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Liu E, Cid M, Manson DK, Shinall MC, Hua M. Palliative Care Clinicians' Views on Metrics for Successful Specialist Palliative Care Delivery in the ICU. J Pain Symptom Manage 2024; 68:78-85.e4. [PMID: 38631650 DOI: 10.1016/j.jpainsymman.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/02/2024] [Accepted: 04/06/2024] [Indexed: 04/19/2024]
Abstract
CONTEXT A quarter of palliative care (PC) clinicians' consultations are now requested from the intensive care unit (ICU). Despite this high usage, a standardized set of quality metrics for PC delivery in the ICU does not exist. OBJECTIVES To explore PC clinicians' views on how to best measure quality of care delivery in their role as a consultant in the ICU setting. METHODS Secondary analysis of a parent dataset consisting of qualitative data from semi-structured interviews exploring ways to optimize PC clinicians' role in the ICU. Nineteen participants were recruited across five academic medical centers in the US. Participants included PC physicians (n = 14), nurse practitioners (n = 2), and social workers (n = 3). Thematic analysis with an inductive approach was used to generate themes. RESULTS We identified two central themes: difficulties in measuring PC quality in the ICU (theme 1) and tension between the role of PC and metrics (theme 2). Theme 1 had two subthemes related to logistical challenges in measuring outcomes and PC clinicians' preference for metrics that incorporate subjective feedback from patients, family members, and the primary ICU team. Theme 2 described how PC clinicians often felt a disconnect between the goal of meeting a metric and their goals in delivering high-quality clinical care. CONCLUSION Our findings provide insight into PC clinician perspectives on quality metrics and identify major barriers that need to be addressed to successfully implement quality measurement in the ICU setting.
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Affiliation(s)
- Evan Liu
- Tufts University School of Medicine (E.L.), Boston, Massachusetts, USA
| | - Miguel Cid
- Department of Anesthesiology (M.C.), College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Daniel K Manson
- Division of Pulmonary, Allergy, and Critical Care Medicine (D.M.), College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Myrick C Shinall
- Division of General Surgery (M.S.), Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Geriatrics Research, Education, and Clinical Center (M.S.), VA Tennessee Valley Health Care System, Nashville, Tennessee, USA
| | - May Hua
- Department of Anesthesiology (M.H.), College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Epidemiology (M.H.), Mailman School of Public Health, Columbia University, New York, New York, USA.
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2
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Helgeson SA, Burnside RC, Robinson MT, Mack RC, Ball CT, Guru PK, Moss JE. Early Versus Usual Palliative Care Consultation in the Intensive Care Unit. Am J Hosp Palliat Care 2022; 40:544-551. [PMID: 35833450 DOI: 10.1177/10499091221115732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Palliative Medicine involvement in MICU patients have improved length of stay and mortality, but with varying effects on specific patient decision outcomes, such as, advance care planning. These studies have utilized Palliative Medicine later in the hospital or ICU course, with some evidence showing that earlier involvement resulted in better results. The purpose of this study was to evaluate the benefits of early (within 24 hours) palliative care consultation in medical ICU (MICU) patients to clinical and satisfaction outcomes. METHODS An unblinded randomized study performed in the MICU in one academic hospital in the USA. Ninety-one adult patients admitted to MICU received a Palliative care medicine consultation within 24 hours as the intervention. MEASUREMENTS AND RESULTS Ninety-one patients admitted to the MICU underwent randomization with 50 patients randomly assigned to receive Palliative Medicine consultation and 41 patients randomly assigned to receive standard-of-care based on predefined criteria. The median satisfaction score was 23 points higher for the patients in the intervention group (P < .001). The median length of MICU stay was 5 days shorter in the intervention group compared to the control group (95% CI; 1 day to 18 days, P = .018). Advance care planning was completed in the hospital for 34% of patients in the intervention arm and 12% of patients in the controls arm (absolute risk difference 22%, 95% CI 4% to 37%, P = .016). CONCLUSION Early Palliative Medicine consultation within 24 hours of MICU admission showed significant benefits to patients by improving satisfaction and decreasing length of stay. This study provides evidence that Palliative Medicine involvement earlier in the course of severe disease is important. Further studies in other types of intensive care units (neurological and Cardiovascular) are necessary to determine their impact.
