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Haas A, Price RA, Elliott MN, Teno JM, DeYoreo M. Hospice Care Experiences Among Medicare Decedents With and Without COVID-19, 2020-2021. J Pain Symptom Manage 2024; 67:e153-e156. [PMID: 37918456 DOI: 10.1016/j.jpainsymman.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Ann Haas
- RAND Corporation (A.H.), Pittsburgh, Pennsylvania 15213, USA; RAND Corporation (R.A.P., J.M.T.), Arlington, Virginia 22202, USA; RAND Corporation (M.N.E., M.D.), Santa Monica, California 90401, USA; Brown University School of Public Health (J.M.T.), Providence, Rhode Island 02903, USA.
| | - Rebecca Anhang Price
- RAND Corporation (A.H.), Pittsburgh, Pennsylvania 15213, USA; RAND Corporation (R.A.P., J.M.T.), Arlington, Virginia 22202, USA; RAND Corporation (M.N.E., M.D.), Santa Monica, California 90401, USA; Brown University School of Public Health (J.M.T.), Providence, Rhode Island 02903, USA
| | - Marc N Elliott
- RAND Corporation (A.H.), Pittsburgh, Pennsylvania 15213, USA; RAND Corporation (R.A.P., J.M.T.), Arlington, Virginia 22202, USA; RAND Corporation (M.N.E., M.D.), Santa Monica, California 90401, USA; Brown University School of Public Health (J.M.T.), Providence, Rhode Island 02903, USA
| | - Joan M Teno
- RAND Corporation (A.H.), Pittsburgh, Pennsylvania 15213, USA; RAND Corporation (R.A.P., J.M.T.), Arlington, Virginia 22202, USA; RAND Corporation (M.N.E., M.D.), Santa Monica, California 90401, USA; Brown University School of Public Health (J.M.T.), Providence, Rhode Island 02903, USA
| | - Maria DeYoreo
- RAND Corporation (A.H.), Pittsburgh, Pennsylvania 15213, USA; RAND Corporation (R.A.P., J.M.T.), Arlington, Virginia 22202, USA; RAND Corporation (M.N.E., M.D.), Santa Monica, California 90401, USA; Brown University School of Public Health (J.M.T.), Providence, Rhode Island 02903, USA
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2
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Younan S, Cardona M, Sahay A, Willis E, Ni Chroinin D. Advanced care planning in the early phase of COVID-19: a rapid review of the practice and policy lessons learned. FRONTIERS IN HEALTH SERVICES 2023; 3:1242413. [PMID: 37780404 PMCID: PMC10541151 DOI: 10.3389/frhs.2023.1242413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023]
Abstract
Background The importance of advance care planning (ACP) has been highlighted by the advent of life-threatening COVID-19. Anecdotal evidence suggests changes in implementation of policies and procedures is needed to support uptake of ACPs. We investigated the barriers and enablers of ACP in the COVID-19 context and identify recommendations to facilitate ACP, to inform future policy and practice. Methods We adopted the WHO recommendation of using rapid reviews for the production of actionable evidence for this study. We searched PUBMED from January 2020 to April 2021. All study designs including commentaries were included that focused on ACPs during COVID-19. Preprints/unpublished papers and Non-English language articles were excluded. Titles and abstracts were screened, full-texts were reviewed, and discrepancies resolved by discussion until consensus. Results From amongst 343 papers screened, 123 underwent full-text review. In total, 74 papers were included, comprising commentaries (39) and primary research studies covering cohorts, reviews, case studies, and cross-sectional designs (35). The various study types and settings such as hospitals, outpatient services, aged care and community indicated widespread interest in accelerating ACP documentation to facilitate management decisions and care which is unwanted/not aligned with goals. Enablers of ACP included targeted public awareness, availability of telehealth, easy access to online tools and adopting person-centered approach, respectful of patient autonomy and values. The emerging barriers were uncertainty regarding clinical outcomes, cultural and communication difficulties, barriers associated with legal and ethical considerations, infection control restrictions, lack of time, and limited resources and support systems. Conclusion The pandemic has provided opportunities for rapid implementation of ACP in creative ways to circumvent social distancing restrictions and high demand for health services. This review suggests the pandemic has provided some impetus to drive adaptable ACP conversations at individual, local, and international levels, affording an opportunity for longer term improvements in ACP practice and patient care. The enablers of ACP and the accelerated adoption evident here will hopefully continue to be part of everyday practice, with or without the pandemic.
