and an expert workshop. Participants rated the extent to which they agree with a) the clarity of the wording, and b) the relevance for the further development of the BQKPMV on a four-point Likert scale. Consensus was assumed when 75% of participants (rather) agreed to a recommendation with regard to both criteria. If no consensus was reached, the recommendations were adjusted using the free text comments and presented again in the next round. Descriptive analyses were applied. RESULTS Forty-five experts participated in the first Delphi round, 31 in the second, and 30 in the third round (43% female, average age 55). Consensus was obtained for seven recommendations in round 1, for six in round 2 and for three in round 3. These final 16 recommendations relate to four topics: awareness and implementation of the BQKPMV (6 recommendations), framework conditions of the BQKPMV (3), discrimination of forms of care (5), and cooperation at the interfaces of care (2). DISCUSSION The Delphi method was used to identify concrete recommendations for the further development of the BQKPMV that are relevant to health care practice. In the final set of recommendations, a particular focus lies on increasing awareness and communicating information about the scope of the health care service, added value and framework conditions of the BQKPMV. CONCLUSION The results provide an empirically sound basis for the further development of the BQKPMV. They show a concrete need for change and highlight that an optimisation of the BQKPMV is necessary.
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Affiliation(s)
- Katharina van Baal
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | - Hannah Frerichs
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Jona Theodor Stahmeyer
- Stabsbereich Versorgungsforschung, AOK - Die Gesundheitskasse für Niedersachsen, Hannover, Deutschland
| | - Melissa Hemmerling
- Stabsbereich Versorgungsforschung, AOK - Die Gesundheitskasse für Niedersachsen, Hannover, Deutschland
| | - Cora Schulze
- Fachverband spezialisierte ambulante Palliativversorgung Niedersachsen e.V., Papenburg, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stephanie Stiel
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
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Pape AE, Gschnell M, Maul J, Volberg C. [Physical therapy and occupational therapy in German palliative care: Where do we stand?]. Z Evid Fortbild Qual Gesundhwes 2022; 175:59-66. [PMID: 36402688 DOI: 10.1016/j.zefq.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Physical therapy (PT) and occupational therapy (OT) as supportive forms of treatment in palliative care, together with other treatment measures, can create participation for seriously ill patients in the form of a life that is as autonomous as possible until the end of life. However, specially trained staff are needed for the care of palliative patients in order to do justice to the clients' special life situation. In Germany, no corresponding survey on the subject has so far been conducted. So it is unclear to what extent PT and OT are offered in palliative care structures in this country, which tasks are assigned to the respective professional groups, and what the level of knowledge is that caregivers have about treatment options. AIM Compilation of an overview of the provision, need and use of PT and OT in the various areas of palliative care in Germany. If there is a lack of provision, the reasons for this will be identified. METHODS In this cross-sectional survey, a self-designed 9-item questionnaire was sent out to a total of 260 hospices, 323 palliative care units and 304 specialized outpatient palliative care services (SOPC) listed on the homepage of the German Society for Palliative Medicine (DGP). The respondents' answers were analysed using a purely descriptive approach. RESULTS The response rate was 439 (49.5%). A total of 434 questionnaires (49%) were included in the analysis. A heterogeneous distribution of PT and OT offers between outpatient, inpatient, and hospice palliative care can be seen, with the outpatient area showing a significantly fewer offerings. 29% of the SOPC teams can offer neither PT nor OT. This is mostly due to a shortage of skilled workers or a lack of funding opportunities. The different areas of responsibility of physiotherapists and occupational therapists are known to the majority of respondents (hospice 87%, palliative care unit 83%, SOPC 81%) and are also reflected in the distribution of tasks between the two professional groups. Especially palliative care units and SOPC teams state that they would like to offer more PT and OT (palliative care units 42% more PT and 58% more OT; SOPC 65% more PT and 50% more OT). DISCUSSION This cross-sectional survey is the first of its kind to provide an overview of the PT and OT offerings in the different sectors of German palliative care. In a comparison of the two forms of therapy, occupational therapists are used less frequently than physiotherapists. An international comparison of the study situation also shows that the use of OT in palliative care, in particular, has not yet been implemented satisfactorily. Outside Germany, the main reasons for this are a shortage of specialists and a lack of knowledge about the tasks of OT. CONCLUSION PT and OT are frequently used treatment options in all areas of German palliative care. In order to better classify structural problems in care, further differentiated surveys should be conducted. Furthermore, a better knowledge base should be created through research and information activities of both professional groups in palliative care.