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Affiliation(s)
- Scott A Helgeson
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Rebecca C Burnside
- Department of Critical Care Medicine, 8511Lexington Medical Center, West Columbia, SC, USA
| | - Maisha T Robinson
- Departments of Neurology and Palliative Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Rachel C Mack
- Department of Palliative Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen T Ball
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Pramod K Guru
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - John E Moss
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
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3
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Shirley L, DiScala S, Brooks A, Vartan CM, Silverman M. Pilot of a
pharmacist‐integrated
interprofessional team to optimize prescribing in a telemedicine palliative care clinic. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lauren Shirley
- Washington DC VA Medical Center Washington District of Columbia USA
| | - Sandra DiScala
- West Palm Beach VA Medical Center West Palm Beach Florida USA
| | - Abigail Brooks
- West Palm Beach VA Medical Center West Palm Beach Florida USA
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4
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O'Hanlon CE, Lindvall C, Lorenz KA, Giannitrapani KF, Garrido M, Asch SM, Wenger N, Malin J, Dy SM, Canning M, Gamboa RC, Walling AM. Measure Scan and Synthesis of Palliative and End-of-Life Process Quality Measures for Advanced Cancer. JCO Oncol Pract 2020; 17:e140-e148. [PMID: 32758085 DOI: 10.1200/op.20.00240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Monitoring and improving the quality of palliative and end-of-life cancer care remain pressing needs in the United States. Among existing measures that assess the quality of palliative and end-of-life care, many operationalize similar concepts. We identified existing palliative care process measures and synthesized these measures to aid stakeholder prioritization that will facilitate health system implementation in patients with advanced cancer. METHODS We reviewed MEDLINE/PubMed-indexed articles for process quality measures related to palliative and end-of-life care for patients with advanced cancer, supplemented by expert input. Measures were inductively grouped into "measure concepts" and higher-level groups. RESULTS Literature review identified 226 unique measures from 23 measure sources, which we grouped into 64 measure concepts within 12 groups. Groups were advance care planning (11 measure concepts), pain (7), dyspnea (9), palliative care-specific issues (6), other specific symptoms (17), comprehensive assessment (2), symptom assessment (1), hospice/palliative care referral (1), spiritual care (2), mental health (5), information provision (2), and culturally appropriate care (1). CONCLUSION Measure concepts covered the spectrum of care from acute symptom management to advance care planning and psychosocial needs, with variability in the number of measure concepts per group. This taxonomy of process quality measure concepts can be used by health systems seeking stakeholder input to prioritize targets for improving palliative and end-of-life care quality in patients with advanced cancer.
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Affiliation(s)
- Claire E O'Hanlon
- Veterans Affairs Greater Los Angeles Health Care System, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; and Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Karl A Lorenz
- Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Karleen F Giannitrapani
- Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Melissa Garrido
- Veterans Affairs Boston Healthcare System, Partnered Evidence-Based Policy Resource Center, Boston, MA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Steven M Asch
- Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Neil Wenger
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA
| | | | - Sydney Morss Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MDThe views expressed are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government
| | - Mark Canning
- Veterans Affairs Greater Los Angeles Health Care System, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA
| | - Raziel C Gamboa
- Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA
| | - Anne M Walling
- Veterans Affairs Greater Los Angeles Health Care System, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA.,Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA
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5
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Goals of Care: Development and Use of the Serious Veterinary Illness Conversation Guide. Vet Clin North Am Small Anim Pract 2019; 49:399-415. [PMID: 30853241 DOI: 10.1016/j.cvsm.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Goals of care (GOC) conversations and resulting goal-concordant treatment are the heart of palliative medicine. Despite repeated evidence that GOC conversations offer significant benefit and minimal harm, barriers to widespread and high-quality implementation persist in human medicine. One strategy to overcoming these barriers has been utilization of a structured checklist format for serious illness conversations. The Serious Illness Conversation Guide was developed for human patients and has been modified for use in the veterinary profession. The guide promotes individualized, goal-concordant care planning even when conflict and emotional demands are high.
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6
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Mun E, Nakatsuka C, Umbarger L, Ruta R, Mccarty T, Machado C, Ceria-Ulep C. Use of Improving Palliative Care in the ICU (Intensive Care Unit) Guidelines for a Palliative Care Initiative in an ICU. Perm J 2017; 21:16-037. [PMID: 28241905 DOI: 10.7812/tpp/16-037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE For improved utilization of the existing palliative care team in the intensive care unit (ICU), a process was needed to identify patients who might need a palliative care consultation in a timelier manner. METHODS A systematic method to create a new program that would be compatible with our specific ICU environment and patient population was developed. A literature review revealed a fairly extensive array of reports and numerous clinical practice guidelines, which were assessed for information and strategies that would be appropriate for our unit. RESULTS The recommendations provided by the Center to Advance Palliative Care from its Improving Palliative Care in the ICU project were used to successfully implement a new palliative care initiative in our ICU. CONCLUSION The guidelines provided by the Improving Palliative Care in the ICU project were an important tool to direct the development of a new palliative care ICU initiative.