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Affiliation(s)
- Sarah Younan
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
| | - Magnolia Cardona
- Institute for Evidence Based Healthcare, Bond University, Gold Coast, QLD, Australia
| | - Ashlyn Sahay
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Mackay, QLD, Australia
| | - Eileen Willis
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Mackay, QLD, Australia
| | - Danielle Ni Chroinin
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
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3
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Sugg HVR, Richards DA, Russell AM, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Iles-Smith H, Kent M, Logan PA, Morgan LM, Morley N, Rafferty AM, Shepherd MH, Singh SJ, Tooze SJ, Whear R. Nurses' strategies for overcoming barriers to fundamental nursing care in patients with COVID-19 caused by infection with the SARS-COV-2 virus: Results from the 'COVID-NURSE' survey. J Adv Nurs 2023; 79:1003-1017. [PMID: 35467757 PMCID: PMC9111453 DOI: 10.1111/jan.15261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
AIMS To identify strategies used by registered nurses and non-registered nursing care staff in overcoming barriers when providing fundamental nursing care for non-invasively ventilated inpatients with COVID-19. DESIGN Online survey with open-ended questions to collect qualitative data. METHODS In August 2020, we asked UK-based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non-invasively ventilated patients with COVID-19. We analysed data using Framework Analysis. RESULTS A total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non-verbal communication with patients, using information technology to enable patients' significant others to communicate with staff and patients, and establishing clear information-sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self-care and using 'runners' and interdisciplinary input. 3) Addressing patients' well-being and values required spending time with patients, acting in loco familiae, providing access to psychological and spiritual support, obtaining information about patients' wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks. CONCLUSIONS Our respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well-being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing. IMPACT As these strategies are unlikely to be exclusive to the COVID-19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial.
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Affiliation(s)
- Holly V R Sugg
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David A Richards
- College of Medicine and Health, University of Exeter, Exeter, UK.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Sarah Burnett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Cockcroft
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, Exeter, UK.,The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | | | - Faye E Doris
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Harriet A Hunt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Salford, UK.,Northern Care Alliance NHS Group, Salford, UK
| | - Merryn Kent
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham, Queens Medical centre, Nottingham, UK
| | - Leila M Morgan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Naomi Morley
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Maggie H Shepherd
- College of Medicine and Health, University of Exeter, Exeter, UK.,NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Susannah J Tooze
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- College of Medicine and Health, University of Exeter, Exeter, UK
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4
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Devery K, Winsall M, Rawlings D. A qualitative study exploring challenges and solutions to negotiating goals of care at the end of life in hospital settings. Int J Qual Health Care 2022; 34:mzac089. [PMID: 36305626 PMCID: PMC9683075 DOI: 10.1093/intqhc/mzac089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Negotiating goals of care (GoC) with patients is an essential skill for all health-care professionals (HCPs) in hospitals. End-of-Life Essentials (EOLE) is a Commonwealth-funded project that delivers free, peer-reviewed, evidence-based, online education and practice change resources. To date, around 26 000 doctors, nurses and allied health professionals have registered to access the education. 'Planning End-of-Life Care-Goals of Care' features in the suite of EOLE modules and includes education around negotiating GoC with patients and families. OBJECTIVE The aim of the study was to explore the views of module learners (HCPs) on challenges they have faced when negotiating GoC at the EOL with patients and families. METHODS Participants were learners (HCPs) who registered to the EOLE website and engaged with the GoC module. Learners' responses to the question posed at the end of the module 'What are the hardest or most challenging things about negotiating GoC with patients and families?' were extracted for a 12-month period. Qualitative data were analysed thematically in NVivo V.12, guided by the theoretical framework of pragmatism. An open, inductive approach was used to code the data, with axial coding used to refine and organize themes and subthemes. RESULTS A total of 451 learner statements were analysed. Five themes emerged from the data: (i) differing views and opinions; (ii) challenges to understanding; (iii) managing emotions; (iv) initiating the EOL conversation and (v) lack of professional knowledge or capacity. Five subthemes were also organized under the theme 'differing views and opinions'. CONCLUSION Planning EOL care demands high-level, compassionately skilful and sensitive care and services, which are in line with the patient's and family's wishes. In practice, however, there are many challenges to this, such as ensuring that patients, families, and HCPs are aware of different expectations regarding future health-care possibilities, and that HCPs are prepared for negotiating GoC to achieve quality and safe EOL care in hospitals.
