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Wakefield D, Ta Y, Dewhurst F, Hussain J, Chamberlain C, Etkind S. Qualified and motivated, but limited by specialty-specific barriers: a national survey of UK Palliative Medicine consultants research experience. BMJ Support Palliat Care 2024; 14:76-86. [PMID: 37611937 DOI: 10.1136/spcare-2023-004198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Providing high-quality safe palliative care requires high-quality clinically driven research. Little is known about how to optimise clinical research capacity in this field.To understand interest and capacity to conduct clinical research in palliative medicine and identify key facilitators and barriers, by surveying palliative medicine consultants and academic trainees. METHODS National online survey exploring experience in conducting research, including facilitators and barriers. Sent to all current UK palliative medicine consultants, and previous/current academic trainees. Descriptive statistics are reported with framework analysis of free text responses. RESULTS 195 surveys were submitted including 15 respondents with Integrated Academic Training (IAT) experience. 78% (n=140/180) of consultants were interested in conducting research. Despite this enthusiasm, 83% had no allocated time within their job plan. 88% of those who undertook IAT would recommend IAT, but 60% reported difficulty transitioning from academic trainee to research active consultant.Barriers to research included; insufficient research culture and integration, with small teams working in a mixture of National Health Service (NHS) and non-NHS settings, leading to isolated, silo working. Even those who had undertaken IAT, felt a 'cliff edge' in opportunities after completing IAT. Filling service gaps was routinely prioritised over research activity. CONCLUSION Palliative medicine consultants, including those who have completed academic training want to conduct research but overwhelming barriers limit activity. A palliative care-specific strategy that permeates different palliative care settings, promotes interspecialty collaboration and improves the current infrastructure for palliative care research to maximise gains from IAT and embed a research culture are suggested.
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Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Felicity Dewhurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- St Oswald's Hospice, Newcastle upon Tyne, UK
| | - Jamilla Hussain
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Charlotte Chamberlain
- Faculty of Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Simon Etkind
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Bernardis A, Gonzalez-Jaramillo V, Ebneter AS, Eychmüller S. Palliative care and COVID-19: a bibliometric analysis. BMJ Support Palliat Care 2023:spcare-2022-004108. [PMID: 36702518 DOI: 10.1136/spcare-2022-004108] [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: 12/01/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the impact of COVID-19 on the palliative care (PC) publication trend in the last 10 years and the collaboration between countries and main topics that were discussed in the papers. METHODS We used Scopus to identify publications on PC between 2012 and 2021 and publications about PC and COVID-19 between 2020 and 2021. We used VOSviewer to assess the main topics using the keywords from the papers and to assess country collaboration. RESULTS 1937 publications resulted. An increase in publications about PC was observed during the pandemic, only partially explained by OVID-19-related publications. Cancer-related PC publications were the ones with the most marked increase. We identified six clusters in the distribution of the keywords: bioethics, cancer, nursing home/telemedicine, public health, caring and PC following the WHO definition. The countries with higher number of publications were the United States and England. CONCLUSION We showed an increase in the number of PC publications in the last 2 years that was only partially explained by COVID-19-related publications. Most of the publications increase was due to cancer-related publications, since, during the time of the pandemic, publications on cancer and PC increased markedly, while those on heart failure, lung disease and dementia, remained constant.
