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Jadhav U, Bhanushali J, Sindhu A, Reddy BSK. Navigating Compassion: A Comprehensive Review of Palliative Care in Respiratory Medicine. Cureus 2023; 15:e50613. [PMID: 38226109 PMCID: PMC10788689 DOI: 10.7759/cureus.50613] [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: 11/30/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Palliative care has emerged as a crucial aspect of comprehensive healthcare, particularly in respiratory medicine. This review navigates the intricate landscape of palliative care in the context of respiratory diseases, including chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and lung cancer. The exploration begins with a comprehensive examination of palliative care's definition, significance, and purpose in respiratory medicine. It progresses to understanding common respiratory diseases, their impact on patients' quality of life, and the nuances of disease progression and prognosis. Delving into the principles of palliative care, the review highlights the importance of a patient- and family-centered approach, emphasizing the multidisciplinary collaboration required for holistic care. Symptom management takes center stage, with a detailed exploration of dyspnea, cough, and pain, covering pharmacological and non-pharmacological interventions. The psychosocial and spiritual dimensions are then unveiled, recognizing the psychological impact of respiratory diseases and the significance of addressing spiritual needs with cultural sensitivity. Communication in palliative care is explored through breaking lousy news, advance care planning, and shared decision-making. The section acknowledges the complex considerations surrounding end-of-life care, including recognizing the end-of-life phase, establishing care goals, and withdrawing life-sustaining therapies. Recognizing the indispensable role of caregivers, the review underscores the importance of caregiver support. It delineates strategies for providing emotional and practical support alongside a crucial focus on self-care for caregivers who shoulder the responsibilities of providing palliative care. As the exploration concludes, the challenges in implementing palliative care in respiratory medicine are outlined, from late referrals to communication barriers. However, the review also envisions a future marked by innovation, with emerging approaches, such as telehealth and personalized medicine, offering promising avenues for improvement. Research gaps and areas for improvement are identified, emphasizing the need for a collaborative effort to enhance the quality of palliative care for individuals facing respiratory diseases. The review culminates in a call to action, urging early palliative care integration, investment in education and training, research initiatives, advocacy for accessible services, and collaboration across disciplines. By heeding this call, healthcare providers, researchers, and policymakers can collectively contribute to the evolution and enhancement of palliative care in the challenging landscape of respiratory medicine.
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Affiliation(s)
- Ulhas Jadhav
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jay Bhanushali
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arman Sindhu
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bingu Shiv Kiran Reddy
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Cancer statistics in Chinese older people, 2022: current burden, time trends, and comparisons with the US, Japan, and the Republic of Korea. SCIENCE CHINA LIFE SCIENCES 2022; 66:1079-1091. [PMID: 36543994 DOI: 10.1007/s11427-022-2218-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022]
Abstract
Largely due to population ageing, the cancer burden from older people has been rising, which imposed considerable pressure on current Chinese healthcare system. We provide comprehensive information about cancer burden of Chinese older people based on the most recent data from National Central Cancer Registry of China. The logarithmic linear regression was used to project the current cancer burden in 2022, and Joinpoint regression was used for temporal trend analysis from 2000 to 2017. We also estimated cancer statistics of older people in the US, Japan and the Republic of Korea for comparisons. It is estimated that 2.79 million cases and 1.94 million deaths occur for Chinese older people, representing 55.8% and 68.2% of cases and deaths in all population in 2022. The overall cancer incidence rate gradually increased among older women, while the mortality rates declined for both sexes. Notably, approximately 10.0% of all cases and 17.7% of all deaths are from people aged over 80 years, and cancer incidence and mortality in this age group showed upward trends for women. Lung cancer and digestive cancers are the leading cancer types for Chinese older people. Compared with other countries, China has lower incidence rates but higher mortality rates for older people. The rapidly growing burden of prostate cancer, breast cancer, colorectal cancer, and declines in esophageal cancer, stomach cancer, and liver cancer among older people indicate the cancer pattern in China is being in a transition stage to that in developed countries. Our findings imply that it should be the national health priority to meet the growing demands for cancer diagnosis, treatment and care services from the older people as the rapid population ageing in next few decades.