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Affiliation(s)
- Kim Devery
- Palliative & Supportive Services, Flinders University, Bedford Park, South Australia 5042, Australia
- Research Centre for Palliative Care, Death and Dying, Palliative and Supportive Services, Flinders University, Bedford Park, Adelaide, South Australia 5042, Australia
| | - Megan Winsall
- Palliative & Supportive Services, Flinders University, Bedford Park, South Australia 5042, Australia
| | - Deb Rawlings
- Palliative & Supportive Services, Flinders University, Bedford Park, South Australia 5042, Australia
- Research Centre for Palliative Care, Death and Dying, Palliative and Supportive Services, Flinders University, Bedford Park, Adelaide, South Australia 5042, Australia
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5
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Supporting dementia family care partners during COVID-19: Perspectives from hospice staff. Geriatr Nurs 2022; 47:265-272. [PMID: 36030641 PMCID: PMC9359485 DOI: 10.1016/j.gerinurse.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022]
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6
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Wahidie D, Altinok K, Yılmaz-Aslan Y, Brzoska P. [Strategies, guidelines and recommendations for coping with the COVID-19 pandemic in palliative and hospice care facilities. Results of a scoping review]. Z Gerontol Geriatr 2022; 55:151-156. [PMID: 35061068 PMCID: PMC8780045 DOI: 10.1007/s00391-022-02016-8] [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: 06/12/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Hintergrund Palliativ- und Hospizeinrichtungen sind durch die COVID-19-Pandemie besonderen Herausforderungen ausgesetzt. Gründe dafür sind insbesondere das hohe Alter und bestehende Vorerkrankungen der Patienten sowie ein körperlich naher Kontakt zwischen Mitarbeitern und Patienten. Ziel der Arbeit Ziel der vorliegenden Studie ist es, bestehende Strategien, Richtlinien und Empfehlungen zum Umgang mit den Herausforderungen der COVID-19-Pandemie in der Palliativ- und Hospizversorgung zu ermitteln, die in Deutschland und anderen Ländern zum Einsatz kommen. Material und Methoden Im Rahmen eines Scoping Reviews wurden die Datenbanken PubMed, CINAHL, Web of Science und PsycInfo durchsucht. Zusätzlich wurde „graue Literatur“ über Google Search und Google Scholar recherchiert. Eingeschlossen wurden alle deutsch- und englischsprachigen Artikel im Zeitraum Januar 2020 bis August 2021, die sich auf die stationäre Palliativ- und Hospizversorgung beziehen. Ergebnisse Insgesamt wurden 51 Veröffentlichungen in die Analyse aufgenommen. Die identifizierten Maßnahmen lassen sich 10 verschiedenen Kategorien zuordnen: Maßnahmen zur Infektionskontrolle, strukturelle Maßnahmen, Besuchsregelungen, Kommunikationsstrukturen, Schulung und Aufklärung, psychosoziale Unterstützungsmaßnahmen, spezifische Überlegungen für Menschen mit Demenz, vorausschauende Pflegeplanung, Abschiednahme sowie Maßnahmen nach dem Tod. Diskussion Bei der Bewältigung der COVID-19-Pandemie dominieren insbesondere Maßnahmen zur Ermöglichung der Kommunikation zwischen Patienten, Mitarbeitern und Angehörigen, psychosoziale Unterstützungsmaßnahmen, strukturelle Maßnahmen und Empfehlungen zur Schulung und Aufklärung aller Beteiligten. Strategien zur Palliativversorgung von Menschen mit Demenz in Pandemiezeiten sowie zu Abschiednahme und Trauerbewältigung von Hinterbliebenen finden weniger Beachtung. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-022-02016-8) enthalten.
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Affiliation(s)
- Diana Wahidie
- Fakultät für Gesundheit/Department für Humanmedizin, Lehrstuhl für Versorgungsforschung, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland
| | - Kübra Altinok
- Fakultät für Gesundheit/Department für Humanmedizin, Lehrstuhl für Versorgungsforschung, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland
| | - Yüce Yılmaz-Aslan
- Fakultät für Gesundheit/Department für Humanmedizin, Lehrstuhl für Versorgungsforschung, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland.,Fakultät für Gesundheitswissenschaften, AG3 Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld, Deutschland.,Fakultät für Gesundheitswissenschaften, AG6 Versorgungsforschung und Pflegewissenschaft, Universität Bielefeld, Bielefeld, Deutschland
| | - Patrick Brzoska
- Fakultät für Gesundheit/Department für Humanmedizin, Lehrstuhl für Versorgungsforschung, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland.