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Affiliation(s)
| | - Valentina Gonzalez-Jaramillo
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Andreas S Ebneter
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Eychmüller
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
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3
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Diernberger K, Luta X, Bowden J, Droney J, Lemmon E, Tramonti G, Shinkins B, Gray E, Marti J, Hall PS. Variation in hospital cost trajectories at the end of life by age, multimorbidity and cancer type. Int J Popul Data Sci 2023; 8:1768. [PMID: 36721848 PMCID: PMC9871727 DOI: 10.23889/ijpds.v8i1.1768] [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: 01/18/2023] Open
Abstract
Background Approximately thirty thousand people in Scotland are diagnosed with cancer annually, of whom a third live less than one year. The timing, nature and value of hospital-based healthcare for patients with advanced cancer are not well understood. The study's aim was to describe the timing and nature of hospital-based healthcare use and associated costs in the last year of life for patients with a cancer diagnosis. Methods We undertook a Scottish population-wide administrative data linkage study of hospital-based healthcare use for individuals with a cancer diagnosis, who died aged 60 and over between 2012 and 2017. Hospital admissions and length of stay (LOS), as well as the number and nature of outpatient and day case appointments were analysed. Generalised linear models were used to adjust costs for age, gender, socioeconomic deprivation status, rural-urban (RU) status and comorbidity. Results The study included 85,732 decedents with a cancer diagnosis. For 64,553 (75.3%) of them, cancer was the primary cause of death. Mean age at death was 80.01 (SD 8.15) years. The mean number of inpatient stays in the last year of life was 5.88 (SD 5.68), with a mean LOS of 7 days. Admission rates rose sharply in the last month of life. One year adjusted and unadjusted costs decreased with increasing age. A higher comorbidity burden was associated with higher costs. Major cost differences were present between cancer types. Conclusions People in Scotland in their last year of life with cancer are high users of secondary care. Hospitalisation accounts for a high proportion of costs, particularly in the last month of life. Further research is needed to examine triggers for hospitalisations and to identify influenceable reasons for unwarranted variation in hospital use among different cancer cohorts.
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Affiliation(s)
- Katharina Diernberger
- Edinburgh Clinical Trials Unit, University of Edinburgh, United Kingdom,Edinburgh Cancer Research Centre, University of Edinburgh, United Kingdom,Corresponding author: Katharina Diernberger
| | - Xhyljeta Luta
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland,Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Joanna Bowden
- NHS Fife, Scotland, United Kingdom,University of St Andrews, Scotland, United Kingdom
| | - Joanne Droney
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Elizabeth Lemmon
- Edinburgh Clinical Trials Unit, University of Edinburgh, United Kingdom
| | - Giovanni Tramonti
- Edinburgh Clinical Trials Unit, University of Edinburgh, United Kingdom
| | - Bethany Shinkins
- Academic Unit of Health Economics, University of Leeds, United Kingdom
| | - Ewan Gray
- Edinburgh Clinical Trials Unit, University of Edinburgh, United Kingdom
| | - Joachim Marti
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Peter S. Hall
- Edinburgh Clinical Trials Unit, University of Edinburgh, United Kingdom,Edinburgh Cancer Research Centre, University of Edinburgh, United Kingdom
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Qureshi SP, Jones D, Dewar A. Physicians' Conceptions of the Dying Patient: Scoping Review and Qualitative Content Analysis of the United Kingdom Medical Literature. QUALITATIVE HEALTH RESEARCH 2022; 32:1881-1896. [PMID: 35981561 PMCID: PMC9511242 DOI: 10.1177/10497323221119939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Most people in high income countries experience dying while receiving healthcare, yet dying has no clear beginning, and contexts influence how dying is conceptualised. This study investigates how UK physicians conceptualise the dying patient. We employed Scoping Study Methodology to obtain medical literature from 2006-2021, and Qualitative Content Analysis to analyse stated and implied meanings of language used, informed by social-materialism. Our findings indicate physicians do not conceive a dichotomous distinction between dying and not dying, but construct conceptions of the dying patient in subjective ways linked to their practice. We argue that the focus of future research should be on exploring practice-based challenges in the workplace to understanding patient dying. Furthermore, pre-Covid-19 literature related dying to chronic illness, but analysis of literature published since the pandemic generated conceptions of dying from acute illness. Researchers should note the ongoing effects of Covid-19 on societal and medical awareness of dying.