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Affiliation(s)
- Eluned Mun
- Retired Intensive Care Nurse and a current Nurse Practitioner at the Rehabilitation Hospital of the Pacific in Honolulu, HI.
| | - Craig Nakatsuka
- Retired Palliative Care and Internal Medicine Physician at Kaiser Permanente Medical Center at Moanalua in Honolulu, HI.
| | - Lillian Umbarger
- Intensivist and Pulmonologist at Kaiser Permanente Medical Center at Moanalua in Honolulu, HI.
| | - Ruth Ruta
- Intensive Care Nurse at Kaiser Permanente Medical Center at Moanalua in Honolulu, HI.
| | - Tracy Mccarty
- Clinical Coordinator for the Intensive Care Unit at Kaiser Permanente Medical Center at Moanalua in Honolulu, HI.
| | - Cynthia Machado
- Intensive Care Nurse at Kaiser Permenente Medical Center at Moanalua in Honolulu, HI.
| | - Clementina Ceria-Ulep
- Professor and Department Chair in the School of Nursing and Dental Hygiene at the University of Hawaii at Manoa in Honolulu.
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7
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Kaye EC, Abramson ZR, Snaman JM, Friebert SE, Baker JN. Productivity in Pediatric Palliative Care: Measuring and Monitoring an Elusive Metric. J Pain Symptom Manage 2017; 53:952-961. [PMID: 28062335 DOI: 10.1016/j.jpainsymman.2016.12.326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/16/2016] [Accepted: 12/15/2016] [Indexed: 11/17/2022]
Abstract
CONTEXT Workforce productivity is poorly defined in health care. Particularly in the field of pediatric palliative care (PPC), the absence of consensus metrics impedes aggregation and analysis of data to track workforce efficiency and effectiveness. Lack of uniformly measured data also compromises the development of innovative strategies to improve productivity and hinders investigation of the link between productivity and quality of care, which are interrelated but not interchangeable. OBJECTIVES To review the literature regarding the definition and measurement of productivity in PPC; to identify barriers to productivity within traditional PPC models; and to recommend novel metrics to study productivity as a component of quality care in PPC. METHODS PubMed® and Cochrane Database of Systematic Reviews searches for scholarly literature were performed using key words (pediatric palliative care, palliative care, team, workforce, workflow, productivity, algorithm, quality care, quality improvement, quality metric, inpatient, hospital, consultation, model) for articles published between 2000 and 2016. Organizational searches of Center to Advance Palliative Care, National Hospice and Palliative Care Organization, National Association for Home Care & Hospice, American Academy of Hospice and Palliative Medicine, Hospice and Palliative Nurses Association, National Quality Forum, and National Consensus Project for Quality Palliative Care were also performed. Additional semistructured interviews were conducted with directors from seven prominent PPC programs across the U.S. to review standard operating procedures for PPC team workflow and productivity. RESULTS Little consensus exists in the PPC field regarding optimal ways to define, measure, and analyze provider and program productivity. Barriers to accurate monitoring of productivity include difficulties with identification, measurement, and interpretation of metrics applicable to an interdisciplinary care paradigm. In the context of inefficiencies inherent to traditional consultation models, novel productivity metrics are proposed. CONCLUSIONS Further research is needed to determine optimal metrics for monitoring productivity within PPC teams. Innovative approaches should be studied with the goal of improving efficiency of care without compromising value.
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Affiliation(s)
- Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
| | | | - Jennifer M Snaman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sarah E Friebert
- Division of Pediatric Palliative Care, Akron Children's Hospital, Akron, Ohio, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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8
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Mun E, Umbarger L, Ceria-Ulep C, Nakatsuka C. Palliative Care Processes Embedded in the ICU Workflow May Reserve Palliative Care Teams for Refractory Cases. Am J Hosp Palliat Care 2016; 35:60-65. [PMID: 28273756 DOI: 10.1177/1049909116684821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
CONTEXT Palliative Care Teams have been shown to be instrumental in the early identification of multiple aspects of advanced care planning. Despite an increased number of services to meet the rising consultation demand, it is conceivable that the numbers of palliative care consultations generated from an ICU alone could become overwhelming for an existing palliative care team. OBJECTIVE Improve end-of-life care in the ICU by incorporating basic palliative care processes into the daily routine ICU workflow, thereby reserving the palliative care team for refractory situations. METHODS A structured, palliative care, quality-improvement program was implemented and evaluated in the ICU at Kaiser Permanente Medical Center in Hawaii. This included selecting trigger criteria, a care model, forming guidelines, and developing evaluation criteria. MAIN OUTCOME MEASURES These included the early identification of the multiple features of advanced care planning, numbers of proactive ICU and palliative care family meetings, and changes in code status and treatment upon completion of either meeting. RESULTS Early identification of Goals-of-Care, advance directives, and code status by the ICU staff led to a proactive ICU family meeting with resultant increases in changes in code status and treatment. The numbers of palliative care consultations also rose, but not significantly. CONCLUSIONS Palliative care processes could be incorporated into a daily ICU workflow allowing for integration of aspects of advanced care planning to be identified in a systematic and proactive manner. This reserved the palliative care team for situations when palliative care efforts performed by the ICU staff were ineffective.
