1
|
Steinfeldt J, Wild B, Buergel T, Pietzner M, Upmeier Zu Belzen J, Vauvelle A, Hegselmann S, Denaxas S, Hemingway H, Langenberg C, Landmesser U, Deanfield J, Eils R. Medical history predicts phenome-wide disease onset and enables the rapid response to emerging health threats. Nat Commun 2024; 15:4257. [PMID: 38763986 PMCID: PMC11102902 DOI: 10.1038/s41467-024-48568-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/03/2024] [Indexed: 05/21/2024] Open
Abstract
The COVID-19 pandemic exposed a global deficiency of systematic, data-driven guidance to identify high-risk individuals. Here, we illustrate the utility of routinely recorded medical history to predict the risk for 1883 diseases across clinical specialties and support the rapid response to emerging health threats such as COVID-19. We developed a neural network to learn from health records of 502,460 UK Biobank. Importantly, we observed discriminative improvements over basic demographic predictors for 1774 (94.3%) endpoints. After transferring the unmodified risk models to the All of US cohort, we replicated these improvements for 1347 (89.8%) of 1500 investigated endpoints, demonstrating generalizability across healthcare systems and historically underrepresented groups. Ultimately, we showed how this approach could have been used to identify individuals vulnerable to severe COVID-19. Our study demonstrates the potential of medical history to support guidance for emerging pandemics by systematically estimating risk for thousands of diseases at once at minimal cost.
Collapse
Affiliation(s)
- Jakob Steinfeldt
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik/Centrum, Charitéplatz 1, 10117, Berlin, Germany
- Computational Medicine, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
- Friede Springer Cardiovascular Prevention Center@Charite, Charite - University Medicine Berlin, Berlin, Germany
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Benjamin Wild
- Center for Digital Health, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
| | - Thore Buergel
- Institute of Cardiovascular Sciences, University College London, London, UK
- Center for Digital Health, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
| | - Maik Pietzner
- Computational Medicine, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Precision Health University Research Institute, Queen Mary University of London and Barts NHS Trust, London, UK
| | - Julius Upmeier Zu Belzen
- Center for Digital Health, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
| | - Andre Vauvelle
- Institute of Health Informatics, University College London, London, UK
| | - Stefan Hegselmann
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Massachusetts, USA
- Pattern Recognition and Image Analysis Lab, University of Münster, Münster, Germany
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- British Heart Foundation Data Science Centre, London, UK
- Health Data Research UK, London, UK
- National Institute for Health Research, Biomedical Research Centre at University College London Hospitals National Institute for Health Research, Biomedical Research Centre, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- National Institute for Health Research, Biomedical Research Centre at University College London Hospitals National Institute for Health Research, Biomedical Research Centre, London, UK
| | - Claudia Langenberg
- Computational Medicine, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Precision Health University Research Institute, Queen Mary University of London and Barts NHS Trust, London, UK
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik/Centrum, Charitéplatz 1, 10117, Berlin, Germany
- Friede Springer Cardiovascular Prevention Center@Charite, Charite - University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Berlin, Germany
| | - John Deanfield
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Roland Eils
- Center for Digital Health, Berlin Institute of Health (BIH), Charite - University Medicine Berlin, Berlin, Germany.
- Health Data Science Unit, Heidelberg University Hospital and BioQuant, Heidelberg, Germany.
| |
Collapse
|
2
|
Gutiérrez-Sánchez D, López-Leiva I, Martín-de-Las-Heras S, Rubio L, Martín-Martín J. Validation of the Collett-Lester fear of death scale in occupational therapy students: psychometric testing and implications for palliative care education. BMC Palliat Care 2024; 23:47. [PMID: 38378523 PMCID: PMC10880346 DOI: 10.1186/s12904-024-01386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/15/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The fear of death is a common experience among healthcare students and professionals that may impact the quality of care provided to patients, particularly those receiving palliative care. The Collett-Lester Fear of Death Scale is a widely used instrument to assess this fear, although its psychometric properties have not been extensively studied in Occupational Therapy students. The present study aimed to validate the Collett-Lester Fear of Death Scale (CL-FODS) in a sample of Occupational Therapy students and to explore its implications for palliative care education. METHOD A cross-sectional study was conducted to perform psychometric testing of the CL-FODS in Occupational Therapy undergraduate students. Structural validity, internal consistency, and test-retest reliability were analysed. A total of 195 Occupational Therapy students were included in this study. Additionally, the participants completed a brief survey on their experiences and attitudes towards palliative care. RESULTS The internal consistency was satisfactory (α = 0.888). The exploratory factor analysis to evaluate the internal structure yielded four factors. The model fit indices were: comparative fit index = 0.89, and root mean square error of approximation = 0.06). The test-retest reliability was satisfactory and demonstrated an intraclass correlation coefficient of 0.939. CONCLUSION The Spanish version of the CL-FODS showed satisfactory psychometric properties; therefore, assessing fear of death in Occupational Therapy students is helpful. This study highlights the importance of addressing fear of death and palliative care education in Occupational Therapy undergraduates to improve future professional attitudes and, consequently, the quality of patient care at the end of life.