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Affiliation(s)
- Shaun Peter Qureshi
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
| | - Derek Jones
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
| | - Avril Dewar
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
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5
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Wakefield D, Etkind SN, Bemand-Qureshi L, Sutherland A, Koffman J, Dewhurst F, Noble S, Chamberlain C. UK Palliative trainees Research Collaborative (UK-PRC): the first 5 years - 0-100 study sites. BMJ Support Palliat Care 2022:bmjspcare-2022-003635. [PMID: 35459685 DOI: 10.1136/bmjspcare-2022-003635] [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: 03/15/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Palliative care research suffers from underfunding and a workforce spread across multiple settings leading to a lack of large-scale studies. To facilitate multisite research and audit we set up the UK Palliative trainees Research Collaborative (UKPRC), the first national trainee-led audit and research collaborative in palliative care. Here, we critically review the progress and potential of the UKPRC since its inception in 2016, identifying key challenges and facilitators. Members of the UKPRC steering committee collaborated to write this reflection, reviewing existing evidence regarding trainee-led research collaboratives. FINDINGS The UKPRC has representation from 16/19 UK training regions. Projects are run by a core team; local collaborators collect data at each site. The collaborative is supported by academic leads and newly qualified consultants to develop a culture of continuous improvement in practice. We have conducted four national projects to date, including an audit covering 119 sites. Facilitators for our work include a focus on inclusivity and national representation; support from recently qualified consultants to ensure continuity; and taking a pragmatic approach, focusing initially on straightforward projects to build momentum. Challenges include the step from national audit to multisite, patient-facing research and maintaining continuity in a membership with high turnover. CONCLUSIONS There is potential to change practice through large scale data collection via the trainee-led collaborative model. Collaboration is especially important in a small specialty with limited resources. The UKPRC has demonstrated 'proof of concept' and has the potential to support and sustain a culture where research can flourish within palliative care.
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Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
- Alice House Hospice, Hartlepool, UK
| | - Simon Noah Etkind
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Lucy Bemand-Qureshi
- Redbridge Macmillan Specialist Community Palliative Care Team, London, UK
- Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| | | | - Jonathan Koffman
- Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Felicity Dewhurst
- Newcastle University, Newcastle upon Tyne, UK
- St Oswald's Hospice, Newcastle-Upon-Tyne, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
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van der Steen JT, Bloomer MJ, Martins Pereira S. The importance of methodology to palliative care research: A new article type for Palliative Medicine. Palliat Med 2022; 36:4-6. [PMID: 34965752 PMCID: PMC8796148 DOI: 10.1177/02692163211069566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Sandra Martins Pereira
- CEGE: Research Center in Management and Economics, Universidade Católica Portuguesa, Porto, Portugal
- Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal
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7
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de Lima C, Dos Santos Neto MF, Costa RFA, Franco JO, Calfi GS, Paiva BSR, Paiva CE. Characteristics of Palliative Care Publications by South American Authors in the Last 20 Years: Systematic Literature Review With Bibliometric Analysis. J Pain Symptom Manage 2021; 62:e177-e185. [PMID: 33819513 DOI: 10.1016/j.jpainsymman.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Research on palliative care (PC) can be used as a direct measure to assess the level of PC development in a country or region. OBJECTIVES To investigate the scientific production in the field of PC in South American countries over the last two decades. METHODS The search was performed using the terms "palliative care," "hospice care," "hospices," and "terminal care" combined with the names of South American countries in several databases. The trend in publications over time was analyzed by linear equations (R2) and by calculating the annual percentage change (APC). The article citations were extracted from Web of Science (WOS), Scopus and Google Scholar, and the countries' impact factors (IFc) were calculated. RESULTS Of the 4259 identified articles, 641 were included in the analysis. There was a clear increase in the number of publications over the analyzed period (R2 = 0.8794, APC = 14.42%). Brazil was the country with the highest number of publications (n = 389); however, after adjustments by population, GDP and number of researchers, Chile was the country with the greatest prominence, including the highest IF in WOS (4.409). Only 8.3% of publications were systematic review, clinical trial or cohort studies; only 15.4% were funded. CONCLUSION This bibliometric review identified an annual increase of 14% in the number of scientific publications by researchers from South America over the last 20 years. Although Brazil produced the most articles, Chile, had the most efficient scientific production. In general, the articles had low potential for scientific impact.