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7
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Whear R, Abbott RA, Bethel A, Richards DA, Garside R, Cockcroft E, Iles‐Smith H, Logan PA, Rafferty AM, Shepherd M, Sugg HVR, Russell AM, Cruickshank S, Tooze S, Melendez‐Torres GJ, Thompson Coon J. Impact of COVID-19 and other infectious conditions requiring isolation on the provision of and adaptations to fundamental nursing care in hospital in terms of overall patient experience, care quality, functional ability, and treatment outcomes: systematic review. J Adv Nurs 2022; 78:78-108. [PMID: 34554585 PMCID: PMC8657334 DOI: 10.1111/jan.15047] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/02/2021] [Accepted: 09/05/2021] [Indexed: 01/28/2023]
Abstract
AIM This systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care. DESIGN Systematic review. DATA SOURCES In July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID-19 Database (https://search.bvsalud.org/) MedRxiv (https://www.medrxiv.org/), bioRxiv (https://www.biorxiv.org/) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards. REVIEW METHODS We included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID-19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non-professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person. RESULTS Of 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub-themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership. CONCLUSION To prepare for continuation of the COVID-19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence-based care to be provided in future. IMPACT Our review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics.
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Affiliation(s)
- Rebecca Whear
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - Rebecca A. Abbott
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - Alison Bethel
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - David A. Richards
- College of Medicine and HealthUniversity of ExeterExeterUK
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Ruth Garside
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Emma Cockcroft
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Heather Iles‐Smith
- School of Health and SocietyUniversity of SalfordSalfordUK
- Northern Care Alliance NHS GroupSalfordUK
| | - Pip A. Logan
- School of MedicineUniversity of NottinghamQueens Medical CentreNottinghamUK
| | - Ann Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative CareKing’s College LondonLondonUK
| | - Maggie Shepherd
- NIHR Exeter Clinical Research FacilityRoyal Devon and Exeter NHS Foundation TrustExeterUK
- Institute of Biomedical and Clinical ScienceCollege of Medicine and HealthUniversity of ExeterExeterUK
| | | | | | | | - Susannah Tooze
- College of Medicine and HealthUniversity of ExeterExeterUK
| | | | - Jo Thompson Coon
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
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8
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Rowe JG, Potts M, McGhie R, Dinh A, Engel I, England K, Sinclair CT. Palliative Care Practice During the COVID-19 Pandemic: A Descriptive Qualitative Study of Palliative Care Clinicians. J Pain Symptom Manage 2021; 62:1111-1116. [PMID: 34147579 PMCID: PMC8265891 DOI: 10.1016/j.jpainsymman.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/30/2021] [Accepted: 06/11/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT COVID-19 created unprecedented demand for palliative care at a time when in-person communication was highly restricted, straining efforts to care for patients and families. OBJECTIVES To qualitatively explore the challenges presented by the COVID-19 pandemic from the perspective of palliative care clinicians. Specifically we sought to: 1) Describe the strategies adopted by palliative care clinicians to cope with new challenges including patient and clinician isolation, prognostication of an emergent disease, and rapidly rising numbers of severely ill patients; 2) Identify additions or adjustments to in-person and system-related palliative care training, methods, and tools made during pandemics. METHODS This descriptive qualitative study utilized a thematic approach for data analysis of individual, semi-structured interviews with palliative care clinicians (n = 25). Codes, categories, and emerging themes were identified through an iterative, comparative method. Methods align with the Consolidated Criteria for Reporting Qualitative Research (COREQ) RESULTS: A theme of "Expanding the reach of palliative care for today and the future" was identified with three subthemes: 1) Redefining attitudes and hardship due to collective uncertainty, 2) Breaking with the past towards integrated concept of palliative care, and 3) Building capacity through primary palliative care training. CONCLUSION COVID-19 forced hospital systems to consider the inclusion of palliative care in unforeseen ways due to an uncontrollable, unpredictable disease. Faced with unprecedented uncertainty, palliative care clinicians utilized strategies for integration and innovation across hospitals, particularly in intensive care units and emergency departments. A need to build capacity through increased primary palliative care access and training was identified.
