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van Zuilekom I, Metselaar S, Godrie F, Onwuteaka-Philipsen B, van Os-Medendorp H. Generalist, specialist, or expert in palliative care? A cross-sectional open survey on healthcare professionals' self-description. BMC Palliat Care 2024; 23:120. [PMID: 38755581 PMCID: PMC11097520 DOI: 10.1186/s12904-024-01449-9] [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: 10/12/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In the Netherlands, palliative care is provided by generalist healthcare professionals (HCPs) if possible and by palliative care specialists if necessary. However, it still needs to be clarified what specialist expertise entails, what specialized care consists of, and which training or work experience is needed to become a palliative care specialist. In addition to generalists and specialists, 'experts' in palliative care are recognized within the nursing and medical professions, but it is unclear how these three roles relate. This study aims to explore how HCPs working in palliative care describe themselves in terms of generalist, specialist, and expert and how this self-description is related to their work experience and education. METHODS A cross-sectional open online survey with both pre-structured and open-ended questions among HCPs who provide palliative care. Analyses were done using descriptive statistics and by deductive thematic coding of open-ended questions. RESULTS Eight hundred fifty-four HCPs filled out the survey; 74% received additional training, and 79% had more than five years of working experience in palliative care. Based on working experience, 17% describe themselves as a generalist, 34% as a specialist, and 44% as an expert. Almost three out of four HCPs attributed their level of expertise on both their education and their working experience. Self-described specialists/experts had more working experience in palliative care, often had additional training, attended to more patients with palliative care needs, and were more often physicians as compared to generalists. A deductive analysis of the open questions revealed the similarities and distinctions between the roles of a specialist and an expert. Seventy-six percent of the respondents mentioned the importance of having both specialists and experts and wished more clarity about what defines a specialist or an expert, how to become one, and when you need them. In practice, both roles were used interchangeably. Competencies for the specialist/expert role consist of consulting, leadership, and understanding the importance of collaboration. CONCLUSIONS Although the grounds on which HCPs describe themselves as generalist, specialist, or experts differ, HCPs who describe themselves as specialists or experts mostly do so based on both their post-graduate education and their work experience. HCPs find it important to have specialists and experts in palliative care in addition to generalists and indicate more clarity about (the requirements for) these three roles is needed.
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Affiliation(s)
- Ingrid van Zuilekom
- Saxion, University of Applied Science, School of Health, research group Smart Health, Postbus 70.000, 7500 KB, Enschede, The Netherlands.
- Amsterdam UMC Location VUmc, De Boelelaan 1117 1081 HV Amsterdam Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Suzanne Metselaar
- Amsterdam UMC Location VUmc, Department of Ethics, Law and Humanities, De Boelelaan 1117 1081 HV Amsterdam Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - Fleur Godrie
- Amsterdam UMC Location VUmc, Department of Ethics, Law and Humanities, De Boelelaan 1117 1081 HV Amsterdam Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - Bregje Onwuteaka-Philipsen
- Amsterdam UMC Location VUmc, Chair Amsterdam UMC Expertise Center for Palliative Care, Department of Public and Occupational Health, Locatie VUmc | MF D349 | van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
| | - Harmieke van Os-Medendorp
- Domain of Health, Sports and Welfare, Inholland, University of Applied Sciences, De Boelelaan, 1109, 1081 HV, Amsterdam, The Netherlands
- Spaarne Gasthuis Academy, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
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Chowdhury MK, Saikot S, Farheen N, Ahmad N, Alam S, Connor SR. Impact of Community Palliative Care on Quality of Life among Cancer Patients in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6443. [PMID: 37568985 PMCID: PMC10418368 DOI: 10.3390/ijerph20156443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
Cancer, a leading cause of mortality worldwide, is often diagnosed at late stages in low- and middle-income countries, resulting in preventable suffering. When added to standard oncological care, palliative care may improve the quality of life (QOL) of these patients. A longitudinal observational study was conducted from January 2020 to December 2021. Thirty-nine cancer patients were enrolled in the Compassionate Narayanganj community palliative care group (NPC), where they received comprehensive palliative care in addition to oncological care. Thirty-one patients from the Dept. of Oncology (DO) at BSMMU received standard oncological care. In contrast to the DO group, the NPC group had a higher percentage of female patients, was older, and had slightly higher levels of education. At 10 to 14 weeks follow-up, a significant improvement in overall QOL was observed in the NPC group (p = 0.007), as well as in the psychological (p = 0.003), social (p = 0.002), and environmental domains (p = 0.15). Among the secondary outcomes, the palliative care group had reduced disability and neuropathic pain scores. Additionally, there were statistically significant reductions in pain, drowsiness, and shortness of breath, as well as an improvement in general wellbeing, based on the results of the Edmonton Symptom Assessment Scale-Revised. At the community level in Bangladesh, increased access to palliative care may improve cancer patient outcomes such as QOL and symptom burden.