Collapse
Affiliation(s)
- Daniel Gutiérrez-Sánchez
- Faculty of Health Sciences, Department of Nursing, University of Málaga, Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Inmaculada López-Leiva
- Faculty of Health Sciences, Department of Nursing, University of Málaga, Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Stella Martín-de-Las-Heras
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
- Legal and Forensic Medicine Area, Department of Human Anatomy, Legal Medicine and History of Science, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Leticia Rubio
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain.
- Legal and Forensic Medicine Area, Department of Human Anatomy, Legal Medicine and History of Science, Faculty of Medicine, University of Málaga, Málaga, Spain.
| | - Jaime Martín-Martín
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
- Legal and Forensic Medicine Area, Department of Human Anatomy, Legal Medicine and History of Science, Faculty of Medicine, University of Málaga, Málaga, Spain
| |
Collapse
|
3
|
Rohilla KK, Kalyani CV, Gupta A, Gupta S, Gupta M, Matella N. Development and Validation of Palliative Care Bundle for Advanced Gallbladder Cancer "PALLICR". South Asian J Cancer 2023; 12:384-389. [PMID: 38130282 PMCID: PMC10733058 DOI: 10.1055/s-0043-1764377] [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] [Indexed: 12/23/2023] Open
Abstract
Kusum K. RohillaBackground The aim of this study was to develop and validate a comprehensive palliative care bundle "PALLICR" for advanced gallbladder cancer (GBC) patients. Materials and Methods The present study was an exploratory study with instrument validation design which was conducted at All India Institute of Medical Sciences, Rishikesh, India. A total of 25 advance cancer patients were selected using the purposive sampling technique. Results The newly developed PALLICR bundle consists of six items under three subfactors, that is, functional recovery, resilience, and quality of life. The final version of bundle with six items of PALLICR bundle was validated and showed a good fit to provide palliative care to advanced GBC patients. Standardized scales, that is, palliative care outcome scale, European Organization for Research and Treatment of Cancer quality-of-life scale for patients and caregiver strain index for caregivers were used for evaluation of PALLICR bundle effectiveness. Conclusion PALLICR bundle is valid and reliable methods to provide palliative care to advanced GBC patients.
Collapse
Affiliation(s)
- Kusum K. Rohilla
- College of Nursing, All India Institute of Medical Sciences, Deoghar, India
| | - C Vasantha Kalyani
- College of Nursing, All India Institute of Medical Sciences, Deoghar, India
| | - Amit Gupta
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Sweety Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Manoj Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | | |
Collapse
|
4
|
Matthys M, Chambaere K, Beernaert K, Cohen J, Van Brussel L, Deforche B, Quintiens B, Deliens L, Dhollander N. What does the general public know about palliative care? A population-based survey. BMJ Support Palliat Care 2023:spcare-2023-004384. [PMID: 37699664 DOI: 10.1136/spcare-2023-004384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES The need for public education on palliative care has been widely argued for. To develop effective educational strategies, a stronger evidence base is needed on what exactly is known and unknown about palliative care as well as what the differences are between subgroups. METHODS We conducted a cross-sectional population-based survey. Mail questionnaires were sent to a random sample of 4400 citizens (aged ≥16 years) within 4 municipalities in Flanders, Belgium. The Palliative Care Knowledge Scale (PaCKS) was used to measure knowledge. Associations between knowledge and sociodemographics and various experiential factors were tested, as well as the congruence between actual and self-perceived knowledge scores. RESULTS Response was obtained from 2008 (45.6%) citizens. The mean PaCKS score was 7.87 (SD 3.41; range 0-13) with the highest proportion (84.7%) correctly answering that palliative care is not specifically for older adults and the lowest (32.1%) correctly answering that improving the ability to participate in daily life is a palliative care goal. Being aged between 30 and 59, non-religious, more highly educated, having professional healthcare experience and knowing palliative care through personal experience were significantly associated with higher knowledge, while sex and informal caregiving experience were not. 52.4% self-perceived their knowledge as lower than it actually was. CONCLUSIONS While the general public seems to be familiar with some basic concepts of palliative care, several key aspects remain unknown. Educational strategies, with suggested potential for community-based and experience-based approaches, may need to focus specifically on these aspects and not just on the broader palliative care concept.
Collapse
Affiliation(s)
- Marjolein Matthys
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Medicine & Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | - Benedicte Deforche
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Movement and Nutrition for Health and Performance Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bert Quintiens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Medicine & Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Naomi Dhollander
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Medicine & Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
5
|
Sánchez-Cárdenas MA, León-Delgado MX, Rodríguez-Campos LF, Correa-Morales JE, González-Salazar LV, Cañón Piñeros ÁM, Fuentes-Bermúdez GP, María Vargas-Escobar L. Building an action plan to tackle palliative care inequality through multi-stakeholder platforms. Palliat Care Soc Pract 2023; 17:26323524231189520. [PMID: 37584058 PMCID: PMC10424546 DOI: 10.1177/26323524231189520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/05/2023] [Indexed: 08/17/2023] Open
Abstract
Background To achieve universal care and overcome existing barriers, the most effective strategy is to devise an action plan that incorporates palliative care into primary health care (PHC), as recommended by the World Health Organization's (WHO) Astana Declaration. In Colombia, a country with an upper-middle-income status, about 128,000 individuals experience severe health-related suffering (SHS) that necessitates palliative care. Although the country's healthcare system has made steady strides in the integration and development of palliative care, there is still no national plan in place for palliative care. Objective Build up Colombia's palliative care plan through stakeholder consensus. Method Based on the participatory action research method and the multi-stakeholder platforms model, this study convened 142 stakeholders from different levels of the health system (patient representatives, journalists, health professionals, government entities, insurance companies, universities, and drug regulatory authorities). Results The national plan aims to achieve its objectives through a series of strategic actions. These include integrating and diversifying palliative care services, improving access to opioids, increasing palliative care education, promoting community-based palliative care programs, securing funding, and implementing a regulatory framework for palliative care by public policymakers. Conclusions The national palliative care is an alliance that aims to reduce palliative care inequity in Colombia by 2026 by empowering stakeholders nationwide to collaborate around specific goals and objectives.