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Affiliation(s)
| | - Maryellen Potts
- University of Kansas School of Nursing, Kansas City, Missouri, USA
| | - Ronan McGhie
- University of Kansas, Kansas City, Missouri, USA
| | - Annie Dinh
- University of Kansas, Kansas City, Missouri, USA
| | - Ilana Engel
- University of Kansas, Kansas City, Missouri, USA
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9
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Rose EK, O'Connor J. "Addressing Advance Care Planning in Patients with COPD". Chest 2021; 161:676-683. [PMID: 34762924 DOI: 10.1016/j.chest.2021.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive debilitating disease with diminished quality of life after COPD hospital admissions. Due to the nature of the disease, it is important to address patients' goals of care, preferably prior to the development of refractory COPD. Advance Care Planning (ACP) is an all-encompassing term that involves discussing goals with patients. Various review articles on ACP and COPD focus on defining ACP, identifying barriers to addressing ACP, and using interventions to incorporate ACP in practice. There is evidence that ACP improves quality of communication, reduces admissions, and increases quality of life, but often the focus of that research has been on patients with cancer. Many of the articles have suggestions for how to apply ACP to chronic lung disease, but without further research and definitive guidance it may be difficult to obtain funding for programs dedicated to ACP. There are currently no guidelines for addressing ACP in patients with COPD. Research addresses why advance care planning is important, yet there are barriers that patients, families, and healthcare providers encounter, preventing meaningful discussions. Research has also found that utilizing multidisciplinary teams improves care and quality of life, yet research should be dedicated to investigating the effects of advance care planning initiatives on outcomes in patients with COPD, particularly in reducing hospital admissions and improving quality of life. This review seeks to educate providers about end-stage COPD and advance care planning, the evidence demonstrating advance care planning's importance, and the current and future state of research.
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Affiliation(s)
- Emily K Rose
- Virginia Commonwealth University School of Medicine.
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10
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Palmer JA, Sullivan JL, Wachterman MW, Sager ZS, Wiener RS. "If You Built It, They Could Come": Opportunities to Expand Access to Palliative Care. J Palliat Med 2021; 25:200-204. [PMID: 34861114 DOI: 10.1089/jpm.2021.0109] [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: 11/13/2022] Open
Abstract
There are growing calls to broaden palliative care access to more populations, diseases, and care settings and to earlier in the disease process; yet, supply of specialty palliative care is not likely to keep pace with demand. This article discusses possible solutions by which to bridge the gap between limited palliative care supply and demand. The proposed solutions include: (1) specialist workforce development; (2) alternate models of care; (3) triaging systems; and (4) telemedicine. Education/training, research, and policy mechanisms could operationalize these solutions. With the solutions in hand, the field may be able to increase the reach, sustainability, and equity of palliative care, thereby improving access and enabling a multitude of positive patient, family, and health care system outcomes.
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Affiliation(s)
- Jennifer A Palmer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Melissa W Wachterman
- Department of Palliative Medicine and Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Zachary S Sager
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Palliative Medicine and New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
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11
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De Panfilis L, Peruselli C, Artioli G, Perin M, Bruera E, Brazil K, Tanzi S. A Qualitative Study on Nudging and Palliative Care: "An Attractive but Misleading Concept". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189575. [PMID: 34574501 PMCID: PMC8468152 DOI: 10.3390/ijerph18189575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/04/2022]
Abstract
The debate about the ethical decision-making process in the healthcare context has been enriched with a theory called “nudging”, which has been defined as the framing of information that can significantly influence behaviour without restricting choice. The literature shows very limited data on the opinion and experience of palliative care healthcare professionals on the use of nudging techniques in their care setting. The aim of this study is to explore the beliefs of experienced palliative care professionals towards nudging. We performed a qualitative study using textual data collected through a focus group. It was audio-recorded, and the transcripts were subjected to a thematic analysis. It was performed within an oncological research hospital with a small and multidisciplinary group of healthcare professionals specialised in PC. Participants reported two overarching positions grounded in two main themes: (1) translating nudging in the PC setting and (2) towards a neutral space. The participants found few justifications for the use of nudging in the PC field, even if it can be very attractive and reassuring. Participants also expressed concerns about the excessive risk of developing pure paternalism.