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Holdsworth LM, Mui HZ, Winget M, Lorenz KA. "Never waste a good crisis": A qualitative study of the impact of COVID-19 on palliative care in seven hospitals using the Dynamic Sustainability Framework. Palliat Med 2022; 36:1544-1551. [PMID: 36305617 PMCID: PMC9618919 DOI: 10.1177/02692163221123966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to rapid adaptations among palliative care services, but it is unclear how these adaptations vary in relation to their unique organizational contexts. AIM Understand how the pandemic impacted the implementation of new and existing palliative care programs in diverse hospital systems using the Dynamic Sustainability Framework. DESIGN Twelve in-depth interviews with 15 key informants representing palliative care programs from seven hospital systems between April and June 2020. SETTING Public, not-for-profit private, community, and academic teaching hospitals in the San Francisco Bay Area with existing palliative care programs that were expanding services to new clinical areas (e.g. new outpatient clinic or community-based care). RESULTS Six themes characterized how palliative care programs were impacted and adapted during the early stages of the COVID-19 pandemic: palliative care involvement in preparing for surge, increased emphasis on advance care planning, advocating for visitors for dying patients, providing emotional support to clinicians, adopting virtual approaches to care, and gaps in chaplaincy support. There was variation in how new and existing programs were able to adapt to early pandemic stresses; systems with new outpatient programs struggled to utilize their programs effectively during the crisis onset. CONCLUSIONS The fit between palliative care programs and practice setting was critical to program resiliency during the early stages of the pandemic. Reconceptualizing the Dynamic Sustainability Framework to reflect a bidirectional relationship between ecological system, practice setting, and intervention levels might better guide implementers and researchers in understanding how ecological/macro changes can influence interventions on the ground.
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Affiliation(s)
- Laura M Holdsworth
- Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Heather Z Mui
- Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Marcy Winget
- Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Karl A Lorenz
- Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA, USA
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Minard LV, Fisher J, Broadfield L, Walsh G, Sketris I. Opioid Use at End-Of-Life Among Nova Scotia Patients With Cancer. Front Pharmacol 2022; 13:836864. [PMID: 35401210 PMCID: PMC8987150 DOI: 10.3389/fphar.2022.836864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose: To determine the factors associated with opioid analgesic prescriptions as measured by community pharmacy dispensations to all Nova Scotia (NS) patients with cancer at end-of-life from 2005 to 2009. Methods: The NS Cancer Registry and the NS Prescription Monitoring Program (NSPMP) were used to link Nova Scotians who had a cancer diagnosis and received a prescription for opioids in their last year of life (n = 6,186) from 2005 to 2009. The association of factors with opioid dispensations at end-of-life were determined (e.g., patient demographics, type of prescriber, type of cancer, and opioid type, formulation, and dose). Results: Almost 54% (n = 6,186) of the end-of-life study population with cancer (n = 11,498) was linked to the NSPMP and therefore dispensed opioids. Most prescriptions were written by general practitioners (89%) and were for strong opioids (81%). Immediate-release formulations were more common than modified-release formulations. Although the annual average parenteral morphine equivalents (MEQ) did not change during the study period, the number of opioid prescriptions per patient per year increased from 5.9 in 2006 to 7.0 in 2009 (p < 0.0001). Patients age 80 and over received the fewest prescriptions (mean 3.9/year) and the lowest opioid doses (17.0 MEQ) while patients aged 40–49 received the most prescriptions (mean 14.5/year) and the highest doses of opioid (80.2 MEQ). Conclusion: Our study examined opioid analgesic use at end-of-life in patients with cancer for a large real-world population and determined factors, trends and patterns associated with type and dose of opioid dispensed. We provide information regarding how general practitioners prescribe opioid therapy to patients at end-of-life. Our data suggest that at the time of this study, there may have been under-prescribing of opioids to patients with cancer at end-of-life. This information can be used to increase awareness among general practitioners, and to inform recommendations from professional regulatory bodies, to aid in managing pain for cancer patients at end-of-life. Future work could address how opioid prescribing has changed over time, and whether efforts to reduce opioid prescribing in response to the opioid crisis have affected patients with cancer at end-of-life in Nova Scotia.