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Affiliation(s)
- Eluned Mun
- 1 Department of Physician Services, The Rehabilitation Hospital of the Pacific, Honolulu, HI, USA
| | - Lillian Umbarger
- 2 Department of Intensive Care Unit, Kaiser Permanente Medical Center, Honolulu, HI, USA
| | - Clementina Ceria-Ulep
- 3 Department of School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Craig Nakatsuka
- 4 Department of Palliative Care, Kaiser Permanente Medical Center, Honolulu, HI, USA
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9
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Mun E, Ceria-Ulep C, Umbarger L, Nakatsuka C. Trend of Decreased Length of Stay in the Intensive Care Unit (ICU) and in the Hospital with Palliative Care Integration into the ICU. Perm J 2016; 20:16-036. [PMID: 27644048 DOI: 10.7812/tpp/16-036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Is a decrease in length of stay (LOS) in the intensive care unit (ICU) and hospital possible with the implementation of a structured, palliative care, quality-improvement program in the ICU? OBJECTIVE Incorporate palliative care into the routine ICU workflow to increase the numbers of palliative care consultations, improve end-of-life care in the ICU, and demonstrate an impact on ICU and/or hospital LOS. DESIGN A program was developed that followed recommendations from the Center to Advance Palliative Care's Improving Palliative Care in the ICU project. This program included selecting trigger criteria and a care model, forming guidelines, and developing evaluation criteria. The early identification of multiple measures led to proactive meetings with ICU patients' families and/or palliative care consultations. MAIN OUTCOME MEASURES Early identification of advance directives, code status, goals of care, and ICU LOS and hospital LOS. RESULTS A comparison between pre- and postintervention data showed positive trends in measured outcomes, including increased early identification of advance directives, code status, and goals of care along with a decrease in ICU LOS and hospital LOS. In addition, the number of ICU family meetings and palliative care consultations increased. CONCLUSION It was concluded that providing palliative care in the ICU is feasible and may decrease both ICU LOS and overall hospital LOS.
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Affiliation(s)
- Eluned Mun
- Retired Intensive Care Nurse and a current Nurse Practitioner at the Rehabilitation Hospital of the Pacific in Honolulu, HI.
| | - Clementina Ceria-Ulep
- Professor and Department Chair in the School of Nursing and Dental Hygiene at the University of Hawaii at Manoa in Honolulu.
| | - Lillian Umbarger
- Intensivist and Pulmonologist at the Moanalua Medical Center in Honolulu, HI.
| | - Craig Nakatsuka
- Palliative Care and Internal Medicine Physician at the Moanalua Medical Center in Honolulu, HI.
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10
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Kamal AH, Bull J, Kavalieratos D, Nicolla JM, Roe L, Adams M, Abernethy AP. Development of the Quality Data Collection Tool for Prospective Quality Assessment and Reporting in Palliative Care. J Palliat Med 2016; 19:1148-1155. [PMID: 27348507 DOI: 10.1089/jpm.2016.0036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Assessing and reporting the quality of care provided are increasingly important in palliative care, but we currently lack practical, efficient approaches for collection and reporting. OBJECTIVE In response, the Global Palliative Care Quality Alliance ("Alliance") sought to create a Quality Data Collection Tool for Palliative Care (QDACT-PC). METHODS We collaboratively and iteratively developed QDACT-PC, an electronic, point-of-care quality monitoring system for palliative care that supports prospective quality assessment and reporting in any clinical setting. QDACT-PC is the web-based data collection and reporting interface. Quality measures selected to be used in QDACT-PC were derived from a systematic review summarizing all published palliative care quality measure sets; Alliance clinical providers prioritized measures to be included in QDACT-PC to ensure maximal clinical relevance. Data elements and variables required to ascertain conformance to all selected quality measures were included in the QDACT-PC data dictionary. Whenever possible, variables collected in QDACT-PC align with validated surveys and/or nationally recognized common data elements. QDACT-PC data elements and software programmed business rules inform real-time assessments of conformance to selected quality measures. Data are deposited into a centralized registry for future analyses. RESULTS QDACT-PC can be used to report on >80% of all published palliative care quality measures and 100% of high-priority measure. CONCLUSION Electronic methods for collecting point-of-care quality monitoring data can be developed using collaborative partnerships between community and academic palliative care providers. Feasibility testing and creation of feedback reports are ongoing.
