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Quaidoo TG, Adu B, Iddrisu M, Osei-Tutu F, Baaba C, Quiadoo Y, Poku CA. Unlocking timely palliative care: assessing referral practices and barriers at a ghanaian teaching hospital. BMC Palliat Care 2024; 23:90. [PMID: 38575917 PMCID: PMC10996152 DOI: 10.1186/s12904-024-01411-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The need for primary care physicians to be heavily involved in the provision of palliative care is growing. International agencies and practice standards advocate for early palliative care and the use of specialized palliative care services for patients with life-threatening illnesses. This study was conducted to investigate physicians' referral practices and perceived barriers to timely referral at the Korle Bu Teaching Hospital. METHODS A cross-sectional study design was employed using a convenience sampling technique to recruit 153 physicians for the study. Data on socio-demography, referral practices, timing and perceived barriers were collected using a structured questionnaire. Binary Logistic regression using crude and adjusted odds was performed to determine the factors associated with late referral. Significance was set at p < 0.05. RESULTS The prevalence of late referral was reported to be 68.0%. There were poor referral practices among physicians to palliative care services, and the major barriers to late referral were attributed to the perception that referring to a palliative care specialist means that the physician has abandoned his patient and family members' decisions and physicians' personnel choices or opinions on palliative care. CONCLUSION The healthcare system needs tailored interventions targeted at improving physicians' knowledge and communication strategies, as well as tackling systemic deficiencies to facilitate early and appropriate palliative care referrals. It is recommended that educational programs be implemented, palliative care training be integrated into medical curricula and culturally sensitive approaches be developed to address misconceptions surrounding end-of-life care.
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Affiliation(s)
| | - Barbara Adu
- Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Merri Iddrisu
- School of Nursing and Midwifery, University of Ghana, Legon, Ghana
| | | | | | - Yekua Quiadoo
- Department of Humanity, University of Ghana, Legon, Ghana
| | - Collins Atta Poku
- School of Nursing and Midwifery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Jewitt N, Mah K, Bonares M, Weingarten K, Ross H, Amin R, Morgan CT, Zimmermann C, Wentlandt K. Pediatric and Adult Cardiologists' and Respirologists' Referral Practices to Palliative Care. J Pain Symptom Manage 2022; 64:461-470. [PMID: 35905938 DOI: 10.1016/j.jpainsymman.2022.07.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Children and adults with advanced cardiac or respiratory disease may benefit from specialized palliative care (SPC), but there has been little SPC research in this area. OBJECTIVES To explore pediatric cardiologists' and respirologists' (pediatric clinicians) beliefs about and referral practices to SPC and compare these results to adult cardiologists and respirologists (adult clinicians). METHODS Pediatric and adult clinicians were sent a survey exploring SPC referral practices and beliefs. Responses were summarized with descriptive statistics. Pediatric and adult clinicians' responses were compared using Pearson's chi-square test. RESULTS The response rate was 56% (989/1759); 9% (87/989) were pediatric clinicians. Pediatric clinicians were more likely than adult clinicians to be female, work in an academic center, and experience fewer patient deaths (P<0.001). Pediatric clinicians reported better access to SPC clinical nurse specialists, spiritual care specialists and bereavement counselors (P<0.001), while adult clinicians reported better access to palliative care units (P<0.001). Pediatric clinicians referred to SPC earlier, while adult clinicians tended to refer after disease directed therapies were stopped (P<0.001). More than half of all clinicians felt patients had negative perceptions of the phrase "palliative care". Although most clinicians were satisfied with SPC quality (73-82%), fewer adult clinicians were satisfied with SPC availability (74 vs. 47%; P<0.001). Fewer pediatric clinicians felt that SPC prioritized oncology patients (13 vs. 53%; P<0.001). CONCLUSION There are important differences between pediatric and adult clinicians' beliefs about and referral practices to SPC. This may reflect unique features of pediatric diseases, provider characteristics, care philosophies, or service availability.