Collapse
|
6
|
Salas Moreira AP, Baceiredo BG, Centeno C, Reigada C. Educational innovation as a communication strategy in palliative care: A study protocol and preliminary results. PLoS One 2023; 18:e0286343. [PMID: 37294774 PMCID: PMC10256175 DOI: 10.1371/journal.pone.0286343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/02/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Society associates palliative care with "death" or "end of life", which cause them fear and anxiety. In Spain, the media worsens the misunderstanding by depicting a wrong picture of palliative care. Educational innovation for university students may serve as an alternative communication strategy. Care and Society is a university course designed by and for students from non-health degrees to help disseminate the palliative care message. The first year of the Teach-Inn Pal project aims to evaluate the effects of the course and to identify areas of improvement. OBJECTIVE To present an evaluation to determine if the course can work as a campaign to refocus the public opinion on palliative care and share the preliminary results of the pilot study. METHODOLOGY A prospective Participatory Action Research study. University students enrolled in the course (n = 29) are invited to test and redesign the palliative care message. Knowledge and empathy will be measured throughout the learning process. Afterwards, qualitative, thematic, inductive analysis of the course material will be carried out. This study is registered on the ISRCTN Registry under the name "Can a university course help communicate palliative care?" (Registration number: ISRCTN10236642). DISCUSSION This study is part of a doctoral thesis. Education is used as a creative outlet, allowing rapid testing of multiple tools to create ambassadors of palliative care that may reframe the public opinion. CONCLUSION The understanding of students about palliative care changed, the overall impression of the experience was positive, and students were also able to explain palliative care to people with little or no experience in the topic. However, to determine if they became ambassadors the results of the mid-term assessment are required.
Collapse
Affiliation(s)
- Ana Paula Salas Moreira
- ATLANTES Global Observatory of Palliative Care, Culture and Society Institute, University of Navarra, Pamplona, Spain
| | - Beatriz Gómez Baceiredo
- ATLANTES Global Observatory of Palliative Care, Culture and Society Institute, University of Navarra, Pamplona, Spain
- Journalism Department, School of Communication of the University of Navarra, Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative Care, Culture and Society Institute, University of Navarra, Pamplona, Spain
| | - Carla Reigada
- ATLANTES Global Observatory of Palliative Care, Culture and Society Institute, University of Navarra, Pamplona, Spain
| |
Collapse
|
7
|
Davies I, Meystre C, Dale J. Do Healthy People Engage With Education About Death, Dying and Advance Care Planning? An Early Evaluation of the Omega Course. Am J Hosp Palliat Care 2023; 40:67-73. [PMID: 36270635 DOI: 10.1177/10499091221116794] [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: 12/15/2022] Open
Abstract
Background: Death can be difficult to address personally, to discuss and to plan for. Since 2016 The Omega Course (Omega) has educated local people in Kenilworth, UK, about death and dying; broaching these issues and teaching communication skills whilst enabling social interaction. It aspires to produce practical outcomes with positive implications for end of life (EoL) planning and future neighbourhood care within the town. Aim: To investigate the impact of Omega on the attitudes and actions of participants. Method: Anonymous questionnaires, distributed by Qualtrics, or by post if preferred, were sent to 62 participants of Omega aged 22-94 two and a half years post course institution. Thematic analysis and inferential statistics were used. Results: 23 replies (37%) scored changes across 4 areas; barriers to discussion, ease discussing death, fears about death and future planning capability. All showed a significant beneficial change using a Paired Sample t-test (P< .01). Respondents noted common fears of death and dying, barriers to discussing the topic and planning for it. The course helped to allay fear, enabled discussion and encouraged planning for death and EoL. Respondents rated the course as 9.1/10 for achieving its aims. They appreciated discussing death and dying in a supportive environment and found the approach effective in developing their skills and changing attitudes. Conclusion: Omega has the potential to change attitudes towards death; promoting discussion, planning, and tackling misconceptions.