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Affiliation(s)
- Crislaine de Lima
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Martins Fideles Dos Santos Neto
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | - Julia Onishi Franco
- Barretos School of Health Sciences Dr. Paulo Prata, FACISB, Barretos, São Paulo, Brazil
| | - Giovanna Simões Calfi
- Barretos School of Health Sciences Dr. Paulo Prata, FACISB, Barretos, São Paulo, Brazil
| | | | - Carlos Eduardo Paiva
- Oncology Graduate Program, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Department of Clinical Oncology, Breast and Gynecology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
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8
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Finucane A, Carduff E, Meade R, Doyle S, Fenning S, Cumming S, Hekerem D, Rahman F, Lugton J, Johnston B, Murray SA. Palliative care research promotion in policy and practice: a knowledge exchange process. BMJ Support Palliat Care 2021; 12:bmjspcare-2021-003096. [PMID: 34400402 PMCID: PMC9380483 DOI: 10.1136/bmjspcare-2021-003096] [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: 04/06/2021] [Accepted: 07/24/2021] [Indexed: 11/04/2022]
Abstract
In palliative care, as in many areas of medicine, there is a considerable amount of research conducted that makes sound recommendations but does not result consistently in improved care. For instance, though palliative care has been shown to benefit all people with a life-threatening illness, its main reach continues to be for those with cancer. Drawing on relational models of research use, we set out to engage policy-makers, educators, clinicians, commissioners and service providers in a knowledge exchange process to identify implications of research for Scottish palliative care priorities. First, we mapped the existing palliative care research evidence in Scotland. We then organised evidence review meetings and a wider stakeholder event where research producers and users came together to coproduce implications of the evidence for policy, education and practice. We used questionnaires and key stakeholder feedback meetings to explore impacts of this process on research uptake and use immediately after the events and over time. In this paper, we reflect on this knowledge exchange process and the broader context in which it was set. We found that participation fostered relationships and led to a rich and enthusiastic exploration of research evidence from multiple perspectives. Potential impacts relating to earlier identification for palliative care, education and need-based commissioning ensued. We make suggestions to guide replication.
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Affiliation(s)
- Anne Finucane
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
- Policy and Research, Marie Curie Hospice, Edinburgh, UK
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Emma Carduff
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
- Policy and Research, Marie Curie Hospice, Glasgow, UK
| | - Richard Meade
- Policy and Research, Marie Curie Scotland, Edinburgh, UK
| | - Sarah Doyle
- Queen's Nursing Institute Scotland, Edinburgh, UK
| | - Stephen Fenning
- NHS Fife Specialist Palliative Care Service, NHS Fife, Kircaldy, UK
| | | | - Diana Hekerem
- Improvement Hub (iHub), Healthcare Improvement Scotland, Edinburgh, UK
| | - Fariel Rahman
- Children's Hospice Association Scotland, Edinburgh, UK
| | - Jean Lugton
- Policy and Research, Marie Curie Hospice, Edinburgh, UK
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
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9
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Nyatanga B. Achieving palliative care access for all: a lens on Scotland. Br J Community Nurs 2021; 26:307. [PMID: 34105365 DOI: 10.12968/bjcn.2021.26.6.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Brian Nyatanga
- Senior Lecturer, Three Counties School of Nursing and Midwifery, University of Worcester
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10
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Diernberger K, Luta X, Bowden J, Fallon M, Droney J, Lemmon E, Gray E, Marti J, Hall P. Healthcare use and costs in the last year of life: a national population data linkage study. BMJ Support Palliat Care 2021:bmjspcare-2020-002708. [PMID: 33579797 DOI: 10.1136/bmjspcare-2020-002708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND People who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain. OBJECTIVES To describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life. METHODS Retrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274 048). RESULTS Secondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last 3 months. The mean cost was £10 000. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation. CONCLUSIONS Hospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer. Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end-of-life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.