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Affiliation(s)
- Natalie Jewitt
- Pediatric Advanced Care Team (PACT), The Hospital for Sick Children, Toronto, Ontario, Canada (N.J., K.W.); Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.)
| | - Kenneth Mah
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada (K.M., C.Z., K.W.)
| | - Michael Bonares
- Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.B.); Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (M.B., C.Z.)
| | - Kevin Weingarten
- Pediatric Advanced Care Team (PACT), The Hospital for Sick Children, Toronto, Ontario, Canada (N.J., K.W.); Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.)
| | - Heather Ross
- Peter Munk Cardiac Centre, Department of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada (H.R.)
| | - Reshma Amin
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.); Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (R.A.)
| | - Conall Thomas Morgan
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.); Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (C.T.M.)
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada (K.M., C.Z., K.W.); Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (M.B., C.Z.)
| | - Kirsten Wentlandt
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada (K.M., C.Z., K.W.); Division of Palliative Care, Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada (K.W.).
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Theroux CI, Elliott V, Davis S, Crerand CE, Kremen J, Tishelman A, Hutaff-Lee C, Nahata L. Fertility Counseling Practices for Patients with Turner Syndrome in Pediatric Endocrine Clinics: Results of a Pediatric Endocrine Society Survey. Horm Res Paediatr 2022; 95:321-330. [PMID: 35413716 PMCID: PMC9529777 DOI: 10.1159/000524573] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/08/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Turner syndrome (TS) is associated with a high risk of primary ovarian insufficiency. Current guidelines recommend early fertility counseling for affected youth and their families. This study assessed clinical providers' (MD, NP, or PA) fertility counseling practices for girls with TS. METHODS TS providers were invited to complete a survey via the Pediatric Endocrine Society listserv. Descriptive statistics summarized variables of interest. Correlations were used to identify associations between barriers/practice characteristics and fertility preservation (FP) referral. Thematic analysis was used to examine qualitative responses. RESULTS 119 providers completed the survey. Seventy percent reported discussing fertility implications of TS routinely in pediatric care. Fifty-six percent reported often or always referring patients with spontaneous menarche to FP specialists, whereas only 19% reported often or always referring their patients without spontaneous menarche (p < 0.001). Barriers associated with FP referral frequency included unfamiliarity with FP options, belief that FP is not a possible goal for their patients, and absence of a local reproductive endocrinologist. Qualitatively, four referral barrier themes were identified: (1) questionable utility of referral, (2) lack of perceived interest among patients/families, (3) provider barriers (e.g., lack of knowledge), (4) logistical/structural barriers to accessing fertility-related care. DISCUSSION/CONCLUSION Pediatric endocrinology providers report inconsistently discussing fertility implications of TS. The frequency of referral to an FP specialist and factors/barriers affecting the decision to refer remain variable. Future research should focus on expanding provider education, addressing barriers to high-quality fertility counseling and referral for patients with TS, and investigating FP outcomes in TS.