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Affiliation(s)
- Ludovica De Panfilis
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Correspondence: ; Tel.: +39-0522-269212
| | - Carlo Peruselli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (C.P.); (G.A.); (S.T.)
| | - Giovanna Artioli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (C.P.); (G.A.); (S.T.)
| | - Marta Perin
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, & Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK;
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (C.P.); (G.A.); (S.T.)
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12
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Starr LT, O'Connor NR, Meghani SH. Improved Serious Illness Communication May Help Mitigate Racial Disparities in Care Among Black Americans with COVID-19. J Gen Intern Med 2021; 36:1071-1076. [PMID: 33464466 PMCID: PMC7814859 DOI: 10.1007/s11606-020-06557-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Lauren T Starr
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | - Nina R O'Connor
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Salimah H Meghani
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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13
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Wittenberg E, Goldsmith JV, Chen C, Prince-Paul M, Johnson RR. Opportunities to improve COVID-19 provider communication resources: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:438-451. [PMID: 33455825 PMCID: PMC7831717 DOI: 10.1016/j.pec.2020.12.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Communication related to COVID-19 between provider and the patient/family is impacted by isolation requirements, time limitations, and lack of family/partner access. Our goal was to determine the content of provider communication resources and peer-reviewed articles on COVID-19 communication in order to identify opportunities for developing future COVID-19 communication curricula and support tools. METHODS A systematic review was conducted using the UpToDate clinical decision support resource database, CINAHL, PubMed, PsycInfo, and Web of Science. The grey literature review was conducted in September 2020 and articles published between January-September 2020 written in English were included. RESULTS A total of 89 sources were included in the review, (n = 36 provider communication resources, n = 53 peer-reviewed articles). Resources were available for all providers, mainly physicians, and consisted of general approaches to COVID-19 communication with care planning as the most common topic. Only four resources met best practices for patient-centered communication. All but three articles described physician communication where a general emphasis on patient communication was the most prevalent topic. Reduced communication channels, absence of family, time, burnout, telemedicine, and reduced patient-centered care were identified as communication barriers. Communication facilitators were team communication, time, patient-centered and family communication, and available training resources. CONCLUSIONS Overall, resources lack content that address non-physician providers, communication with family, and strategies for telehealth communication to promote family engagement. The gaps identified in this review reveal a need to develop more materials on the following topics: provider moral distress, prevention communication, empathy and compassion, and grief and bereavement. An evidence-base and theoretical grounding in communication theory is also needed. PRACTICE IMPLICATIONS Future development of COVID-19 communication resources for providers should address members of the interdisciplinary team, communication with family, engagement strategies for culturally-sensitive telehealth interactions, and support for provider moral distress.
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Affiliation(s)
- Elaine Wittenberg
- From California State University Los Angeles, Department of Communication Studies, Los Angeles CA, USA.
| | - Joy V Goldsmith
- From University of Memphis, Department of Communication and Film, Memphis TN, USA
| | - Chiahui Chen
- From University at Buffalo-The State University of New York, School of Nursing, Buffalo, NY, USA
| | | | - Renee R Johnson
- From California State University Los Angeles, Patricia A. Chin School of Nursing, Los Angeles CA, USA
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15
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Lipworth AD, Collins EJ, Keitz SA, Hesketh PJ, Resnic FS, Wozniak JM, Mosenthal AC. Development of a Novel Communication Liaison Program to Support COVID-19 Patients and Their Families. J Pain Symptom Manage 2021; 61:e1-e10. [PMID: 33246074 PMCID: PMC7685060 DOI: 10.1016/j.jpainsymman.2020.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022]
Abstract
In the spring of 2020, our hospital faced a surge of critically ill coronavirus disease 2019 patients, with intensive care unit (ICU) occupancy peaking at 204% of the baseline maximum capacity. In anticipation of this surge, we developed a remote communication liaison program to help the ICU and palliative care teams support families of critically ill patients. In just nine days from inception until implementation, we recruited and prepared ambulatory specialty providers to serve in this role effectively, despite minimal prior critical care experience. We report here the primary elements needed to reproduce and scale this program in other hospitals facing similar ICU surges, including a checklist for replication (Appendix I). Keys to success include strong logistical support, clinical reference material designed for rapid evolution, and a liaison team structure with peer coaching.