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Affiliation(s)
- Katharina Diernberger
- Edinburgh Health Economics Group, University of Edinburgh, Edinburgh, UK
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Xhyljeta Luta
- Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | | | - Marie Fallon
- Palliative Medicine, University of Edinburgh, Edinburgh, UK
| | - Joanne Droney
- Palliative Care, The Royal Marsden NHS Foundation Trust, London, UK
| | - Elizabeth Lemmon
- Edinburgh Health Economics Group, University of Edinburgh, Edinburgh, UK
| | - Ewan Gray
- Edinburgh Health Economics Group, University of Edinburgh, Edinburgh, UK
| | - Joachim Marti
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Department of Surgery and Cancer, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Peter Hall
- Edinburgh Health Economics Group, University of Edinburgh, Edinburgh, UK
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11
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Zhang M, Li X. Focuses and trends of the studies on pediatric palliative care:A bibliometric analysis from 2004 to 2018. Int J Nurs Sci 2021; 8:5-14. [PMID: 33575439 PMCID: PMC7859508 DOI: 10.1016/j.ijnss.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/10/2020] [Accepted: 11/26/2020] [Indexed: 10/25/2022] Open
Abstract
Objectives To investigate the focuses and trends of the studies on pediatric palliative care (PPC) and provide directions for future research. Methods Relevant papers about PPC published from 2004 to 2018 were analyzed using bibliometric analysis methods, including co-word analysis, biclustering analysis, and strategic diagram analysis. The included papers were divided into three groups based on the publication time, including 2004-2008, 2009-2013, and 2014-2018. Results A total of 1132 papers were published between 2004 and 2018, and there were 293 papers published between 2004 and 2008, 396 between 2009 and 2013, and 443 between 2014 and 2018. There were 42 high-frequency MeSH terms/MeSH subheadings in papers published between 2004 and 2018, including 12 between 2004 and 2008, 13 between 2009 and 2013, and 17 between 2014 and 2018. Conclusion Studies on PPC were making progress, with the increasing number, expanding scope, and uneven global distribution. Integration palliative care into pediatrics, cancer treatments in pediatric oncology, education methods on PPC, and establishment of professional teams were the major themes during 2004-2008, then the themes changed into establishing interventions to enhance the quality of life of the patients and parents, building professional-family relationship, and investigating attitude of health personnel in PPC during 2009-2013 and subsequently turned into communication skills, end-of-life decision making, and guidelines making on PPC during 2014-2018. Underdeveloped and protential themes including effective approaches to deal with the ethical dilemmas, training programs on communication skills, family support and guideline making are worth studying in the future.
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Affiliation(s)
- Miao Zhang
- School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, Liaoning, China
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12
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Breen LJ, Johnson AR, O'Connor M, Howting D, Aoun SM. Challenges in Palliative Care Research on Family Caregivers: Who Volunteers for Interviews? J Palliat Med 2020; 24:112-115. [PMID: 32255736 DOI: 10.1089/jpm.2019.0672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Interviews are a common method of data collection in palliative care research because they facilitate the gathering of rich, experiential data that are important for theory and practice. What is less clear is the extent to which those interviewed are representative of the larger group. Objective: The aim of this study was to determine if family caregivers who volunteer to be interviewed were similar or different to those who do not. Design: This study used data from the Caregiving and Bereavement study, a prospective, longitudinal mixed-methods study of family caregivers' general health, quality of life, and grief. Setting/Subjects: The 16 caregivers who volunteered to be interviewed were compared to the 20 who did not. Measurements: Comparisons were made in terms of the caregivers' demographic characteristics as well as measures of their quality of life, general health, general grief, and caregiver prolonged grief (i.e., before death). Results: Compared to caregivers who did not volunteer for an interview, those who volunteered were significantly older and reported less caregiver prolonged grief. Logistic regression showed that for each 1-unit increase in the caregiver prolonged grief score, individuals were 13% less likely to agree to an interview. Conclusions: Research findings based upon family caregivers who volunteer for research interviews might not provide a full picture of their experiences and needs. Researchers are encouraged to consider strategies that sample broadly and promote the participation of the full range of family caregivers in research to address the neglected areas of pre- and postdeath bereavement care.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Andrew R Johnson