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Affiliation(s)
- Anna Elisabeth Pape
- Klinik für Geriatrie, Physikalische Medizin und Rehabilitation, Klinikum Bremen-Ost, Bremen, Deutschland
| | - Martin Gschnell
- Klinik für Dermatologie und Allergologie, Hauttumorzentrum, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Julian Maul
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Christian Volberg
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland; AG Ethik in der Medizin, Fachbereich 20, Dekanat Humanmedizin, Philipps-Universität Marburg, Marburg, Deutschland.
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12
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van Baal K, Ülgüt R, Schulze C, Schneider N, Stiel S. [Implementing an intermediate level of outpatient palliative care in Germany: Experiences and views of specialised outpatient palliative care teams]. Z Evid Fortbild Qual Gesundhwes 2022; 173:64-74. [PMID: 35750609 DOI: 10.1016/j.zefq.2022.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In the course of the implementation of the German Hospice and Palliative Care Act of 2015, an agreement was reached to establish an intermediate level of outpatient palliative care (BQKPMV) in Germany. By its degree of specialization, this form of care is located between generalist and specialist outpatient palliative care (AAPV/SAPV). It is still unclear which experiences the SAPV teams have gained with the approach of BQKPMV and how it affects their care routines. METHODS Between May and August 2021, the project team developed and tested a questionnaire for SAPV teams about their experiences with and views on BQKPMV as a care approach at the interface to SAPV. In September 2021, all 58 teams providing SAPV in Lower Saxony were invited to participate. The information provided by the participants was analyzed using descriptive statistics and frequency analyses. RESULTS With 52 participants (78% female; mean age of 50 years), a participation rate of 89.7 % was achieved. Twenty-eight participants indicated that they were aware of BQKPMV and its content, and 10 had received a request for cooperation under the BQKPMV program. Fifty percent of these 10 requests (n = 5) led to a cooperation agreement. The following questions were answered only by participants who were familiar with the content of BQKPMV (N = 28). For a majority of 15 participants, the BQKPMV has (rather) no part in day-to-day care in SAPV. From the participants' point of view, BQKPMV largely fails to supplement the existing regulations of SAPV in a meaningful way (n = 14 is not [likely] true), to promote smooth transition between the forms of outpatient palliative care (n = 13 is not [likely] true) and to facilitate communication among the professionals involved (n = 13 is not [likely] true). DISCUSSION These results show that the participating SAPV teams know little about BQKPMV and that there has been little cooperation at the interface between SAPV and BQKPMV. In day-to-day care, there is a clear separation between SAPV and BQKPMV provided by general practitioners, which corresponds with the proposition of the legislator by excluding simultaneous provision of both forms of care. The close cooperation between general practitioners and SAPV teams, which is also required under the agreement regarding BQKPMV, leads to challenges in day-to-day care. CONCLUSION It remains unclear whether and to what extent the close cooperation envisaged in the framework of BQKPMV can be put into practice at the interface between general practitioners and SAPV teams in their daily routines. Practical recommendations for advancing BQKPMV are needed, which, for example, address the exclusion of the simultaneous provision of both forms of care. Further developments of BQKPMV should aim at establishing a framework in which the tasks and duties of health care provision are distributed and remunerated in accordance with the competencies and resources of health care providers.