Collapse
|
8
|
Dakka FJ. Nurses Barriers to Evidence-Based Practice in Palliative Care: A Systematic Review. SAGE Open Nurs 2022; 8:23779608221142957. [PMCID: PMC9742693 DOI: 10.1177/23779608221142957] [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: 09/20/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
Background Research shows low evidence-based practice (EBP) uptake among palliative care nurses, a global concern because the demand for palliative care services is rising, raising the urgent need to improve healthcare quality. Promoting EBP uptake in palliative care can improve healthcare quality. This systematic review investigated nurses’ barriers to EBP implementation in palliative care. Methods PubMed, MEDLINE, CINHAL, and Google Scholar were used to identify seven articles. Articles were included for review if they were published within the past 10 years (English only) and investigated barriers to EBP implementation in palliative care. Results Four barriers were identified: (a) time and resource constraints, (b) lack of readiness for organizational change, (c) negative attitudes toward palliative care, and (d) process-specific difficulties. Conclusion This systematic review's findings can inform policy changes to improve the uptake of EBP in palliative care.
Collapse
Affiliation(s)
- Falah Jamal Dakka
- Falah Jamal Dakka, Arbel Geriatric Center—Moria Group, ELHANAN 4, Petah Tikva, Israel.
| |
Collapse
|
9
|
Oji N, Onyeka T, Soyannwo O, Paal P, Elsner F. Perspectives, perceived self-efficacy, and preparedness of newly qualified physicians' in practising palliative care-a qualitative study. Palliat Care 2022; 21:141. [PMID: 35922778 PMCID: PMC9351146 DOI: 10.1186/s12904-022-01028-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dealing with life-limiting illnesses, death, dying and grief, is uncharted territory for medical graduates. It is a field that is heavily influenced by cultural, religio-spiritual and social factors. This adds complexity to palliative and end-of-life-care, which challenges newly qualified physicians and requires the formation of appropriate knowledge, skills, and attitudes in junior doctors. This study aimed to obtain insight into the perspectives, perceived self-efficacy, and preparedness of newly qualified Nigerian physicians in practising palliative care and identify potential variables influencing them. METHODS The study was a cross-sectional, multi-centre survey of newly qualified Nigerian physicians, using semi-structured, in-depth qualitative interviews. The data were analysed by applying content-structuring qualitative content analysis. RESULTS Forty semi-structured interviews were conducted with medical house officers at two tertiary institutions in Nigeria. The perceived self-efficacy and preparedness of newly qualified Nigerian physicians in practising palliative care were reported to be higher in areas of family involvement, and pain and symptom management than in areas of breaking bad news, prognosis, and diagnosing dying. Major influences on the young physicians' perceived self-efficacy and preparedness in practising palliative care were socio-economic circumstances of a resource-limited setting and cultural-religious considerations. In addition, the perceived impact of palliative care education and experience was documented. CONCLUSIONS This study offers valuable insights into the perceived self-efficacy and preparedness of newly qualified physicians and reveals the influence of socio-cultural and socio-economic variables in Nigeria. Evidence of the social, cultural, and religio-spiritual dimensions of palliative care is indispensable for culturally sensitive care. These results could aid in the development of appropriate knowledge, skills, and attitudes in newly qualified physicians through culturally and contextually appropriate palliative care training measures. The results may be applicable to other sub-Saharan African settings and may be used to improve future palliative care education, training, and practice.
Collapse
Affiliation(s)
- Nwabata Oji
- Department of Palliative Medicine, Uniklinik RWTH Aachen, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 57, 52074, Aachen, Germany.
| | - Tonia Onyeka
- Department of Anaesthesia / Pain and Palliative Care Unit, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Olaitan Soyannwo
- Hospice and Palliative Care Department, University College Hospital Ibadan, Queen Elizabeth Road, Ibadan, Oyo State, Nigeria
| | - Piret Paal
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Frank Elsner
- Department of Palliative Medicine, Uniklinik RWTH Aachen, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 57, 52074, Aachen, Germany
| |
Collapse
|
10
|
Hasson F, Betts M, Shannon C, Fee A. Roles and responsibilities of the community palliative care key worker: a scoping review. Br J Community Nurs 2022; 27:384-391. [PMID: 35924904 DOI: 10.12968/bjcn.2022.27.8.384] [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: 11/11/2022]
Abstract
This article illustrates the completion of a scoping review of the evidence relating to the role of the palliative care key worker, providing an insight into current literature. While advocated in international and national policies, the evidence underpinning this role is lacking, with only five empirical papers: two national and three international. The review identifies the need for the key worker role in palliative care; however, little consensus exists on who should adopt this role and their remits. Several implementation barriers are cited relating to communication and training. Further research on the development, implementation and consensus on the allocation of duties of the key worker role would expand the existing evidence base.
Collapse
Affiliation(s)
- Felicity Hasson
- Senior Lecturer, Institute of Nursing and Health Research, Ulster University, Northern Ireland
| | - Maria Betts
- MSc Student, Institute of Nursing and Health Research, Ulster University, Northern Ireland
| | - Christine Shannon
- Research Associate, Institute of Nursing and Health Research, Ulster University, Northern Ireland
| | - Anne Fee
- Research Associate, Institute of Nursing and Health Research, Ulster University, Northern Ireland
| |
Collapse
|
11
|
Rao SR, Salins N, Goh CR, Bhatnagar S. “Building palliative care capacity in cancer treatment centres: a participatory action research”. Palliat Care 2022; 21:101. [PMID: 35659229 PMCID: PMC9166521 DOI: 10.1186/s12904-022-00989-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
There is a significant lack of palliative care access and service delivery in the Indian cancer institutes. In this paper, we describe the development, implementation, and evaluation of a palliative care capacity-building program in Indian cancer institutes.