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Affiliation(s)
| | - Janet Bull
- 2 Four Seasons , Flat Rock, North Carolina
| | - Dio Kavalieratos
- 3 Division of General Internal Medicine, Department of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | | | - Laura Roe
- 1 Duke University , Durham, North Carolina
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11
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Nakazawa Y, Kato M, Yoshida S, Miyashita M, Morita T, Kizawa Y. Population-Based Quality Indicators for Palliative Care Programs for Cancer Patients in Japan: A Delphi Study. J Pain Symptom Manage 2016; 51:652-661. [PMID: 26674609 DOI: 10.1016/j.jpainsymman.2015.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 11/27/2022]
Abstract
CONTEXT Cancer control programs in Japan strongly endorse the dissemination of palliative care, and various policy measures have been implemented; however, indicators for evaluating palliative care programs have not been defined. OBJECTIVES The aim of this study was to develop quality indicators for palliative care programs taking a population-based view to meet the challenge of cancer control in the Japanese population. METHODS We conducted a modified Delphi survey. The panelists rated a list of indicators over three iterative rounds according to four perspectives: 1) consistency with the policy target, 2) relevance to the problem, 3) clarity of expression, and 4) measurement feasibility. The criterion for adoption of candidate indicators was set at a total mean score of 7 or more. Finally, the most relevant and important indicators were selected; consensus was defined by agreement of panelists at the panel meeting. RESULTS Among 49 panelists surveyed, 48 (98%), 39 (80%), and 43 (88%) responded over the three rounds, respectively. The 15 indicators were identified from 11 domains: patient-reported quality of life, bereaved family-reported quality at the end of life, family care, place of death, bereaved family-reported quality of palliative care, specialized palliative care services, opioid utilization, public perceptions about palliative care, palliative care education to primary care providers, specialist palliative care services, and regional palliative care. CONCLUSION Comprehensive quality indicators for palliative care programs were identified. The indicators are currently being used, and the feasibility of measuring change over time will be examined. It is expected that the indicators will be used effectively in the future. It is important to evaluate outcomes of the program, to improve weaknesses, improve outcomes, and promote the welfare of cancer patients.
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Affiliation(s)
- Yoko Nakazawa
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan.
| | - Masahi Kato
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Saran Yoshida
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Division of Palliative Medicine, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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12
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Turriziani A, Attanasio G, Scarcella F, Sangalli L, Scopa A, Genualdo A, Quici S, Nazzicone G, Ricciotti MA, La Commare F. The importance of measuring customer satisfaction in palliative care. Future Oncol 2016; 12:807-13. [PMID: 26837318 DOI: 10.2217/fon.15.359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the last decades, palliative care has been more and more focused on the evaluation of patients' and families' satisfaction with care. However, the evaluation of customer satisfaction in palliative care presents a number of issues such as the presence of both patients and their families, the frail condition of the patients and the complexity of their needs, and the lack of standard quality indicators and appropriate measurement tools. In this manuscript, we critically review existing evidence and literature on the evaluation of satisfaction in the palliative care context. Moreover, we provide - as a practical example - the preliminary results of our experience in this setting with the development of a dedicated tool for the measurement of satisfaction.
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Affiliation(s)
- Adriana Turriziani
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gennaro Attanasio
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesco Scarcella
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luisa Sangalli
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Anna Scopa
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Alessandra Genualdo
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stefano Quici
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giulia Nazzicone
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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13
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Ceronsky L, Johnson LG, Weng K. Quality Measures for Community-Based, Rural Palliative Care Programs in Minnesota: A Pilot Study. J Palliat Med 2015; 18:618-24. [DOI: 10.1089/jpm.2014.0435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Lyn Ceronsky
- Palliative Care Department, University of Minnesota Medical Center, Minneapolis, Minnesota
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Abstract
Primary care physicians are often the first medical providers patients seek out, and are in an excellent position to provide primary palliative care. Primary palliative care encompasses basic skills including basic evaluation and management of symptoms and discussions about goals of care and advance care planning. Specialty palliative care consultation complements primary care by assisting with complex psychosocial-spiritual patient and family situations. This article reviews primary palliative care skill sets and criteria for when to consider referring patients to specialty palliative care and hospice services.