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Affiliation(s)
- Katharina van Baal
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | - Rojda Ülgüt
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Cora Schulze
- Fachverband spezialisierte ambulante Palliativversorgung Niedersachsen e.V, Papenburg, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stephanie Stiel
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
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Ploeger C, Schütze D, Seipp H, Kuss K, Hach M, Gerlach FM, Erler A, Engler J. [Similarities and differences in specialized outpatient palliative care for adults, children and adolescents: results from focus group discussions with health care professionals]. Z Evid Fortbild Qual Gesundhwes 2022; 172:54-60. [PMID: 35717310 DOI: 10.1016/j.zefq.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/22/2022] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In Germany, people with life-limiting conditions and complex symptoms are eligible for specialized outpatient palliative care (SOPC). Requirements, delivery and goals of SOPC have been laid down by the Federal Joint Committee in a nationwide guideline. The guideline emphasizes the need to consider the special needs of children and adolescents with life-limiting conditions. A specification of these needs has so far been missing. The focus group discussion presented here aimed at investigating similarities and differences between the specialized outpatient palliative care of adults (SOPC for adults) on the one hand, and children and adolescents (SOPPC) on the other hand, from the perspective of health care professionals in order to further define specifics of SOPPC. METHOD In three focus group discussions a total of 11 nursing and 8 medical professionals from SOPC for adults and SOPPC engaged in face-to-face discussions on the similarities and differences of both care forms. Discussions were designed openly and stimulated with three guiding questions only. Focus group discussions were audio-recorded, transcribed verbatim and analyzed by thematic analysis supported by the software MAXQDA. RESULTS Within the following six themes, similarities as well as key differences between SOPC and SOPPC were identified: the participants discussed diseases, coverage area and locations, therapy goals, the psychosocial care situation, the role of relatives and end-of-life care. From the participants' perspective different underlying diseases constitute a main difference that causes further differences in the expertise required. Furthermore, SOPC for adults and SOPPC differ in the dimension of areas covered by one team, the number of patients per team and the reasons for SOPC visits. Differences in terminal care and the mourning process within the team became evident. Some similarities existed regarding goal-setting, psychosocial care and the role of relatives, but concrete patterns and the importance of these aspects differed because a particularly complex and emotional communication is required when a child is dying. CONCLUSION From the perspective of health care professionals, SOPC for adults and SOPPC differ with regard to underlying diseases as well as care patterns such as collaboration with relatives and their need for psychosocial support. Therefore, the care for children, adolescents and young adults with life-limiting conditions and pediatric diseases all over Germany should be delivered within the frame of an independent care structure by teams whose members possess specific pediatric expertise.
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Affiliation(s)
- Cornelia Ploeger
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - Dania Schütze
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Deutschland.
| | - Hannah Seipp
- Abteilung Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - Katrin Kuss
- Abteilung Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | | | - Ferdinand M Gerlach
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - Antje Erler
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - Jennifer Engler
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Deutschland
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van Baal K, Schrader S, Schneider N, Wiese B, Stiel S, Afshar K. [End-of-life care in a rural small-town region in Lower Saxony: a retrospective cross-sectional analysis based on routinely collected general practice data]. Z Evid Fortbild Qual Gesundhwes 2022; 168:48-56. [PMID: 34998676 DOI: 10.1016/j.zefq.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/29/2021] [Accepted: 10/07/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Up to 90% of people at the end of life are in need of palliative care. The majority can be cared for within general outpatient palliative care (AAPV) by general practitioners. Previous studies have described outpatient palliative care to fall short behind the estimated needs and to be initiated rather late in the health care process. Yet, little is known about the development of outpatient palliative care in recent years and about the parameters influencing its utilisation. Therefore, this study aimed to investigate the number and time of initiation for AAPV and specialised outpatient palliative care (SAPV) in a rural and small-town region in Lower Saxony on the basis of routinely collected general practice data. Furthermore, this study sought to estimate the influence of various parameters related to patients, practices and physicians on the provision of AAPV and SAPV. METHODS All general practitioners (n=190) in two counties in Lower Saxony were invited to take part in the project "Optimal care at the end of life - OPAL" (Innovation Fund, 01VSF17028) between autumn 2018 and spring 2019. In the participating practices, clinical data pertaining to patients with statutory health insurance, who had died in the second or third quarter of 2018, were collected in pseudonymised form and analysed using selected indicators for end-of-life care. The number of hospital stays and the provision of AAPV and SAPV were the subject of the descriptive analyses. In order to take the cluster effect of the practices into account, mixed-model analyses were carried out. RESULTS The data of 279 deceased patients (48% female; median age 82 years) from 31 general practices were analysed. In the last year of life, AAPV was provided for 78 deceased patients (28.0%) with a median onset of 20 days before death. 52 deceased patients (18.6%) received SAPV with a median onset of 28 days before death, respectively. In the last six months of life, 207 deceased patients (74.2%) were hospitalised at least once. The mixed-model analyses showed a greater probability of receiving AAPV (odds ratio (OR)=3.3) or SAPV (OR=3.2) in the last year of life for patients with oncological diseases. It was also shown that GPs with a higher value on the subscale practice organisation billed more AAPV (OR=1.4). DISCUSSION The number of patients with SAPV is at least equivalent to the estimated needs known from the literature in both selected regions. In contrast, AAPV seems to be provided relatively rarely and rather late in the health care process. Relevant reasons for this may be the lack of concrete criteria for AAPV (e. g., ambiguities and competing codes for billing) as well as prognostic uncertainties of health care providers especially for patients with non-oncological diseases. CONCLUSION Strategies to further develop end-of-life care should especially strengthen the AAPV provided by general practitioners and focus on patients with non-oncological diseases.