Methods
Participatory action research method was used to develop, implement and evaluate the outcomes of the palliative care capacity-building program. Participants were healthcare practitioners from various cancer institutes in India. Training and education in palliative care, infrastructure for palliative care provision, and opioid availability were identified as key requisites for capacity-building. Researchers developed interventions towards capacity building, which were modified and further developed after each cycle of the capacity-building program. Qualitative content analysis was used to develop an action plan to build capacity. Descriptive statistics were used to measure the outcomes of the action plan.
Results
Seventy-three healthcare practitioners from 31 cancer treatment centres in India were purposively recruited between 2016 and 2020. The outcome indicators of the project were defined a priori, and were audited by an independent auditor. The three cycles of the program resulted in the development of palliative care services in 23 of the 31 institutes enrolled in the program. Stand-alone palliative care outpatient services were established in all the 23 centres, with the required infrastructure and manpower being provided by the organization. Morphine availability improved and use increased in these centres, which was an indication of improved pain management skills among the participants. The initiation and continuation of education, training, and advocacy activities in 20 centres suggested that healthcare providers continued to remain engaged with the program even after the cessation of their training cycle.
Conclusion
This program illustrates how a transformational change at the organizational and individual level can lead to the development of sustained provision of palliative care services in cancer institutes.
Collapse
|
12
|
Chen L, Li XH, Pan X, Pan QN, Huang HQ, Tao PY, Li GY, Ma JH, Huang JC. Nurses' knowledge, attitudes, and willingness to practice hospice care: An analysis of influencing factors. PLoS One 2022; 17:e0259647. [PMID: 35202415 PMCID: PMC8870562 DOI: 10.1371/journal.pone.0259647] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hospice care is a multidisciplinary approach that focused on patients’ quality of life, and nurses allocate more of their time with patients and patients’ families than those nurses working in other disciplines. Nurses’ knowledge of and attitudes toward hospice care can affect the quality of hospice care. At present, China’s hospice care institutions are suffering from an obvious shortage of nursing staff. Since clinical nurses are the main force behind the future provision of hospice care, their knowledge of, attitudes and willingness to practice can greatly promoted the growth of hospice care, however, available data on clinical nurses’ willingness to practice hospice care are limited. Methods A cross-sectional descriptive study design was employed to collect data from 1833 nurses working in tertiary or secondary general hospitals in Guangxi, China. We examined nurses’ demographic characteristics and scores on the Chinese version of the hospice care knowledge scale, the Chinese version of the Bradley Attitude Assessment Questionnaire, and a brief quiz concerning their willingness to practice hospice care in the future. Descriptive, single factor, multiple regression analyses and logistic regression analyses were used for data analysis. Results Nurses displayed moderate mean scores for both knowledge of and attitudes, and only 505 (27.5%) nurses expressed their willingness to practice hospice care, 1329 (72.5%) of nurses sampled expressed their unwillingness or uncertainty. Multivariate regression analyses showed that education, professional qualification, monthly income, whether they had been trained in hospice care, and willingness to practice hospice care were the main influencing factors of knowledge; education, whether they lived with someone aged >60 years, and whether they had been trained in hospice care were main factors influencing attitudes. Additionally, logistic regression analyses showed that hospice care knowledge, whether they had been trained in hospice care, and whether they had clinical experience affected the nurses’ willingness to practice hospice care. Conclusion This study highlighted a knowledge gap and moderate attitudes toward hospice care among nurses, and most nurses did not prefer to practice hospice care. Having been trained in hospice care was the main common factor of nurses’ knowledge of, attitudes toward, and willingness to practice hospice care in the future, indicating the necessity to provide nurses with more targeted hospice care training.
Collapse
Affiliation(s)
- Lin Chen
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao-Hong Li
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao Pan
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qi-Ni Pan
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hui-Qiao Huang
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- * E-mail: (HQH); (PYT)
| | - Pin-Yue Tao
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- * E-mail: (HQH); (PYT)
| | - Gao-Ye Li
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guxngxi, China
| | - Jin-Hui Ma
- Department of Nursing, The Fifth People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jing-Can Huang
- Department of Nursing, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| |
Collapse
|
13
|
Vaismoradi M, Behboudi-Gandevani S, Lorenzl S, Weck C, Paal P. Needs Assessment of Safe Medicines Management for Older People With Cognitive Disorders in Home Care: An Integrative Systematic Review. Front Neurol 2021; 12:694572. [PMID: 34539551 PMCID: PMC8446192 DOI: 10.3389/fneur.2021.694572] [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: 04/13/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: The global trend of healthcare is to improve the quality and safety of care for older people with cognitive disorders in their own home. There is a need to identify how medicines management for these older people who are cared by their family caregivers can be safeguarded. This integrative systematic review aimed to perform the needs assessment of medicines management for older people with cognitive disorders who receive care from their family caregivers in their own home. Methods: An integrative systematic review of the international literature was conducted to retrieve all original qualitative and quantitative studies that involved the family caregivers of older people with cognitive disorders in medicines management in their own home. MeSH terms and relevant keywords were used to search four online databases of PubMed (including Medline), Scopus, CINAHL, and Web of Science and to retrieve studies published up to March 2021. Data were extracted by two independent researchers, and the review process was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Given that selected studies were heterogeneous in terms of the methodological structure and research outcomes, a meta-analysis could not be performed. Therefore, narrative data analysis and knowledge synthesis were performed to report the review results. Results: The search process led to retrieving 1,241 studies, of which 12 studies were selected for data analysis and knowledge synthesis. They involved 3,890 older people with cognitive disorders and 3,465 family caregivers. Their methodologies varied and included cohort, randomised controlled trial, cross-sectional studies, grounded theory, qualitative framework analysis, and thematic analysis. The pillars that supported safe medicines management with the participation of family caregivers in home care consisted of the interconnection between older people's needs, family caregivers' role, and collaboration of multidisciplinary healthcare professionals. Conclusion: Medicines management for older people with cognitive disorders is complex and multidimensional. This systematic review provides a comprehensive image of the interconnection between factors influencing the safety of medicines management in home care. Considering that home-based medicines management is accompanied with stress and burden in family caregivers, multidisciplinary collaboration between healthcare professionals is essential along with the empowerment of family caregivers through education and support.