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Affiliation(s)
- Amrita Ghosh
- Pain and Palliative Care Service, 10 Center Drive, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Elizabeth Dzeng
- Division of General Internal Medicine, Program in Palliative Care, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA; University of Cambridge School of Clinical Medicine, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - M Jennifer Cheng
- Pain and Palliative Care Service, 10 Center Drive, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
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Kamal AH, Hanson LC, Casarett DJ, Dy SM, Pantilat SZ, Lupu D, Abernethy AP. The quality imperative for palliative care. J Pain Symptom Manage 2015; 49:243-53. [PMID: 25057987 PMCID: PMC4405112 DOI: 10.1016/j.jpainsymman.2014.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 06/09/2014] [Accepted: 06/25/2014] [Indexed: 12/25/2022]
Abstract
Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the U.S. shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), "here is what we do," and increase the focus on "this is how well we do it" and "let us see how we can do it better." It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline.
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Affiliation(s)
- Arif H Kamal
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA; Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - Laura C Hanson
- Division of Geriatric Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David J Casarett
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steven Z Pantilat
- Palliative Care Program, Division of Hospital Medicine, University of California, San Francisco, California, USA
| | - Dale Lupu
- Center for Aging, Health and Humanities, George Washington University, Washington, DC, USA
| | - Amy P Abernethy
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA; Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA
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16
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Grubbs V, Moss AH, Cohen LM, Fischer MJ, Germain MJ, Jassal SV, Perl J, Weiner DE, Mehrotra R. A palliative approach to dialysis care: a patient-centered transition to the end of life. Clin J Am Soc Nephrol 2014; 9:2203-9. [PMID: 25104274 DOI: 10.2215/cjn.00650114] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of <1 year may desire a palliative approach to dialysis care, which focuses on aligning patient treatment with patients' informed preferences. This commentary elucidates what comprises a palliative approach to dialysis care and describes its potential and appropriate use. It also reviews the barriers to integrating such an approach into the current clinical paradigm of care and existing infrastructure and outlines system-level changes needed to accommodate such an approach.
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Affiliation(s)
- Vanessa Grubbs
- Division of Nephrology, University of California, San Francisco, San Francisco, California; Division of Nephrology, San Francisco General Hospital, San Francisco, California;
| | - Alvin H Moss
- Section of Nephrology, Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Lewis M Cohen
- Department of Psychiatry, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
| | - Michael J Fischer
- Division of Nephrology, Jesse Brown Veterans Affairs Medical Center, University of Illinois Hospital and Health Sciences Center, Chicago, Illinois
| | - Michael J Germain
- Division of Nephrology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
| | | | - Jeffrey Perl
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts; and
| | - Rajnish Mehrotra
- Division of Nephrology, University of Washington, Seattle, Washington
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17
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Kamal AH, Gradison M, Maguire JM, Taylor D, Abernethy AP. Quality measures for palliative care in patients with cancer: a systematic review. J Oncol Pract 2014; 10:281-7. [PMID: 24917264 DOI: 10.1200/jop.2013.001212] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Quality assessment is a critical component of determining the value of medical services, including palliative care. Characterization of the current portfolio of measures that assess the quality of palliative care delivered in oncology is necessary to identify gaps and inform future measure development. METHODS We performed a systematic review of MEDLINE/PubMed and the gray literature for quality measures relevant to palliative care. Measures were categorized into National Quality Forum domains and reviewed for methodology of development and content. Measures were additionally analyzed to draw summative conclusions on scope and span. RESULTS Two hundred eighty-four quality measures within 13 measure sets were identified. The most common domains for measure content were Physical Aspects of Care (35%) and Structure and Processes of Care (22%). Of symptom-related measures, pain (36%) and dyspnea (26%) were the most commonly addressed. Spiritual (4%) and Cultural (1%) Aspects of Care were least represented domains. Generally, measures addressed processes of care, did not delineate benchmarks for success, and often did not specify intended interventions to address unmet needs. This was most evident regarding issues of psychosocial and spiritual assessment and management. CONCLUSION Within a large cohort of quality measures for palliative, care is often a focus on physical manifestations of disease and adverse effects of therapy; relatively little attention is given to the other aspects of suffering commonly observed among patients with advanced cancer, including psychological, social, and spiritual distress.