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Affiliation(s)
- Adam D Lipworth
- Division of Dermatology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA.
| | - Elizabeth J Collins
- Division of Palliative Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Sheri A Keitz
- Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Paul J Hesketh
- Lahey Health Cancer Institute, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Frederic S Resnic
- Division of Cardiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Joanne M Wozniak
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Anne C Mosenthal
- Department of Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
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16
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Maritz JH, Pathak V. Palliative medicine in intensive care unit during a pandemic. Lung India 2021; 38:258-262. [PMID: 33942751 PMCID: PMC8194422 DOI: 10.4103/lungindia.lungindia_630_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The coronavirus disease-2019 (COVID-19) or severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) pandemic has changed the landscape of medical care. Efforts made to limit the spread of the deadly disease have impacted the specialty of palliative medicine in ways that could not have been completely predicted or appreciated. The consequences of these changes have been most evident in the care of COVID-19 patients and families within the intensive care unit. The policies meant to keep staff, patients, and families safe, greatly changed the way that palliative medicine could be provided. This article provides a more in-depth look at how the practice of palliative medicine adapted to such difficult and constantly changing times, particularly in aspects of family meetings, communication, paternalism, managing emotions, death, and grief. Despite the ongoing challenges presented by this virus, the specialty of palliative medicine may be well suited to adapt and flourish.
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Affiliation(s)
- Jennifer H Maritz
- Department of Palliative Medicine, Riverside Health System, Newport News, Virginia, USA
| | - Vikas Pathak
- Department of Pulmonary and Critical Care, Riverside Health System, Newport News, Virginia, USA
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17
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Beltran-Aroca CM, González-Tirado M, Girela-López E. [Ethical issues in primary care during the coronavirus (SARS-CoV-2) pandemic]. Semergen 2020; 47:122-130. [PMID: 33358090 PMCID: PMC7698820 DOI: 10.1016/j.semerg.2020.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/07/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Abstract
Las emergencias de salud pública, como la que estamos viviendo con la pandemia originada por el coronavirus SARS-CoV-2, han originado trágicas limitaciones de recursos que impiden salvar vidas. Provocan tensiones en la atención sanitaria centrada en el paciente como eje del sistema en condiciones normales, y en la misma atención sanitaria en situaciones de emergencia originadas en la COVID-19. En esta revisión abordamos algunos de los problemas asistenciales, organizativos y éticos que este escenario ha provocado en la atención primaria, como: cancelación de actividades programadas; escasa atención domiciliaria y seguimiento de pacientes ancianos, enfermos crónicos e inmovilizados; desabastecimiento de EPI y exposición al riesgo de los profesionales sanitarios, y finalmente los problemas asociados a la telemedicina y a la atención telefónica a los pacientes.
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Affiliation(s)
- C M Beltran-Aroca
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córboba, España.
| | - M González-Tirado
- Centro de Salud de Villafranca de Córdoba, Villafranca de Córboba, Córdoba, España
| | - E Girela-López
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córboba, España
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18
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Kluger BM, Vaughan CL, Robinson MT, Creutzfeldt C, Subramanian I, Holloway RG. Neuropalliative care essentials for the COVID-19 crisis. Neurology 2020; 95:394-398. [PMID: 32591476 PMCID: PMC7538223 DOI: 10.1212/wnl.0000000000010211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/16/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Benzi M Kluger
- From the Departments of Neurology and Medicine (B.M.K. and R.G.H.), University of Rochester Medical Center, NY; Departments of Neurology and Medicine (C.L.V.), University of Colorado Anschutz Medical Campus, Aurora; Departments of Neurology and Family Medicine (M.T.R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.C.), University of Washington Harborview Medical Center, Seattle; and Department of Neurology (I.S.), Geffen School of Medicine, UCLA, and West LA Veterans Affairs Medical Center, CA.