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Affiliation(s)
- Laura V. Minard
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Judith Fisher
- Nova Scotia Department of Health and Wellness, Halifax, NS, Canada
| | | | - Gordon Walsh
- Nova Scotia Health Cancer Care Program, Halifax, NS, Canada
| | - Ingrid Sketris
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
- *Correspondence: Ingrid Sketris, mailto:
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Olsson MM, Windsor C, Chambers S, Green TL. A Scoping Review of End-of-Life Communication in International Palliative Care Guidelines for Acute Care Settings. J Pain Symptom Manage 2021; 62:425-437.e2. [PMID: 33276045 DOI: 10.1016/j.jpainsymman.2020.11.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT End-of-life communication in acute care settings can be challenging and many patients and families have reported low satisfaction with those conversations. OBJECTIVE To explore existing guidelines around palliative care to increase current understanding of end-of-life communication processes applicable to the acute care setting. METHODS A scoping review following the method of Arksey and O'Malley was undertaken to identify eligible documents and thematically summarize findings. Web sites of government authorities, departments, and ministries of health as well as palliative care organizations were searched as were MEDLINE, CINAHL (EBSCOhost), EMBASE, Cochrane Library, Joanna Briggs Institute, and PsycINFO databases. Searches were limited to documents published between January 2009 and August 2019 that were nondisease specific and applicable to the acute care setting. RESULTS Thirteen guidelines from nine different countries were identified. Thematic analysis produced eight themes: 1) The purpose and process of end-of-life communications, 2) cognitive understanding and language in end-of-life communication, 3) legal aspects of end-of-life communication, 4) conflicts and barriers related to end-of-life care, 5) end-of-life communication related to medical record documentation, 6) healthcare professionals' responsibilities and collaboration, 7) education and training, and 8) policies, guidelines, and tools for end-of-life communications. CONCLUSIONS Palliative and end-of-life guidelines applicable to acute care settings outline the purpose of end-of-life communication and address how, when, and by whom such conversations are best initiated and facilitated. How guidelines are developed and what aspects of communications are included and emphasized may differ across countries related to role differences of physicians and nurses and national laws and regulations.
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Affiliation(s)
- Maja Magdalena Olsson
- Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Carol Windsor
- Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shirley Chambers
- Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; Cancer & Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Theresa L Green
- Faculty of Health & Behavioural Sciences, School of Nursing, Midwifery & Social Work, The University of Queensland, Brisbane, Queensland, Australia; Metro North Hospital & Health Service, Surgical Treatment & Rehabilitation Service, Herston, Queensland, Australia
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Ebadinejad Z, Rassouli M, Fakhr-Movahedi A. Assessing the compliance of educational curricula of selected disciplines with the content standards of cancer-related palliative care. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:247. [PMID: 34485544 PMCID: PMC8395876 DOI: 10.4103/jehp.jehp_1415_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/15/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Management of cancer complications requires the provision of palliative care as a comprehensive care by the main and trained members of this method of care. The aim of the present study was to assess the compliance of educational curricula of selected disciplines with the content standards of cancer-related palliative care. MATERIALS AND METHODS In this descriptive-comparative study, the content standards of palliative care for nurses, physicians, and social workers were identified based on the World Health Organization guideline and Oxford Textbook of Palliative Nursing. For this purpose, a separate checklist was prepared for the disciplines with different dimensions. Then the face and content validity of the checklists were checked. Finally, we examined the coordination between selected curricula available on the website of Education Deputy of the Ministry of Health, Treatment and Medical Education with the dimensions of the checklists. RESULTS All three curricula in most domains were relevant with the content standards, but there was the biggest education need in the areas related to the dimensions of "planning and educational," "educating physician in palliative care," and "considering patient preferences" in these disciplines. CONCLUSIONS To meet the educational needs, it is suggested to change some course topics, hold training courses, or joint workshops.