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Affiliation(s)
- Katharina van Baal
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover.
| | - Sophie Schrader
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover
| | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover
| | - Birgitt Wiese
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover
| | - Stephanie Stiel
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover
| | - Kambiz Afshar
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover
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Bauer A, Krauss SH, Freytag A, Jansky M, Schneider W. [Quality of care in specialized palliative homecare from the provider perspective: A qualitative study]. Z Evid Fortbild Qual Gesundhwes 2021; 162:1-9. [PMID: 33820720 DOI: 10.1016/j.zefq.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/20/2021] [Accepted: 02/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Since its introduction in 2007, the quality of care in specialized palliative home care (SAPV) is being measured using the patients' perspective. The perception of beneficial or inhibiting factors on the quality of care from the perspective of care providers received only little attention. OBJECTIVE To investigate the factors that promote or impede the quality of care in SAPV from the care providers' perspective. METHODS Within the framework of a transregional qualitative study, 113 problem-centered interviews were conducted on-site at 10 SAPV providers with their staff as well as their network partners. Grounded theory methodology was used for data curation and analysis. RESULTS The factors that are perceived as either enhancing or inhibiting the quality of care largely depends on the culture of care of the individual SAPV provider. For participating doctors, nurses and psychosocial professionals, successful performance is associated with good symptom control, participation of relatives and the achievement of certainty of action and of interpretation by means of 'good' decision-making procedures. Problematic performances are linked to a lack of time resulting in restlessness and especially in disagreement between the parties involved in the provision of care as well as to the denial of death. CONCLUSIONS The results of the study show that the perceived strategies, interpretations and evaluation categories, which are associated with good quality of care, are very heterogenous. On the basis of qualitative data, they do, however, follow three typical patterns in terms of cultures of care: proceduralism, holism and dualism.
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Affiliation(s)
- Anna Bauer
- Philosophisch-Sozialwissenschaftliche-Fakultät, Institut für Sozialwissenschaften, Professur für Soziologie mit bes. Berücksichtigung der Sozialkunde, Universität Augsburg, Augsburg, Deutschland; Katholisch-Theologische Fakultät, Lehrstuhl für Moraltheologie, Ludwig-Maximilians-Universität, München, Deutschland.