| | - Christina L Vaughan
- From the Departments of Neurology and Medicine (B.M.K. and R.G.H.), University of Rochester Medical Center, NY; Departments of Neurology and Medicine (C.L.V.), University of Colorado Anschutz Medical Campus, Aurora; Departments of Neurology and Family Medicine (M.T.R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.C.), University of Washington Harborview Medical Center, Seattle; and Department of Neurology (I.S.), Geffen School of Medicine, UCLA, and West LA Veterans Affairs Medical Center, CA
| | - Maisha T Robinson
- From the Departments of Neurology and Medicine (B.M.K. and R.G.H.), University of Rochester Medical Center, NY; Departments of Neurology and Medicine (C.L.V.), University of Colorado Anschutz Medical Campus, Aurora; Departments of Neurology and Family Medicine (M.T.R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.C.), University of Washington Harborview Medical Center, Seattle; and Department of Neurology (I.S.), Geffen School of Medicine, UCLA, and West LA Veterans Affairs Medical Center, CA
| | - Claire Creutzfeldt
- From the Departments of Neurology and Medicine (B.M.K. and R.G.H.), University of Rochester Medical Center, NY; Departments of Neurology and Medicine (C.L.V.), University of Colorado Anschutz Medical Campus, Aurora; Departments of Neurology and Family Medicine (M.T.R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.C.), University of Washington Harborview Medical Center, Seattle; and Department of Neurology (I.S.), Geffen School of Medicine, UCLA, and West LA Veterans Affairs Medical Center, CA
| | - Indu Subramanian
- From the Departments of Neurology and Medicine (B.M.K. and R.G.H.), University of Rochester Medical Center, NY; Departments of Neurology and Medicine (C.L.V.), University of Colorado Anschutz Medical Campus, Aurora; Departments of Neurology and Family Medicine (M.T.R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.C.), University of Washington Harborview Medical Center, Seattle; and Department of Neurology (I.S.), Geffen School of Medicine, UCLA, and West LA Veterans Affairs Medical Center, CA
| | - Robert G Holloway
- From the Departments of Neurology and Medicine (B.M.K. and R.G.H.), University of Rochester Medical Center, NY; Departments of Neurology and Medicine (C.L.V.), University of Colorado Anschutz Medical Campus, Aurora; Departments of Neurology and Family Medicine (M.T.R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.C.), University of Washington Harborview Medical Center, Seattle; and Department of Neurology (I.S.), Geffen School of Medicine, UCLA, and West LA Veterans Affairs Medical Center, CA
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19
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Biswas S, Adhikari SD, Bhatnagar S. Integration of Telemedicine for Home-Based End-of-Life Care in Advanced Cancer Patients during Nationwide Lockdown: A Case Series. Indian J Palliat Care 2020; 26:S176-S178. [PMID: 33088116 PMCID: PMC7535007 DOI: 10.4103/ijpc.ijpc_174_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 11/19/2022] Open
Abstract
Dignified death is a basic human right that has been widely overlooked in countries like India. During nationwide lockdown, it is extremely challenging to provide quality end-of-life care (EOLC) to all patients with a poor system for dignified death. Telemedicine, whose feasibility for community-based EOLC in rural settings has already been established, was a useful tool for us to overcome these barriers. Adding a widely used smartphone-based application for video calls along with voice calls and text messages made the process more dynamic and convenient. Here, we share our experience with three patients with advanced malignancy in providing EOLC during COVID-19 lockdown. A well-planned study for the utility of this service for a larger cancer patient population from different sociocultural and demographic backgrounds is warranted in the future.
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Affiliation(s)
- Swagata Biswas
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. Bhimrao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shreya Das Adhikari
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. Bhimrao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. Bhimrao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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20
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Mishra S, Biswas S, Bhatnagar S. Palliative Care Delivery in Cancer Patients in the Era of Covid-19 Outbreak: Unique Needs, Barriers, and Tools for Solutions. Indian J Palliat Care 2020; 26:S130-S141. [PMID: 33088103 PMCID: PMC7535008 DOI: 10.4103/ijpc.ijpc_194_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022] Open
Abstract
World is facing a pandemic recently due to the outbreak of COVID-19 infection. Cancer has been identified as one of the major comorbidities which cause more severe disease due to COVID-19 infection. Moreover, there are several resource limitations and restrictions to avail the standard oncological health facilities due to robust measures taken for infection control. In this situation, palliative care in cancer patients deserves special attention. Their symptom management, psychological, social, cultural needs tremendously increase during the epidemic. Thus, we need to recognize the unique palliative care needs of cancer patients during pandemic and formulate the plan to maintain continuity of services. Triaging systems are essential tools for proper resource allocation during a pandemic. Therefore, we suggest triaging tools for emergency in hospital palliative care services: community-based palliative care and end of life care for cancer patients. Incorporation of newer technologies and identifying the potential resources are the other key components of the preparedness strategy.
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Affiliation(s)
- Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. Bhimrao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Swagata Biswas
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. Bhimrao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. Bhimrao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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