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Affiliation(s)
- Charleen I. Theroux
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Victoria Elliott
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- eXtraOrdinary Kids Turner Syndrome Clinic, Children’s Hospital Colorado, Aurora, CO, USA
| | - Shanlee Davis
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- eXtraOrdinary Kids Turner Syndrome Clinic, Children’s Hospital Colorado, Aurora, CO, USA
| | - Canice E. Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jessica Kremen
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA
| | - Amy Tishelman
- Department of Psychology, Boston College, Boston, MA, USA
| | - Christa Hutaff-Lee
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- eXtraOrdinary Kids Turner Syndrome Clinic, Children’s Hospital Colorado, Aurora, CO, USA
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Yellappa V, Lefèvre P, Battaglioli T, Devadasan N, Van der Stuyft P. Patients pathways to tuberculosis diagnosis and treatment in a fragmented health system: a qualitative study from a south Indian district. BMC Public Health 2017; 17:635. [PMID: 28778192 PMCID: PMC5544986 DOI: 10.1186/s12889-017-4627-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND India's Revised National Tuberculosis (TB) Control Programme (RNTCP) offers free TB diagnosis and treatment. But more than 50% of TB patients seek care from private practitioners (PPs), where TB is managed sub-optimally. In India, there is dearth of studies capturing experiences of TB patients when they navigate through health facilities to seek care. Also, there is less information available on how PPs make decisions to refer TB cases to RNTCP. We conducted this study to understand the factors influencing TB patient's therapeutic itineraries to RNTCP and PP's cross referral practices linked to RNTCP. METHODS We conducted in-depth interviews on a purposive sample of 33 TB patients and 38 PPs. Patients were categorised into three groups: those who reached RNTCP directly, those who were referred by PPs to RNTCP and patients who took DOT from PPs. We assessed patient's experiences in each category and documented their journey from initial symptoms until they reached RNTCP, where they were diagnosed and started on treatment. PPs were categorised into three groups based on their TB case referrals to RNTCP: actively-referring, minimally-referring and non-referring. RESULTS Patients had limited awareness about TB. Patients switched from one provider to the other, since their symptoms were not relieved. A first group of patients, self-medicated by purchasing get rid drugs from private chemists over the counter, before seeking care. A second group sought care from government facilities and had simple itineraries. A third group who sought care from PPs, switched concurrently and/or iteratively from public and private providers in search for relief of symptoms causing important diagnostic delays. Eventually all patients reached RNTCP, diagnosed and started on treatment. PP's cross-referral practices were influenced by patient's paying capacity, familiarity with RNTCP, kickbacks from private labs and chemists, and even to get rid of TB patients. These trade-offs by PPs complicated patient's itineraries to RNTCP. CONCLUSIONS India aims to achieve universal health care for TB. Our study findings help RNTCP to develop initiatives to promote early detection of TB, by involving PPs and private chemists and establish effective referral systems from private sectors to RNTCP.
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Affiliation(s)
- Vijayashree Yellappa
- Institute of Public Health, #250, 2nd C Main, 2nd 'C' Cross-, Girinagar I Phase, Bangalore, Karnataka, 560 085, India. .,Institute of Tropical Medicine, Nationalestraat, 155, 2000, Antwerp, Belgium.
| | - Pierre Lefèvre
- Institute of Tropical Medicine, Nationalestraat, 155, 2000, Antwerp, Belgium
| | - Tullia Battaglioli
- Institute of Tropical Medicine, Nationalestraat, 155, 2000, Antwerp, Belgium
| | - Narayanan Devadasan
- Institute of Public Health, #250, 2nd C Main, 2nd 'C' Cross-, Girinagar I Phase, Bangalore, Karnataka, 560 085, India
| | - Patrick Van der Stuyft
- Institute of Tropical Medicine, Nationalestraat, 155, 2000, Antwerp, Belgium.,Public Health Department, Faculty of Medicine, Ghent University, Ghent, Belgium
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Leach E, Morris E, White HJ, Inglis A, Lehman A, Austin J. How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians' Practice. J Genet Couns 2016; 25:1235-1242. [PMID: 27185057 DOI: 10.1007/s10897-016-9961-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/15/2016] [Indexed: 11/27/2022]
Abstract
Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semi-structured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they felt unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians' minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that it encompasses more than information provision. It is important to increase physicians' awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.
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Affiliation(s)
- Emma Leach
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Emily Morris
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.,Department of Psychiatry, University of British Columbia, Rm A3-112, CFRI Translational Lab Building, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
| | - Hannah J White
- California State University, Stanislaus, Turlock, CA, USA
| | - Angela Inglis
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.,Department of Psychiatry, University of British Columbia, Rm A3-112, CFRI Translational Lab Building, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
| | - Anna Lehman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada. .,Department of Psychiatry, University of British Columbia, Rm A3-112, CFRI Translational Lab Building, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
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