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Denise Howting
- Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia.,Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Samar M Aoun
- Public Health Palliative Care Unit, La Trobe University, Melbourne, Victoria, Australia
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13
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Johnston BM, McCauley R, McQuillan R, Rabbitte M, Honohan C, Mockler D, Thomas S, May P. Effectiveness and cost-effectiveness of out-of-hours palliative care: a systematic review. HRB Open Res 2020; 3:9. [PMID: 33585789 PMCID: PMC7845148 DOI: 10.12688/hrbopenres.13006.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Out-of-hours palliative care is a priority for patients, caregivers and policymakers. Approximately three quarters of the week occurs outside of typical working hours, and the need for support in care of serious and terminal illness during these times is commonplace. Evidence on relevant interventions is unclear. Aim: To review systematically the evidence on the effect of out-of-hours specialist or generalist palliative care for adults on patient and caregiver outcomes, and costs and cost-effectiveness. Methods: A systematic review of peer-reviewed and grey literature was conducted. We searched Embase, MEDLINE [Ovid], Cochrane Library, CINAHL, Allied and Complementary Medicine [Ovid], PsycINFO, Web of Science, Scopus, EconLit (Ovid), and grey literature published between 1 January 2000 and 12 th November 2019. Studies that comparatively evaluated the effect of out-of-hours specialist or generalist palliative care for adults on patient and caregiver outcomes, and on costs and cost-effectiveness were eligible, irrespective of design. Only English-language studies were eligible. Two reviewers independently examined the returned studies at each stage (title and abstract review, full-text review, and quality assessment). Results: We identified one eligible peer-reviewed study, judged as insufficient quality. Other sources returned no eligible material. The systematic review therefore included no studies. Conclusions: The importance of integrated, 24-hour care for people in line with a palliative care approach is not reflected in the literature, which lacks evidence on the effects of interventions provided outside typical working hours. Registration: PROSPERO CRD42018111041.
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Affiliation(s)
- Bridget M. Johnston
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Rachel McCauley
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Regina McQuillan
- Palliative Medicine, St Francis Hospice, Dublin, D05 T9K8, Ireland
- Palliative Medicine, Beaumont Hospital, Dublin, D09 V2N0, Ireland
| | - Mary Rabbitte
- All-Ireland Institute of Hospice and Palliative Medicine, Dublin, D6W, Ireland
| | - Caitriona Honohan
- The Library of Trinity College Dublin, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - David Mockler
- The Library of Trinity College Dublin, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
- The Irish Longitudinal study on Ageing (TILDA), Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
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Abstract
AbstractObjectiveThe objective of this study is to map the existent research undertaken in Australia into broad thematic areas and identify the characteristics of the studies and areas of future research in the literature.MethodsA scoping review methodology was employed to map the current areas of research undertaken in Australia since January 2000 until the end of December 2018 according to years of publications, types of studies, populations studied, research themes, and areas of focus.ResultsOur review identified 1,405 Australian palliative care research publications between January 2000 and December 2018. Nearly 40% of the studies were quantitative (39%) and a third were qualitative studies (31%). The remainder of the studies were reviews, mixed methods, quality improvement projects, and others. One-third (30%) of the research was done with carers' participants followed by nurses (22%) and doctors and physicians (18%). The most frequently reported diagnosis in the studies was cancer with 42% of the publication total. The most frequently explored theme was physical symptoms (such as pain, breathlessness, nausea, delirium, and dyspnea) with a total of 16% of all articles followed by communication (15%). There was a large gap to the next most frequently explored theme with service delivery (9%) and coordination of care (8%). Assessment of patients (7%), end-of-life decision-making (6%), and rural/regional (6%) all produced a similar number of publications. Very few studies addressed topics such as quality of life, E-Health, after-hours care, spirituality, and health economics. Moreover, there were only 15 (1%) studies focused on the last days of life.Significance of the resultsThe current review presented a comprehensive search of the literature across almost two decades in Australia in the palliative care setting. It has covered a breadth of research topics and highlighted urgent areas for further research.