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Affiliation(s)
- Zahra Ebadinejad
- Student Research Committee, Pediatric and Neonatal Nursing Department, School of Nursing, Semnan University of Medical Sciences, Semnan, Iran
| | - Maryam Rassouli
- Cancer Research Centre, Pediatric Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Fakhr-Movahedi
- Nursing Care Research Center, Pediatric and Neonatal Nursing Department, School of Nursing, Semnan University of Medical Sciences, Semnan, Iran
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Moshidi ML, Malema RN, Muthelo L, Mothiba TM. Provision of Care to the People with HIV: Voices of Professional Nurses in the Public Hospitals of Limpopo Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063112. [PMID: 33803507 PMCID: PMC8002935 DOI: 10.3390/ijerph18063112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
The battle against the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) epidemic are still raging in South Africa (SA) despite all the preventive strategies implemented via the five-year strategic plan (2011-2015). The intensity of the AIDS pandemic in SA creates additional challenges for the health workers as they have to deal with an increasing number of people who suffer from this disease. Professional nurses are a critical part of the workforce. The qualitative, explorative, descriptive, and contextual study design was conducted in five public hospitals from each district of Limpopo Province. The purpose of the study was to explore and describe experiences regarding support received by professional nurses while providing care to HIV and AIDS patients in the public hospitals of Limpopo Province. Purposive sampling was employed to select the participants who provided care to HIV and AIDS patients for 24 months or more. The recruitment of participants continued until data saturation was reached at participant number 20. Data were collected through face-to-face individual interviews using a semi-structured guide. Data were analyzed using Tech's qualitative data analysis method. Trustworthiness was measured through credibility, dependability, confirmability, and transferability. Findings: Emotional and physical strain due to a shortage of staff, heavy workload, staff turnover, and high absenteeism were experienced by the nurses fulfilling these tasks. Exhaustion, fatigue, increased levels of stress, and lack of training, counselling, debriefing sessions, recognitions, and reward systems were also experienced. Recommendations: A program for support of all professional nurses providing care to HIV and AIDS patients should be conceptualized and implemented.
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Affiliation(s)
- Maria Lebeko Moshidi
- Department of Nursing Science, University of Limpopo, Sovenga 0727, South Africa; (M.L.M.); (R.N.M.)
| | - Rambelani Nancy Malema
- Department of Nursing Science, University of Limpopo, Sovenga 0727, South Africa; (M.L.M.); (R.N.M.)
| | - Livhuwani Muthelo
- Department of Nursing Science, University of Limpopo, Sovenga 0727, South Africa; (M.L.M.); (R.N.M.)