| | - Sabine H Krauss
- Philosophisch-Sozialwissenschaftliche-Fakultät, Institut für Sozialwissenschaften, Professur für Soziologie mit bes. Berücksichtigung der Sozialkunde, Universität Augsburg, Augsburg, Deutschland
| | - Antje Freytag
- Institut für Allgemeinmedizin des Universitätsklinikums Jena, Jena, Deutschland
| | - Maximiliane Jansky
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Werner Schneider
- Philosophisch-Sozialwissenschaftliche-Fakultät, Institut für Sozialwissenschaften, Professur für Soziologie mit bes. Berücksichtigung der Sozialkunde, Universität Augsburg, Augsburg, Deutschland
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Heckel M, Illig A, Brunner S, Ostgathe C. Evaluating the implementation of national recommendations on multidrug-resistant bacterial microorganisms in end-of-life care. Z Evid Fortbild Qual Gesundhwes 2020; 158-159:47-53. [PMID: 33191182 DOI: 10.1016/j.zefq.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/14/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In 2017, a national recommendation on multidrug-resistant bacterial microorganisms (MDRO) in end-of-life care was published. In order to monitor the implementation in a hospital-based palliative care unit, a dedicated multidisciplinary working group on MDRO was established. It developed a standard operating procedure and a documentation template (checklist). The aim of the present study is to evaluate the implementation status after one year. METHODS A mixed-methods approach was selected. The status of implementation was identified through a survey among staff members. A retrospective routine data analysis was performed. A focus group discussion with members of the working group focused on previous steps, factors conducive to implementation and on remaining problems. RESULTS Almost all (18 out of 20) participants (20 out of 29 eligible staff members) knew the national recommendations. Twelve out of 27 recommendations had a high degree of implementation after one year, another 13 recommendations were seen as at least partly integrated into daily routine. For two recommendations the degree of implementation was rated low: (i) "Taking into account any additional time constraint imposed by protection and isolation measures when planning for personnel and bed occupancy", and (ii) "Facilitating the patient's ability to distinguish and recognize team members and family caregivers". Working group members reported improvements since the implementation, whilst reporting some uncertainty prevailing among both staff members and visitors. Inhibitory factors were said to include the complexity of the standard operating procedure, inadequate usage and poor usability of the checklist. Behavioural and cognitive barriers such as anxieties related to transmission and the sense of security caused by the routine use of protective clothing were considered to be strong. Improving the checklist and the standard operating procedure as well as anchoring procedures in daily routine were considered to be the next important steps. DISCUSSION The implementation of recommendations is an iterative process and requires the ongoing development of appropriate measures for implementation in the respective institution. A multidisciplinary working group with monitoring tasks is an advantage.
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Affiliation(s)
- Maria Heckel
- Department of Palliative Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Annabell Illig
- Department of Palliative Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarah Brunner
- Department of Palliative Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Afshar K, Herbst FA, Tetzlaff F, Stiel S, Schneider N, Müller-Mundt G. [HA-BeL ("Hausärztliche Begleitung in der letzten Lebensphase"): Systematic development and adjustment of the German version of the General Practice End of Life Care Index]. Z Evid Fortbild Qual Gesundhwes 2020; 153-154:84-96. [PMID: 32694009 DOI: 10.1016/j.zefq.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/23/2020] [Accepted: 05/22/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In Germany, no instruments exist to evaluate the practice and organisation of palliative care in general practice. The aim of this project was the systematic development and adjustment of a German version of the General Practice End of Life Care Index (GP-EoLC-I). METHODS The translation and adaptation process followed the TRAPD model: translation, review, adjudication, pre-test, documentation. The process was completed by a back translation, a first pre-test and a feasibility study with general practitioners. RESULTS Nine of the ten general practitioners invited took part in the pre-test (56 % female, median age 55 years, range 40-75). The pre-test showed a median processing time of 15minutes. 17 general practitioners (59 % female, median age 53 years, range 39-69) took part in the pilot study. Adaptation to the German context was necessary for two of the 25 items. In the pre-test and in the pilot study only single values were missing. With the exception of the two adapted items, the back translation showed a high level of consistency with the original version of the questionnaire. DISCUSSION The systematic development and testing of the questionnaire "Hausärztliche Begleitung in der letzten Lebensphase" (HA-BeL) as well as its adaptation for the primary care setting in Germany was successfully completed in a multi-stage process using an interdisciplinary and participatory approach. The results of this empirical testing provide guidance for expenditure and reasonableness, objectivity of application and content-related consistency of the HA-BeL index. CONCLUSION The HA-BeL index is the first self-assessment instrument to be used by general practitioners to evaluate practice and organisation of palliative care in general practice in Germany.