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White C, Noble S, Watson M, Swan F, Nelson A, Johnson MJ. Optimised clinical study recruitment in palliative care: success strategies and lessons learned. BMJ Support Palliat Care 2019; 10:216-220. [PMID: 31302599 DOI: 10.1136/bmjspcare-2019-001820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/21/2019] [Accepted: 06/28/2019] [Indexed: 11/04/2022]
Abstract
Recruitment challenges to clinical research studies in palliative care settings, particularly in hospices, are well documented. However, a recent study (Hospice Inpatient Deep vein thrombosis Detection (HIDDen) study) performed across five hospices in the UK recruited above target and on time. We describe strategies that aided successful recruitment in this study, and the lessons learnt for improving future studies. A recent review suggested that the 'Social Marketing Mix Framework' (SMMF) could help researchers with recruitment strategies in palliative care. We describe the recruiting strategies employed through the Social Marketing Mix lens and consider if it would be a useful framework for future researchers to use at the planning stage. Successful recruitment strategies employed in HIDDen study included: (i) addressing particular study-related factors, (ii) ensuring all patients were screened and offered participation if eligible, (iii) reducing impact on the clinical team through dedicated research nurses at sites, (iv) addressing research team issues with cross-cover between sites, where geographically possible, and (v) regular video conferencing meetings for support and collaborative solving of challenges. Limited pre-existing research infrastructure at most of the recruiting hospices created particular challenges. The SMMF provides a potential structure to help researchers to plan recruitment. However, to fully streamline trial set up and in order for hospice involvement in research to be realised systematically, a centralised approach to governance, organisational culture change whereby hospices embrace research as a legitimate purpose and consistent access to research staff are identified as key strategic elements promoting recruitment to studies in hospices.
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Affiliation(s)
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | | | - Flavia Swan
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hul, Hull, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hul, Hull, UK
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Cunningham N, Cowie J, Watchman K, Methven K. Understanding the training and education needs of homecare workers supporting people with dementia and cancer: A systematic review of reviews. DEMENTIA 2019; 19:2780-2803. [PMID: 31271044 PMCID: PMC7925442 DOI: 10.1177/1471301219859781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many people with dementia, supported by family carers, prefer to live at home and may rely on homecare support services. People with dementia are also often living with multimorbidities, including cancer. The main risk factor for both cancer and dementia is age and the number of people living with dementia and cancer likely to rise. Upskilling the social care workforce to facilitate more complex care is central to national workforce strategies and challenges. Training and education development must also respond to the key requirements of a homecare workforce experiencing financial, recruitment and retention difficulties. This systematic review of reviews provides an overview of dementia and cancer training and education accessible to the homecare workforce. Findings reveal there is a diverse range of training and education available, with mixed evidence of effectiveness. Key barriers and facilitators to effective training and education are identified in order to inform future training, education and learning development for the homecare workforce supporting people with dementia and cancer.
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Sullivan R, Ugalde A, Sinclair C, Breen LJ. Developing a Research Agenda for Adult Palliative Care: A Modified Delphi Study. J Palliat Med 2018; 22:480-488. [PMID: 30461347 DOI: 10.1089/jpm.2018.0462] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Little is known about research priorities in adult palliative care. Identifying research priorities for adult palliative care will help in increasing research quality and translation. Objective: The aim was to identify the views of health professionals' research priorities in adult palliative care that lead to development of a palliative care research agenda in Australia. Design: A modified three-round Delphi survey. Setting/Subjects: Palliative care researchers and clinicians in Australia were invited to participate. Results: A total of 25 panelists completed round 1, 14 completed round 2, and 13 completed round 3. Round 1 resulted in 90 research priorities in 13 categories. Round 2 showed consensus agreement on 19/90 research priorities. Round 3 resulted in the top 10 research priorities of the 19 achieving consensus in round 2. Panelists agreed that research is needed on the transition to palliative care; improving communication about prognosis; increasing access to palliative care for indigenous communities, people who wish to remain at home, and people in aged care; addressing family caregivers' needs; promoting patients' and families' decision making; improving cross-cultural aspects of palliative care; determining the effects of assisted dying legislation; and improving bereavement care in rural, remote, and Aboriginal populations. Conclusions: The expert panelists identified the top 10 research priorities for adult palliative care. These identified research priorities are the most urgent topics requiring attention to increase the quality of life of patients requiring palliative care and their family members.