- Correspondence: ; Tel.: +27-526-839-73
| | - Tebogo Maria Mothiba
- Faculty of Health Sciences Executive Dean’s Office, University of Limpopo, Sovenga 0727, South Africa;
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Martins Pereira S, Hernández-Marrero P, Pasman HR, Capelas ML, Larkin P, Francke AL. Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports. Palliat Med 2021; 35:130-141. [PMID: 32912033 DOI: 10.1177/0269216320956817] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nurses are the largest regulated group of healthcare professionals involved in palliative care. In 2004, a taskforce of the European Association for Palliative Care (EAPC) launched the 'Guide for development of palliative nurse education in Europe' (hereinafter, the EAPC 2004 Guide). No systematic evaluation of its impact in the development of palliative care education was undertaken. AIMS To describe current undergraduate and postgraduate nursing education across Europe; to identify the roles that nurses with different palliative care educational levels have in palliative care; and to assess the uptake of the EAPC 2004 Guide in the development of palliative care nursing in Europe. DESIGN Descriptive research involving an online survey among nursing experts, and the consultation of national representatives. SETTING/PARTICIPANTS A total of 135 nurses (52% response rate) from 25 countries completed the online survey; representatives from 16 countries were consulted. RESULTS In 14 (56%) countries, palliative care was not identified as a mandatory subject within undergraduate nursing education. The EAPC 2004 Guide is widely known and was/is being used in many countries to promote palliative care nursing education. Large variations were found across and within country responses. CONCLUSIONS Palliative care nursing education varies largely in Europe. The wide awareness and use of the EAPC 2004 Guide show how policy measures can influence the development of palliative care education. Recommendations are built and focus on both fostering the use of this guide and implementing policy measures to ensure that palliative care nursing is recognised and certified as a specialty in all European countries.
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Affiliation(s)
- Sandra Martins Pereira
- Católica Porto Business School, CEGE: Research Centre in Management and Economics, Universidade Católica Portuguesa, Porto, Portugal.,Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.,UNESCO Chair in Bioethics, Universidade Católica Portuguesa, Porto, Portugal
| | - Pablo Hernández-Marrero
- Católica Porto Business School, CEGE: Research Centre in Management and Economics, Universidade Católica Portuguesa, Porto, Portugal.,Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.,UNESCO Chair in Bioethics, Universidade Católica Portuguesa, Porto, Portugal
| | - H Roeline Pasman
- Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Manuel Luís Capelas
- Portuguese Observatory for Palliative Care, Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Philip Larkin
- Centre Hospitalier Universitaire Vaudois (CHUV), UNIL
- Université de Lausanne, Lausanne, Switzerland
| | - Anneke L Francke
- Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Lundeby T, Wester TE, Loge JH, Kaasa S, Aass NK, Grotmol KS, Finset A. Challenges and Learning Needs for Providers of Advanced Cancer Care: Focus Group Interviews with Physicians and Nurses. Palliat Med Rep 2020; 1:208-215. [PMID: 34223478 PMCID: PMC8241352 DOI: 10.1089/pmr.2020.0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Implementation of integrated oncology and palliative care improves patient outcomes but may represent a demanding task for health care providers (HCPs). Objective: To explore physicians' and nurses' perceived challenges and learning needs in their care for patients with advanced cancer, and to analyze how these perceptions can provide insight on how to improve care for patients with advanced cancer in an integrated care model. Methods: Residents in oncology, oncologists, nurses, and palliative care physicians were recruited to participate in focus group interviews. Six focus group interviews were conducted with 35 informants. Data were analyzed according to principles of thematic analysis. Results: The discussions in the interviews concerned three broad themes: an emphasis on patients' best interest, perceived as hindered by two sets of barriers; unsatisfactory organizational conditions such as time pressure, lack of referral routines, and few arenas for interdisciplinary collaboration, was perceived as one barrier. The other barrier was related to the appraisal of other HCPs' clinical practices. Participating HCPs expressed in general a positive self-view, but were more critical of other HCPs. Conclusion: Currently, implementation of measures to improve care for patients with advanced cancer appears to be challenging due to cultural and organizational factors, and how HCPs perceive themselves and other HCPs. HCPs' perception of challenges in patient care as not related to themselves (externalization) might be an essential obstacle. Interventions targeting both HCP-related and organizational factors are needed. Particularly important are measures aimed at reducing fragmentation and improving collaboration in care.