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Affiliation(s)
- Kambiz Afshar
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | - Franziska A Herbst
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Fabian Tetzlaff
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stephanie Stiel
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Gabriele Müller-Mundt
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
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Ewertowski H, Hesse AK, Schneider N, Stiel S. [Primary palliative care provision by general practitioners: Development of strategies to improve structural, legal and financial framework conditions]. Z Evid Fortbild Qual Gesundhwes 2020; 149:32-39. [PMID: 32059833 DOI: 10.1016/j.zefq.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/29/2019] [Accepted: 12/22/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION General practitioners (GPs) make a major contribution to outpatient palliative care (AAPV). In 2013, new fee rates for AAPV were included in the uniform assessment standard, which strengthens the financial framework conditions for outpatient palliative care by GPs. The aim of the ALLPRAX project is to improve the framework conditions for AAPV. This contribution focusses on ideas for changing structural, legal, and financial framework conditions for an optimised AAPV. METHODS In April 2018, 28 healthcare professionals (10 GPs, 3 medical assistants, 3 hospital doctors, and 12 representatives of the nursing professions) from hospice and palliative care providers in Lower Saxony were invited to participate in nine group discussions at Hannover Medical School. During these group discussions, inhibitory factors for AAPV and possible solutions were discussed. The analysis of the group discussions was carried out using a summarizing content analysis according to Mayring. RESULTS In order to optimise palliative care by GPs in Germany, it is proposed that a) additional palliative care specialists for care coordination and round-the-clock availability for patients and relatives in GP practices should be provided (structural solution), b) nursing staff should be permitted to prescribe aids (legal solution), and c) higher remuneration for medical consultations should be provided (financial solution). These approaches could increase feasibility in day-to-day practice and create incentives for caregivers to provide more high-quality general outpatient palliative care. DISCUSSION The described high expenditure in general outpatient palliative care, which is hardly inferior to specialised outpatient palliative care from the caregivers' point of view, is not reflected accordingly, neither structurally nor financially. CONCLUSION In order to optimise general outpatient palliative care, structural, legal and financial framework conditions need to be correspondingly adapted.
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Affiliation(s)
| | | | - Nils Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover
| | - Stephanie Stiel
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover.
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Herbst FA, Heckel M, Stiel S, Ostgathe C. Development of empirical recommendations for regional hospice and palliative care networks in Germany: A qualitative study. Z Evid Fortbild Qual Gesundhwes 2018; 140:35-42. [PMID: 30591230 DOI: 10.1016/j.zefq.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/12/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Internationally, efforts are underway to develop coordinated and standardized approaches for palliative care service delivery by improving service quality in hospice and palliative care networks. German legal regulations explicitly demand networking between hospice and palliative care providers. However, there is little research on models of cooperation and the building and development of hospice and palliative care networks. Research-based recommendations for network building and advancement are lacking. OBJECTIVE The study aim was to develop empirical recommendations for the building of new and advancement of existing hospice and palliative care networks in Bavaria, Germany. METHODS The project utilized a qualitative approach. The research project was structured in six sequential phases: 1) semi-structured individual interviews on status quo of networks, 2) a workshop including a focus group to develop definitions of key terms and prioritize major network themes, 3) semi-structured face-to-face interviews on factors enabling and inhibiting cooperation, 4) drafting of a recommendation for regional hospice and palliative care networks, 5) an online consensus survey questionnaire to rate relevance and feasibility of the draft recommendation and an internal consensus meeting to revise the draft, and 6) an expert workshop to develop examples of realization. Coordinators and chairpersons of 12 hospice and palliative care networks constitute the study population for study phases 1 to 3, 5, and 6. Network representatives partook in one (n=6), two (n=6), three (n=4), four (n=2), or all five (n=1) of the study phases 1, 2, 3, 5, and 6. Further experts participated in one (n=10) or both (n=1) of the phases 5 and 6. RESULTS Recommendations were drafted for six thematic fields: (i) missions and aims, (ii) roles and responsibilities, (iii) coordination, (iv) communication and information channels, (v) public visibility, and (vi) funding. The whole set of recommendations was rated by 90% of the participants to be fully or somewhat important for network building and development. A total of 22 recommendations was approved. CONCLUSIONS The call for establishing and developing standards for hospice and palliative care networks was situated within the current policy climate of Germany and the broader international community. The present recommendations can aid implementation of this request and have a strong relevance for practice.
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Affiliation(s)
- Franziska A Herbst
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany; Institute for General Practice, Hannover Medical School, Hannover, Germany.
| | - Maria Heckel
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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