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Affiliation(s)
| | - Anna Ugalde
- 2 School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Craig Sinclair
- 3 Rural Clinical School of Western Australia, University of Western Australia (Albany Centre), Albany, Australia
| | - Lauren J Breen
- 1 School of Psychology, Curtin University, Perth, Australia
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McIlfatrick S, Muldrew DHL, Hasson F, Payne S. Examining palliative and end of life care research in Ireland within a global context: a systematic mapping review of the evidence. BMC Palliat Care 2018; 17:109. [PMID: 30261860 PMCID: PMC6161399 DOI: 10.1186/s12904-018-0364-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022] Open
Abstract
Background Globally the state of palliative care research remains uncertain. Questions remain regarding impact, funding, and research priorities. Building upon previous research, this review examines palliative care research in Ireland and contributes to a wider international debate on the state of palliative care research. Methods A systematic mapping review was undertaken. Eight bibliographic databases and thesis repositories were searched from May 2012 to April 2017. Palliative care related search terms were combined with “Ireland” or “Irish” to increase search sensitivity. Inclusion criteria were applied by two independent reviewers. Descriptive analysis was completed using IBM SPSS v23. Thematic analysis was undertaken using a data-driven approach to develop new themes. Results In total, 808 studies were screened and 151 papers from 117 studies were included for review. The top two areas of research focus included: (1) specific groups, services, and settings (n = 70); and (2) identification, communication and education (n = 37). A diverse variety of research methods were used including mixed methods (25%), surveys (22%), interviews (20%), and reviews (17%). One randomised control trial was conducted. The predominance of research papers focused solely on health care professionals (n = 35%), and the community setting was the most frequent location for data collection (41%). The majority of data was collected across the two jurisdictions of the Republic of Ireland (ROI) and Northern Ireland (NI) (37%), and 23% of studies included data outside of Ireland and the UK. The most frequent sources of funding were: consortiums (n = 40); government (n = 24); and philanthropic bodies (n = 20). Forty percent (n = 60) of papers were either unfunded or did not acknowledge a funder. Conclusions There is a continued increase in palliative care research in Ireland with increased collaborative working nationally and internationally. The quantity and impact of research has increased from the previous review, which can be attributed to significant investment in research funding and collaborative networks. However, research gaps continue to exist including out of hours’ care, physical and psychological symptom control, intervention studies, and the patient and family perspective. Areas for attention include the need to ensure knowledge exchange and demonstrate impact of the research on patient and family carer outcomes. Electronic supplementary material The online version of this article (10.1186/s12904-018-0364-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sonja McIlfatrick
- School of Nursing, Ulster University, Shore Road, Newtownabbey, Co Antrim, BT37 0QB, UK. .,All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland.
| | - Deborah H L Muldrew
- School of Nursing, Ulster University, Shore Road, Newtownabbey, Co Antrim, BT37 0QB, UK
| | - Felicity Hasson
- School of Nursing, Ulster University, Shore Road, Newtownabbey, Co Antrim, BT37 0QB, UK
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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Pereira A, Ferreira A, Martins J. Academic Palliative Care Research in Portugal: Are We on the Right Track? Healthcare (Basel) 2018; 6:healthcare6030097. [PMID: 30103530 PMCID: PMC6163737 DOI: 10.3390/healthcare6030097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The narrow link between practice, education, and research is essential to palliative care development. In Portugal, academic postgraduate publications are the main booster for palliative care research. METHODS This is a bibliometric study that aims to identify Portuguese palliative care postgraduate academic work published in electronic academic repositories between 2000 and 2015. RESULTS 488 publications were identified. The number of publications has increased, especially in the last five years. The most frequently used method was quantitative, healthcare professionals were the most studied participants, and psychological and psychiatric aspects of care comprised the most current theme. Practice-based priorities are financial costs and benefits of palliative care, awareness and understanding of palliative care, underserved populations, best practices, communication, and palliative care in nonhospital settings. CONCLUSION The number of palliative care postgraduate academic publications has increased in Portugal in the past few years. There is academic production in the eight domains of quality palliative care and on the three levels of recommendation for practice-based research priorities. The major research gaps in Portugal are at the system and societal context levels.
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Affiliation(s)
- Alexandra Pereira
- Community Care Unit of Lousada, Rua de Santo Tirso 70, Meinedo, Lousada, 4620-848 Porto, Portugal.
- Abel Salazar Biomedical Institute, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Amélia Ferreira
- Community Care Unit of Lousada, Rua de Santo Tirso 70, Meinedo, Lousada, 4620-848 Porto, Portugal.
- Abel Salazar Biomedical Institute, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - José Martins
- Nursing School of Coimbra, 3046-841 Coimbra, Portugal.
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