Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model

'Well, what do You Want to do?' A Case Study of Community Palliative Care Programme: 'Heidi's Have a Go'

The demand for palliative care has increased in high income countries as mortality in older adults has decreased and life expectancy increased. In this context, the priorities of palliative and end of life care (EoLC) have shifted in Australia, reflected in policy frameworks, national guidelines, service systems and funding models. However, aligning service systems and practice realities with these policy aspirations has been problematic in Australia and elsewhere. The current study investigates the recent implementation of a unique, community palliative care (CPC) programme called Heidi's Have a Go (HHaG) in regional Australia, which seemed to bridge the problematic divide between policy aspirations and practice implementation. Qualitative research was undertaken to examine the programme design and influence from the perspective of programme staff and volunteers. The data generated compelling stories on staff and patient experiences in its first 2 years, achieving service outcomes aligned with current policy and national frameworks and privileging patient voices.

Heidi's legacy: community palliative care at work in regional Australia

Advances in the management of chronic diseases, combined with an aging population, have escalated the prevalence of people with life-limiting conditions and demand for palliative care. In Australia, this has prompted calls for change in policy frameworks, service systems and funding models that underpin care. The complex social, cultural and policy transformation required to enact these changes has been problematic. This paper reports on qualitative research into a unique, Australian Community Palliative Care program reflecting these aspirational changes. The research examined the program design and its implementation through the perspectives of program staff and volunteers.

Barriers in implementing the dying patient law: the Israeli experience - a qualitative study

Background

Coping with end-of-life issues is a major challenge for governments and health systems. Despite progress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel.

Methods

Qualitative in-depth interviews using professionals and decision makers in the health-care and related systems (n = 37) were carried out, along with two focus groups based on brainstorming techniques consisting of nurses (n = 10) and social workers (n = 10). Data was managed and analyzed using Naralyzer software.

Results

Qualitative analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers.

Conclusions

This study highlights the role of the family doctor in end-of-life by training physicians in decision-making workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient’s access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues.

Live discharge from hospice care: psychosocial challenges and opportunities

Hospice social workers face many challenges in attempts to replicate or supplement the holistic support and unique services hospice provides for individuals discharged alive. This discontinuity in care can impact the types of supports needed by individuals and caregivers, which may or may not be accessible within their community. Patients and families who have access to community-based palliative care programs following a discharge generally tend to navigate the process with fewer challenges. This qualitative study (N = 24) explored both the challenges of the live discharge process and the opportunities within social work practice in the US. Results from this study emphasize the need for a framework to better approach a live discharge to ensure appropriate supports are accessible for all patients and caregivers. Specifically, results highlight both the concrete and psychosocial challenges in live discharges as a result of tension between current eligibility requirements and individual feelings and needs. Social workers also provided suggestions to improve the live discharge process, including attention to communication and preparation. This paper outlines specific challenges of live discharge from hospice, a framework for understanding presented challenges, and implications for policy and practice.

A Theoretical Exploration of Live Discharge from Hospice for Caregivers of Adults with Dementia

Patients with dementia may be discharged from hospice if their condition stabilizes. The loss of professional support and an already complex grief process needs careful attention. A live discharge presents a unique experience for each hospice patient, caregiver, and hospice team, which varies from traditional bereavement theories used to describe the grieving process. This article explores live discharge from hospice for caregivers of adults with dementia through a theoretical lens of Symbolic Interactionism (SI) and Attachment Theory (AT). The theories of SI and AT support and assist in understanding the experience of caregivers who lose hospice support due to ineligibility. In addition, caregivers watch the gradual deterioration and psychological loss of someone with dementia while they remain alive described as an ambiguous loss. Ambiguous loss as a subset of traditional bereavement theories provides a framework for this exploration and provides a relevant illustration of the complex needs. This article will conclude with implications for social work practice. It is important for hospice clinicians to be aware of current termination practices necessary to manage appropriate attachments, support the symbolic meaning of the hospice experience, validate the ambiguous losses, and maintain a sense of hope through a live discharge from hospice.