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Affiliation(s)
- Arif H Kamal
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Margaret Gradison
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Jennifer M Maguire
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Donald Taylor
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Amy P Abernethy
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
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18
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Kurella Tamura M, Meier DE. Five policies to promote palliative care for patients with ESRD. Clin J Am Soc Nephrol 2013; 8:1783-90. [PMID: 23744000 PMCID: PMC3789338 DOI: 10.2215/cjn.02180213] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with ESRD experience complex and costly care that does not always meet their needs. Palliative care, which focuses on improving quality of life and relieving suffering for patients with serious illnesses, could address a large unmet need among patients with ESRD. Strengthening palliative care is a top policy priority for health reform efforts based on strong evidence that palliative care improves value. This commentary outlines palliative care policies for patients with ESRD and is directed at policymakers, dialysis providers, nephrology professional societies, accreditation organizations, and funding agencies who play a key role in the delivery and determination of quality of ESRD care. Herein we suggest policies to promote palliative care for patients with ESRD by addressing key barriers, including the lack of access to palliative care, lack of capacity to deliver palliative care, and a limited evidence base. We also provide examples of how these policies could be implemented within the existing ESRD care infrastructure.
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Affiliation(s)
- Manjula Kurella Tamura
- Veterans Affairs Palo Alto Health Care System Geriatrics Research Education and Clinical Center. Palo Alto, California
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Diane E. Meier
- Center to Advance Palliative Care and Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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19
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Parker SM, Remington R, Nannini A, Cifuentes M. Patient Outcomes and Satisfaction With Care Following Palliative Care Consultation. J Hosp Palliat Nurs 2013. [DOI: 10.1097/njh.0b013e318279f4ce] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
PURPOSE Recognizing and accepting when someone is within the palliative care trajectory is often a challenge, particularly for nursing students. In sharing this story of a nurse's experience of caring for her mother, it is hoped that the reader will gain insight into ways to enhance comfort and improve the quality of life of family members, friends, and patients. Through the lens of this lived experience, the challenges associated with honoring the wishes of a loved one during the palliative care trajectory through the end of life are shared. PRACTICE IMPLICATIONS Exploring a person's perceptions about their quality of life is an important component of a nursing assessment. Nurses need to be prepared to maximize opportunities with patients and provide resources and information about options on their quality of life issues. Understanding and respecting another's choice develops with awareness and utilization of evidence-based knowledge in planning interventions. This article provides information on evidence-based resources and standards of practice in the context of a lived experience. CONCLUSION Experiencing the death of loved ones is always difficult. Accepting their wish to not seek medical treatment and the provision of end-of-life care is a challenge. Nurses who become comfortable and knowledgeable about the palliative care trajectory and the end of life experience will be able to provide a higher level of support and thus improve the quality of life for those they encounter.
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Affiliation(s)
- Noreen Nelson
- College of Nursing, New York University, New York, NY
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21
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Campbell CL, Baernholdt M, Yan G, Hinton ID, Lewis E. Racial/ethnic perspectives on the quality of hospice care. Am J Hosp Palliat Care 2012; 30:347-53. [PMID: 22952128 DOI: 10.1177/1049909112457455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents. Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P < .001), and of overall satisfaction with hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001).
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Affiliation(s)
- Cathy L Campbell
- The University of Virginia, School of Nursing, Charlottesville, VA 22908, USA.
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22
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Sheetz MJ, Bowman MAS. Parents' perceptions of a pediatric palliative program. Am J Hosp Palliat Care 2012; 30:291-6. [PMID: 22696532 DOI: 10.1177/1049909112449376] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reports of family satisfaction with pediatric palliative care have been limited. This knowledge is critical for both program development and furthering understanding of needs. The purpose of this study was to assess parents' perceptions about whether a pediatric palliative care program was providing key elements of pediatric palliative care as described in the literature and to assess parental satisfaction with services. Data were collected from 65 parents, using a tool developed for the project, whose children died while receiving services from Rainbow Kids Palliative Care, a program of Primary Children's Medical Center, and the Department of Pediatrics, University of Utah, Salt Lake City, Utah. Respondents reported that the Rainbow Kids team had provided emotional support, helped with decision making and communication, and that their children's symptoms were managed. Furthermore, parent respondents expressed high levels of satisfaction with services from the Rainbow Kids team.
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Affiliation(s)
- M Joan Sheetz
- Rainbow Kids Palliative Care Program, Primary Children's Medical Center, Salt Lake City, UT, USA
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23
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Abstract
Collecting reliable and valid data is an increasing expectation within palliative care. Data remain the crux for demonstrating value and quality of care, which are the critical steps to program sustainability. Parallel goals of conducting research and performing quality assessment and improvement can also ensure program growth, financial health, and viability in an increasingly competitive environment. Mounting expectations by patients, hospitals, and payers and inevitable pay-for-performance paradigms have transitioned data collection procedures from novel projects to expected standard operation within usual palliative care delivery. We present types of data to collect, published guides for data collection, and how data can inform quality, value, and research within a palliative care organization. Our experiences with the Quality Data Collection Tool (QDACT) in the Carolinas Palliative Care Consortium to collect data on quality have led to valuable lessons learned in creating a data collection system. Suggested steps in forming data-sharing collaborations and building data collection procedures are shared.