Collapse
Affiliation(s)
| | | | - Stefan Lorenzl
- Palliative Care, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum Agatharied, Hausham, Germany
| | - Christiane Weck
- Palliative Care, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum Agatharied, Hausham, Germany
| | - Piret Paal
- WHO Collaborating Centre at the Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
14
|
Pilch M, Lunt V, May P, Mockler D, Thomas S, Doyle F. Facilitators and barriers to stakeholder engagement in advance care planning for older adults in community settings: a hybrid systematic review protocol. HRB Open Res 2021; 3:38. [PMID: 34212126 PMCID: PMC8212429 DOI: 10.12688/hrbopenres.13082.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Poor stakeholder engagement in advance care planning (ACP) poses national and international challenges, preventing maximisation of its potential benefits. Conceptualisation of advance care planning as a health behaviour highlights the need to design innovative, evidence-based strategies that will facilitate meaningful end-of-life care decision-making. Aim: To review systematically and synthesise quantitative and qualitative evidence on barriers and facilitators to stakeholders` engagement in ACP for older adults (≥ 50 years old) in a community setting. Methods: A hybrid systematic review will be conducted, identifying studies for consideration in two phases. First, databases will be searched from inception to identify relevant prior systematic reviews, and assess all studies included in those reviews against eligibility criteria (Phase 1). Second, databases will be searched systematically for individual studies falling outside the timeframe of those reviews (Phase 2). A modified SPIDER framework informed eligibility criteria. A study will be considered if it (a) included relevant adult stakeholders; (b) explored engagement in ACP among older adults (≥50 years old); (c) employed any type of design; (d) identified enablers and/or barriers to events specified in the Organising Framework of ACP Outcomes; (e) used either quantitative, qualitative, or mixed methods methodology; and (f) evaluated phenomena of interest in a community setting (e.g., primary care or community healthcare centres). Screening, selection, bias assessment, and data extraction will be completed independently by two reviewers. Integrated methodologies will be employed and quantitative and qualitative data will be combined into a single mixed method synthesis. The Behaviour Change Wheel will be used as an overarching analytical framework and to facilitate interpretation of findings. The Joanna Briggs Institute (JBI) Reviewers` Manual and PRISMA-P guidelines have been used to inform this protocol development. Registration: This protocol has been submitted for registration on PROSPERO, registration number CRD42020189568 and is awaiting review.
Collapse
Affiliation(s)
- Monika Pilch
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Victoria Lunt
- Beaumont Hospital and St Luke's Radiation Oncology Centre at Beaumont Hospital, Beaumont Hospital, Beaumont, Dublin, D9, Ireland
| | - Peter May
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
- The Irish Longitudinal study on Ageing (TILDA), Trinity College Dublin, Dublin, D2, Ireland
| | - David Mockler
- The Library of Trinity College Dublin, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Stephen Thomas
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, D2, Ireland
| |
Collapse
|
15
|
McIlfatrick S, Slater P, Beck E, Bamidele O, McCloskey S, Carr K, Muldrew D, Hanna-Trainor L, Hasson F. Examining public knowledge, attitudes and perceptions towards palliative care: a mixed method sequential study. BMC Palliat Care 2021; 20:44. [PMID: 33731087 PMCID: PMC7971949 DOI: 10.1186/s12904-021-00730-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Palliative care is recognised as a public health issue with the need for earlier integration in the wider healthcare system. However, research indicates that it continues to be accessed late in the course of an illness, public understanding of palliative care is limited, and common misconceptions prevail. Strategies to address this are needed in order to reduce barriers to palliative care delivery and improve access. Methods An explanatory sequential mixed methods study, comprising a cross-sectional survey and interviews was undertaken. Sociodemographic characteristics, public awareness, knowledge and perceptions of palliative care were examined and strategies to raise awareness and overcome barriers within a public health framework were identified. Survey data were analysed using SPSS v25 with factor analysis and non-parametric statistics and qualitative data were analysed using thematic analysis. Results A total of 1201 participants completed the survey (58.3% female, mean age 61 years) and 25 took part in interviews. A fifth of participants (20.1%) had previously heard about palliative care and had an accurate understanding of the term. Being female, higher educated, married, and older, increased respondents’ levels of awareness. The three most commonly held misconceptions included: Palliative care is exclusively for people who are in the last 6 months of life (55.4% answered incorrectly); A goal of palliative care is to address any psychological issues brought up by serious illness (42.2% answered incorrectly); and a goal of palliative care is to improve a person’s ability to participate in daily activities (39.6% answered incorrectly). Talking about palliative and end of life care was advocated but societal taboos restricted this occurring with exposure limited to personal experience. Conclusions Current knowledge gaps and misconceptions derived from limited ad hoc personal experiences and fear of engaging in taboo conversations may deter people from accessing integrated palliative care services early in a disease trajectory. The results indicate the need for public education programmes that move beyond merely raising awareness but provide key messages within a public health approach, which may change attitudes to palliative care thus ultimately improving end of life outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00730-5.