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Affiliation(s)
- Mostofa Kamal Chowdhury
- Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh; (M.K.C.); (N.F.); (N.A.)
| | - Shafiquejjaman Saikot
- Compassionate Narayanganj (Community-Based Palliative Care Project), c/o Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh;
| | - Nadia Farheen
- Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh; (M.K.C.); (N.F.); (N.A.)
| | - Nezamuddin Ahmad
- Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh; (M.K.C.); (N.F.); (N.A.)
| | - Sarwar Alam
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh;
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Pornrattanakavee P, Srichan T, Seetalarom K, Saichaemchan S, Oer-areemitr N, Prasongsook N. Impact of interprofessional collaborative practice in palliative care on outcomes for advanced cancer inpatients in a resource-limited setting. BMC Palliat Care 2022; 21:229. [PMID: 36581913 PMCID: PMC9798714 DOI: 10.1186/s12904-022-01121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/16/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Palliative care for patients with advanced cancer improves suffering symptoms, and quality of life (QoL). However, routine implementation of palliative care by specialty palliative care consultation is still an unmet need among in-patients with advanced cancer. Our study aim is to evaluate the effectiveness of a team-based approach on QoLs and readmission rate when compared to routine practice by among medical oncologists. METHODS This study was a prospective, Quasi-Experimental design. In-patients with advanced cancer were non-randomly assigned to receive palliative care service by team-based approach or medical oncologists only. The primary endpoint was QoL. The secondary endpoint was the readmission rate at 7 and 30 days of hospital discharge. RESULTS One hundred twenty-two in-patients were enrolled. In-patients who were assessed by a team-based approach had significantly improved change scores of subjective well-being (SWB) when compared to another group (∆ SWB: -1 [-19 - 11] vs 0 [-9 - 15], p-value = 0.043). Furthermore, patients who were assessed under a team-based approach had significantly decreased in terms of readmission rate at 7 days of hospital discharge (4.92% in the team-based approach group vs. 19.67% in the medical oncologist group, p-value = 0.013). CONCLUSIONS Interdisciplinary collaboration is the key to success in establishing goals of care, which are supporting the best possible QoL and relieving suffering symptoms for those in-patients with advanced cancer. Furthermore, the readmission rate at 7 days of hospital discharge was significantly reduced by a team-based approach. Therefore, comprehensive palliative care assessment by interprofessional collaborative practice is required. TRIAL REGISTRATION Thai Clinical Trials Registry (TCTR): number 20200312001. Date of first registration on 09/03/2020.