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24
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Foley G, Timonen V, Hardiman O. Experience of services as a key outcome in amyotrophic lateral sclerosis (ALS) care: the case for a better understanding of patient experiences. Am J Hosp Palliat Care 2011; 29:362-7. [PMID: 21998444 DOI: 10.1177/1049909111423774] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
People with amyotrophic lateral sclerosis (ALS) frequently express dissatisfaction with services. Patient satisfaction with services in ALS care is not always measured and service user perspectives are not usually included when evaluating the outcomes of care. There is a lack of consensus on what constitutes satisfaction for patients in ALS care. To date, health care professionals' conceptualization of outcomes in ALS care has excluded measures of patient satisfaction with services. Exploring the context of the ALS service user experience of care will identify a conceptual framework that will include the domains of satisfaction with care for patients with ALS. An instrument that draws on the ALS patient perspective of services, developed on the basis of qualitative investigation, should be used to measure satisfaction with services.
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Affiliation(s)
- Geraldine Foley
- School of Social Work & Social Policy, Trinity College Dublin, Dublin 2, Ireland.
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25
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Meier DE. Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q 2011; 89:343-80. [PMID: 21933272 PMCID: PMC3214714 DOI: 10.1111/j.1468-0009.2011.00632.x] [Citation(s) in RCA: 251] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
CONTEXT A small proportion of patients with serious illness or multiple chronic conditions account for the majority of health care spending. Despite the high cost, evidence demonstrates that these patients receive health care of inadequate quality, characterized by fragmentation, overuse, medical errors, and poor quality of life. METHODS This article examines data demonstrating the impact of the U.S. health care system on clinical care outcomes and costs for the sickest and most vulnerable patients. It also defines palliative care and hospice, synthesizes studies of the outcomes of palliative care and hospice services, reviews variables predicting access to palliative care and hospice services, and identifies those policy priorities necessary to strengthen access to high-quality palliative care. FINDINGS Palliative care and hospice services improve patient-centered outcomes such as pain, depression, and other symptoms; patient and family satisfaction; and the receipt of care in the place that the patient chooses. Some data suggest that, compared with the usual care, palliative care prolongs life. By helping patients get the care they need to avoid unnecessary emergency department and hospital stays and shifting the locus of care to the home or community, palliative care and hospice reduce health care spending for America's sickest and most costly patient populations. CONCLUSIONS Policies focused on enhancing the palliative care workforce, investing in the field's science base, and increasing the availability of services in U.S. hospitals and nursing homes are needed to ensure equitable access to optimal care for seriously ill patients and those with multiple chronic conditions.
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Affiliation(s)
- Diane E Meier
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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26
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Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care. J Palliat Med 2010; 14:17-23. [PMID: 21133809 DOI: 10.1089/jpm.2010.0347] [Citation(s) in RCA: 340] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Workforce shortages, late referrals, and palliative care program resource constraints present significant barriers to meeting the needs of hospitalized patients facing serious illnesses. The Center to Advance Palliative Care convened a consensus panel to select criteria by which patients at high risk for unmet palliative care needs can be identified in advance for a palliative care screening assessment. The consensus panel developed primary and secondary criteria for two checklists-one to use for screening at the time of admission and one for daily patient rounds. The consensus panel believes that by implementing a checklist approach to screening patients for unmet palliative care needs, combined with educational initiatives and other system-change work, hospital staff engaged in day-to-day patient care can identify a majority of such needs, reserving specialty palliative care services for more complex problems.
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Affiliation(s)
- David E Weissman
- Medical College of Wisconsin/Froedtert Hospital , Milwaukee, Wisconsin, USA.
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27
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Bakitas M, Bishop MF, Caron P, Stephens L. Developing successful models of cancer palliative care services. Semin Oncol Nurs 2010; 26:266-84. [PMID: 20971407 PMCID: PMC2976669 DOI: 10.1016/j.soncn.2010.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This article describes successful institutionally based programs for providing high-quality palliative care to persons with cancer and their family members. Challenges and opportunities for program development are also described. DATA SOURCES Published literature from 2000 to present describing concurrent oncology palliative care clinical trials, standards, and guidelines were reviewed. CONCLUSION Clinical trials have shown feasibility and positive outcomes and formed the basis for consensus guidelines that support concurrent oncology palliative care models. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses should advocate for all patients with advanced cancer and their families to have access to concurrent oncology palliative care from the time of diagnosis with a life-limiting cancer.
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Affiliation(s)
- Marie Bakitas
- Section of Palliative Medicine, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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