Collapse
Affiliation(s)
- Sonja McIlfatrick
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland.
| | - Paul Slater
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| | - Esther Beck
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| | - Olufikayo Bamidele
- Institute of Clinical and Applied Health Research, Hull York Medical School, Allam Medical Building, University of Hull, Hull, HU6 7RX, UK
| | - Sharon McCloskey
- Southern Health and Social Care Trust, The Rowans, Craigavon Area Hospital, Lurgan Road, Portadown, BT36 5QQ, Northern Ireland
| | - Karen Carr
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| | - Deborah Muldrew
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| | - Lisa Hanna-Trainor
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| | - Felicity Hasson
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| |
Collapse
|
16
|
Arias-Casais N, Garralda E, Sánchez-Cárdenas MA, Rhee JY, Centeno C. Evaluating the integration of palliative care in national health systems: an indicator rating process with EAPC task force members to measure advanced palliative care development. BMC Palliat Care 2021; 20:36. [PMID: 33627130 PMCID: PMC7905655 DOI: 10.1186/s12904-021-00728-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology. AIM To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above. METHODS A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy. RESULTS The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines. CONCLUSION Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.
Collapse
Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.
| | - Eduardo Garralda
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,IdiSNA (Institute of Health Research of Navarra), Pamplona, Spain
| | - Miguel Antonio Sánchez-Cárdenas
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,IdiSNA (Institute of Health Research of Navarra), Pamplona, Spain
| | - John Y Rhee
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,Department of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,IdiSNA (Institute of Health Research of Navarra), Pamplona, Spain
| |
Collapse
|
17
|
Gutiérrez-Sánchez D, Gómez-García R, Cuesta-Vargas AI, Pérez-Cruzado D. The suffering measurement instruments in palliative care: A systematic review of psychometric properties. Int J Nurs Stud 2020; 110:103704. [PMID: 32717488 DOI: 10.1016/j.ijnurstu.2020.103704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/20/2020] [Accepted: 06/27/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The relief of suffering is considered one of the main goals to reach at the end of life, and nurses play an essential role in the prevention and relief of suffering. Validated instruments for assessing suffering can be useful, and selection of the most appropriate measure is crucial. To date, no systematic review has been performed that contrasts the measurement properties of instruments assessing suffering in the palliative care population, according to the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments methodology. OBJECTIVES The aim of this systematic review is twofold: (1) identify the measures assessing suffering in the palliative care population, and (2) assess the measurement properties of these measures. DESIGN A systematic review of the measurement properties of instruments assessing suffering in palliative care was carried out. DATA SOURCES The search strategy was conducted in Medline, CINAHL, PsycINFO, Web of Science, Cochrane Library, SciELO, Scopus, Cosmin database of systematic reviews and Open gray. REVIEW METHODS The following methodologies were applied: updated COnsensus-based Standards for the selection of health status Measurement INstruments, the Meta-Analysis of Observational Studies in Epidemiology, and the Assessing the Methodological Quality of Systematic Reviews tool. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42018106488). Eligible studies were those that satisfied the following criteria: a) validation studies of measures assessing suffering in the palliative care population, b) assessing at least one measurement property of a measure, c) published in English or Spanish and d) published between January 1980 and September 2019. The included studies were assessed for the methodological quality of the measurement properties and then compared in terms of both the measurement properties and the methodological quality of the processes used. The evidence for each measurement property was summarised and the quality of the evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS The search strategy yielded a total of nine studies and six instruments assessing suffering. The methodological quality of the studies was doubtful and the quality of the evidence was moderate for most of the measurement properties analysed. The Suffering Pictogram was the instrument with the best rating for methodological quality and quality of evidence, for most of the measurement properties evaluated. CONCLUSIONS Instruments assessing suffering in palliative care have been identified in this systematic review. The Suffering Pictogram seems to be the most useful instrument identified. Tweetable abstract: The relief of suffering is one of the main goals to reach at the end of life, and the selection of the most appropriate measure for assessing this construct is crucial.