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Affiliation(s)
- Pitchayapa Pornrattanakavee
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Tassaya Srichan
- grid.414965.b0000 0004 0576 1212Division of Nursing, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Kasan Seetalarom
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Siriwimon Saichaemchan
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nittha Oer-areemitr
- grid.414965.b0000 0004 0576 1212Division of Pulmonary and Critical Care Medicine, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Naiyarat Prasongsook
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Dorr MC, Sewnaik A, Berzenji D, van Hof KS, Grevelink T, Baatenburg de Jong RJ, Offerman MPJ. Learnings From Longitudinal Patient-Reported and Clinical Outcomes in Palliative Head and Neck Cancer Care. Otolaryngol Head Neck Surg 2022:1945998221127203. [PMID: 36166301 DOI: 10.1177/01945998221127203] [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: 11/15/2022]
Abstract
OBJECTIVE Patients with palliative head and neck cancer experience many symptoms in a short period of time. Longitudinal data on patient-reported outcomes in this phase are lacking. The aim of this study is to use structurally obtained patient-reported outcome data combined with clinical patient data and obtain insight in patient-reported outcomes, survival, circumstances of death, and interventions and treatment during the palliative phase in order to improve the quality of end-of-life care and patient-centered counseling. STUDY DESIGN Longitudinal observational cohort study. SETTING Tertiary cancer center. METHOD Quality of life was prospectively collected using the European Organization for Research and Treatment of Cancer QLQ-C15-PAL. Tumor- and patient-specific data were retrospectively collected. Descriptive statistics, linear mixed models, and regression analyses were performed. RESULTS A significant deterioration was found in global health status, physical functioning, fatigue, dyspnea, appetite loss, and constipation over time. However, emotional functioning improved. Median survival was 5.1 months, and only a low percentage of in-hospital death was observed (7.8%). Higher global health status at intake was associated with prolonged survival. CONCLUSION Structural measurement of patient-reported outcome together with clinical outcomes provides unique insight, which enables improvement of patient-centered counseling and care.
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Affiliation(s)
- Maarten C Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diako Berzenji
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kira S van Hof
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tim Grevelink
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marinella P J Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Chapman EJ, Pini S, Edwards Z, Elmokhallalati Y, Murtagh FEM, Bennett MI. Conceptualising effective symptom management in palliative care: a novel model derived from qualitative data. BMC Palliat Care 2022; 21:17. [PMID: 35115005 PMCID: PMC8815221 DOI: 10.1186/s12904-022-00904-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pain, breathlessness and fatigue are some of the most challenging symptoms to manage in patients with advanced disease. Specialist palliative care leads to better symptom management, but factors contributing to successful symptom management in this context have not been explored. Our aim was to understand what facilitates effective symptom management in specialist palliative care within UK hospices and investigate what barriers are experienced. Methods This was a grounded theory study using qualitative semi-structured focus groups and interviews. Participants were recruited from multidisciplinary specialist palliative care teams (doctors, nurses, healthcare assistants, physiotherapists, occupational therapists, complementary therapists, social workers and chaplains) working in inpatient, outpatient and community services provided by five hospices in the United Kingdom. Results We present a novel qualitative data-derived model of effective symptom management in specialist palliative care. We describe a co-ordinated, multi-faceted, sequential approach involving a process of engagement, partnership, decision-making, and delivery. Interventions to manage symptoms are less effective in psychologically distressed patients. Our data highlights that families of patients have a key role in determining effectiveness of symptom management interventions A holistic approach by a co-ordinated, multi-disciplinary team, including support to recognise and minimise psychological distress might facilitate more effective symptom management. Barriers to symptom management include team discordance and lack of understanding about symptom management by patient and families. Conclusions Shared decision-making between patients and professionals and co-ordination of care by a multi-disciplinary team are key components of effective symptom management. Actions to address psychological distress and evaluate the understanding and expectations of patients and their families would enable more effective symptom management. A more effective multi-disciplinary approach would be facilitated by discussion within teams about role competencies and boundaries. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00904-9.