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Affiliation(s)
- Tonje Lundeby
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torunn Elin Wester
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Jon Håvard Loge
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Kathrine Aass
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Støen Grotmol
- Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, Oslo, Norway
| | - Arnstein Finset
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
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Current Topics in Serious Illness and Palliative Medicine: A Curricular Initiative in a US Veterinary Teaching Institution. Vet Clin North Am Small Anim Pract 2019; 49:373-386. [PMID: 30853239 DOI: 10.1016/j.cvsm.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although interest in hospice and palliative care for companion animals is on the rise, formal training in these areas is limited. Veterinary teaching institutions, professional organizations, and accrediting bodies have much to gain from the human palliative medicine field. Core competencies, curricular milestones, and scope of practice for palliative medicine are identified. A formal palliative care intervention has been implemented in a US veterinary teaching institution, and preliminary evaluation data reflect significant potential for integration of palliative care training into veterinary teaching. Positive outcomes for veterinarian well-being and ability to cope with emotional demands are suggested.
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11
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Glajchen M, Berkman C, Otis-Green S, Stein GL, Sedgwick T, Bern-Klug M, Christ G, Csikai E, Downes D, Gerbino S, Head B, Parker-Oliver D, Waldrop D, Portenoy RK. Defining Core Competencies for Generalist-Level Palliative Social Work. J Pain Symptom Manage 2018; 56:886-892. [PMID: 30201485 DOI: 10.1016/j.jpainsymman.2018.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/03/2018] [Indexed: 11/21/2022]
Abstract
CONTEXT Care provided to seriously ill patients by frontline social workers is a component of generalist-level palliative care. The core competencies for high-quality generalist-level palliative social work are necessary to promote training curricula and best practices but have not yet been defined in the U.S. OBJECTIVE The objective of this study was to develop consensus-derived core competencies for generalist-level palliative social work. METHODS Fifty-five proposed social work competencies were categorized by the eight domains of palliative care identified by the National Consensus Project for Quality Palliative Care. The competencies were rated by 41 regionally dispersed, Master's level social workers selected through purposive and snowball sampling using a Delphi method. Each was rated as essential for generalist-level palliative social work, acceptable with modifications, or rejected based on the judgment that it was not essential for generalist-level palliative social work or was outside the scope of practice. Consensus was defined as >70% agreement to accept or reject a competency. Three review rounds were needed to achieve consensus on all competencies. RESULTS Two competencies were added to the original list. Of the 57 proposed competencies, 41 were accepted (19 after modification) and 16 were rejected. Competencies in the social, spiritual, cultural, and ethical/legal aspects of care domains were relatively more likely to be accepted compared with those in structure and processes of care, physical care, psychological care, and care of patient at the end of life. CONCLUSION The 41 consensus-derived competencies for generalist-level palliative social work may inform the development of training curricula and standards for high-quality care.
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Affiliation(s)
- Myra Glajchen
- MJHS Institute for Innovation in Palliative Care, New York, New York.
| | - Cathy Berkman
- Fordham University Graduate School of Social Service, New York, New York
| | | | - Gary L Stein
- Wurzweiler School of Social Work at Yeshiva University, New York, New York
| | - Tom Sedgwick
- New York University Langone Medical Center, New York, New York
| | | | - Grace Christ
- Columbia University School of Social Work, New York, New York
| | - Ellen Csikai
- University of Alabama School of Social Work, Tuscaloosa, Alabama
| | | | - Susan Gerbino
- New York University Silver School of Social Work, New York, New York
| | - Barbara Head
- University of Louisville School of Medicine and Kent School of Social Work, Louisville, Kentucky
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Hafi NAB, Uvais NA. Palliative dermatology – An area of care yet to be explored. PROGRESS IN PALLIATIVE CARE 2018. [DOI: 10.1080/09699260.2018.1492685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- N. A. Bishurul Hafi
- Department of Dermatology, Regional Institute of Medical Sciences, Imphal, India
| | - N. A. Uvais
- Department of Psychiatry, Iqraa International Hospital and Research Centre, Kozhikode, India
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Meier DE, Back AL, Berman A, Block SD, Corrigan JM, Morrison RS. A National Strategy For Palliative Care. Health Aff (Millwood) 2018; 36:1265-1273. [PMID: 28679814 DOI: 10.1377/hlthaff.2017.0164] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In 2014 the World Health Organization called for palliative care to be integrated as an essential element of the health care continuum. Yet in 2017 US palliative care services are found largely in hospitals, and hospice care, which is delivered primarily in the home, is limited to people who are dying soon. The majority of Americans with a serious illness are not dying; are living at home, in assisted living facilities, or in nursing homes; and have limited access to palliative care. Most health care providers lack knowledge about and skills in pain and symptom management, communication, and care coordination, and both the public and health professionals are only vaguely aware of the benefits of palliative care and how and when to access it. The lack of policy supports for palliative care contributes to preventable suffering and low-value care. In this article we outline the need for a national palliative care strategy to ensure reliable access to high-quality palliative care for Americans with serious medical illnesses. We review approaches employed by other countries, list the participants needed to develop and implement an actionable strategy, and identify analogous US national health initiatives to inform a process for implementing the strategy.