Collapse
Affiliation(s)
- Daniel Gutiérrez-Sánchez
- Department of Nursing and Podiatry, University of Málaga, Spain; Biomedical Research Institute of Málaga (IBIMA), Spain
| | - Rafael Gómez-García
- Biomedical Research Institute of Málaga (IBIMA), Spain; Cudeca Foundation, Málaga, Spain
| | - Antonio I Cuesta-Vargas
- Biomedical Research Institute of Málaga (IBIMA), Spain; Department of Physiotherapy, University of Málaga, Spain; Queensland University of Technology, Queensland, Australia.
| | - David Pérez-Cruzado
- Biomedical Research Institute of Málaga (IBIMA), Spain; Occupational Therapy Department. San Antonio Catholic University of Murcia, Murcia, Spain
| |
Collapse
|
18
|
Tziraki C, Grimes C, Ventura F, O’Caoimh R, Santana S, Zavagli V, Varani S, Tramontano D, Apóstolo J, Geurden B, De Luca V, Tramontano G, Romano MR, Anastasaki M, Lionis C, Rodríguez-Acuña R, Capelas ML, dos Santos Afonso T, Molloy DW, Liotta G, Iaccarino G, Triassi M, Eklund P, Roller-Wirnsberger R, Illario M. Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases. Prim Health Care Res Dev 2020; 21:e32. [PMID: 32928334 PMCID: PMC7503185 DOI: 10.1017/s1463423620000328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
Collapse
Affiliation(s)
- Chariklia Tziraki
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
- MELABEV – Community Clubs for Elders, Jerusalem, Israel
| | | | - Filipa Ventura
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Rónán O’Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - Silvina Santana
- Department of Economics, Management, Industrial Engineering and Tourism, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | | | | | - Donatella Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - João Apóstolo
- Department of Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Bart Geurden
- Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincenzo De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Giovanni Tramontano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Maria Rosaria Romano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Lionis
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Manuel Luis Capelas
- Interdisciplinary Health Research Center (CIIS), Institute of Health Sciences, Portuguese Catholic University, Lisbon, Portugal
| | - Tânia dos Santos Afonso
- Faculty of Pharmacy, Center for Pharmaceutical Studies, University of Coimbra, Coimbra, Portugal
| | - David William Molloy
- Centre for Gerontology and Rehabilitation, School of Medicine, University College of Cork, Cork, Ireland
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Patrik Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | | - Maddalena Illario
- Department of Public Health, Federico II University of Naples, Naples, Italy
- Health Innovation Division, General Directorate for Health, Campania Region, Naples, Italy
| |
Collapse
|
19
|
Pilch M, Lunt V, May P, Mockler D, Thomas S, Doyle F. Facilitators and barriers to stakeholder engagement in advance care planning for older adults in community settings: a hybrid systematic review protocol. HRB Open Res 2020; 3:38. [PMID: 34212126 PMCID: PMC8212429 DOI: 10.12688/hrbopenres.13082.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 04/03/2024] Open
Abstract
Background: Poor stakeholder engagement in advance care planning (ACP) poses national and international challenges, preventing maximisation of its potential benefits. Conceptualisation of advance care planning as a health behaviour highlights the need to design innovative, evidence-based strategies that will facilitate meaningful end-of-life care decision-making. Aim: To review systematically and synthesise quantitative and qualitative evidence on barriers and facilitators to stakeholders` engagement in ACP for older adults (≥ 50 years old) in a community setting. Methods: A hybrid systematic review will be conducted, identifying studies for consideration in two phases. First, databases will be searched from inception to identify relevant prior systematic reviews, and assess all studies included in those reviews against eligibility criteria (Phase 1). Second, databases will be searched systematically for individual studies falling outside the timeframe of those reviews (Phase 2). A modified SPIDER framework informed eligibility criteria. A study will be considered if it (a) included relevant adult stakeholders; (b) explored engagement in ACP among older adults (≥50 years old); (c) employed any type of design; (d) identified enablers and/or barriers to events specified in the Organising Framework of ACP Outcomes; (e) used either quantitative, qualitative, or mixed methods methodology; and (f) evaluated phenomena of interest in a community setting (e.g., primary care or community healthcare centres). Screening, selection, bias assessment, and data extraction will be completed independently by two reviewers. Integrated methodologies will be employed and quantitative and qualitative data will be combined into a single mixed method synthesis. The Behaviour Change Wheel will be used as an overarching analytical framework and to facilitate interpretation of findings. The Joanna Briggs Institute (JBI) Reviewers` Manual and PRISMA-P guidelines have been used to inform this protocol development. Registration: This protocol has been submitted for registration on PROSPERO and is awaiting review.
Collapse
Affiliation(s)
- Monika Pilch
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Victoria Lunt
- Beaumont Hospital and St Luke's Radiation Oncology Centre at Beaumont Hospital, Beaumont Hospital, Beaumont, Dublin, D9, Ireland
| | - Peter May
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
- The Irish Longitudinal study on Ageing (TILDA), Trinity College Dublin, Dublin, D2, Ireland
| | - David Mockler
- The Library of Trinity College Dublin, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Stephen Thomas
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, D2, Ireland
| |
Collapse
|
20
|
Twine CP. Chronic Limb Threatening Ischaemia in Octogenarians: Intervention or Palliation? Eur J Vasc Endovasc Surg 2020; 60:242. [PMID: 32312669 DOI: 10.1016/j.ejvs.2020.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/27/2020] [Indexed: 11/26/2022]
|