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Affiliation(s)
- Emma J Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.
| | - Simon Pini
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Zoe Edwards
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Yousuf Elmokhallalati
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
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Friedrichsen M, Hajradinovic Y, Jakobsson M, Brachfeld K, Milberg A. Cultures that collide: an ethnographic study of the introduction of a palliative care consultation team on acute wards. BMC Palliat Care 2021; 20:180. [PMID: 34802436 PMCID: PMC8606051 DOI: 10.1186/s12904-021-00877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
Abstract
Background Acute care and palliative care (PC) are described as different incompatible organisational care cultures. Few studies have observed the actual meeting between these two cultures. In this paper we report part of ethnographic results from an intervention study where a palliative care consultation team (PCCT) used an integrative bedside education approach, trying to embed PC principles and interventions into daily practice in acute wards. Purpose To study the meeting and interaction of two different care cultures, palliative care and curative acute wards, when a PCCT introduces consulting services to acute wards regarding end-of-life palliative care, focusing on the differences between the cultures. Methods An ethnographic study design was used, including observations, interviews and diary entries. A PCCT visited acute care wards during 1 year. The analysis was inspired by Spradleys ethnography. Results Three themes were found: 1) Anticipations meets reality; 2) Valuation of time and prioritising; and 3) The content and creation of palliative care. Conclusion There are many differences in values, and the way PC are provided in the acute care wards compared to what a PCCT expects. The didactic challenges are many and the PC require effort.
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Affiliation(s)
- Maria Friedrichsen
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, 601 82, Norrköping, Sweden.
| | | | - Maria Jakobsson
- Department of Palliative Medicine, Vrinnevi Hospital, Norrköping, Sweden
| | - Kerstin Brachfeld
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, 601 82, Norrköping, Sweden
| | - Anna Milberg
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, 601 82, Norrköping, Sweden.,Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
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Specialist palliative care teams and characteristics related to referral rate: a national cross-sectional survey among hospitals in the Netherlands. BMC Palliat Care 2021; 20:175. [PMID: 34758792 PMCID: PMC8582112 DOI: 10.1186/s12904-021-00875-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Specialist palliative care teams (SPCTs) in hospitals improve quality of life and satisfaction with care for patients with advanced disease. However, referrals to SPCTs are often limited. To identify areas for improvement of SPCTs’ service penetration, we explored the characteristics and level of integration of palliative care programmes and SPCTs in Dutch hospitals and we assessed the relation between these characteristics and specialist palliative care referral rates. Methods We performed a secondary analysis of a national cross-sectional survey conducted among hospitals in the Netherlands from March through May 2018. For this survey, a previously developed online questionnaire, containing 6 consensus-based integration indicators, was sent to palliative care programme leaders in all 78 hospitals. For referral rate we calculated the number of annual inpatient referrals to the SPCT as a percentage of the number of total annual hospital admissions. Referral rate was dichotomized into high (≥ third quartile) and low (< third quartile). Characteristics of SPCTs with high and low referral rate were compared using univariate analyses. P-values < 0.05 were considered significant. Results In total, 63 hospitals (81%) participated in the survey, of which 62 had an operational SPCT. The palliative care programmes of these hospitals consisted of inpatient consultation services (94%), interdisciplinary staffing (61%), outpatient clinics (45%), dedicated acute care beds (21%) and community-based palliative care (27%). The median referral rate was 0.56% (IQR 0.23–1.0%), ranging from 0 to 3.7%. Comparing SPCTs with high referral rate (≥1%, n = 17) and low referral rate (< 1%, n = 45) showed significant differences for SPCTs’ years of existence, staffing, their level of education, participation in other departments’ team meetings, provision of education and conducting research. With regard to integration, significant differences were found for the presence of outpatient clinics and timing of referrals. Conclusion In the Netherlands, palliative care programmes and specialist palliative care teams in hospitals vary in their level of integration and development, with more mature teams showing higher referral rates. Appropriate staffing, dedicated outpatient clinics, education and research appear means to improve service penetration and timing of referral for patients with advanced diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00875-3.
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