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Affiliation(s)
- Diane E Meier
- Diane E. Meier is director of the Center to Advance Palliative Care and a professor in the Department of Geriatrics and Palliative Medicine, both at the Icahn School of Medicine at Mount Sinai, in New York City
| | - Anthony L Back
- Anthony L. Back is a professor in the Department of Medicine and codirector of the Cambia Palliative Care Center of Excellence at the University of Washington, cofounder of Vitaltalk (a nonprofit communication skills training organization), and an affiliate member of the Fred Hutchinson Cancer Research Center, all in Seattle
| | - Amy Berman
- Amy Berman is a senior program officer at the John A. Hartford Foundation, in New York City
| | - Susan D Block
- Susan D. Block is director of the Serious Illness Care Program at Ariadne Labs and a professor of psychiatry and medicine at Harvard Medical School, both in Boston, Massachusetts
| | - Janet M Corrigan
- Janet M. Corrigan is chief program officer for patient care at the Gordon and Betty Moore Foundation, in Palo Alto, California
| | - R Sean Morrison
- R. Sean Morrison is director of the National Palliative Care Research Center and a professor in the Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, in New York City
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Nakazawa Y, Kato M, Miyashita M, Morita T, Kizawa Y. Changes in Nurses' Knowledge, Difficulties, and Self-reported Practices Toward Palliative Care for Cancer Patients in Japan: An Analysis of Two Nationwide Representative Surveys in 2008 and 2015. J Pain Symptom Manage 2018; 55:402-412. [PMID: 28919540 DOI: 10.1016/j.jpainsymman.2017.08.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT The Cancer Control Act was passed in Japan in 2007, and various additional programs on palliative care have been implemented to improve quality of life and relieve pain and suffering in patients with cancer. However, how clinical settings have changed remains unclear. OBJECTIVES The primary aim of the present study was to determine changes in nurses' palliative care knowledge, difficulties, and self-reported practices between 2008 and 2015. METHODS This study was an analysis of two nationwide observational studies from 2008 to 2015. We conducted two questionnaire surveys for representative samples of nurses in designated cancer hospitals, community hospitals, and district nurse services. The measurements used the Palliative Care Knowledge Test (PCKT, range 1-100), the Palliative Care Difficulties Scale (PCDS, range 1-5), and the Palliative Care Self-Reported Practice Scale (PCPS, range 1-5). Comparisons were made using the nonpaired Student t-test and a multivariate linear regression model using two cohorts. RESULTS We analyzed survey results for 2707 nurses in 2008 and 3649 nurses in 2015. Significant improvements were seen in PCKT, PCDS, and PCPS total scores for nurses in every work location over the seven-year study period, with PCKT total scores of 53 vs. 65 (P < 0.001; effect size = 0.60), 47 vs. 55 (P < 0.001; effect size = 0.40), and 52 vs. 55 (P = 0.118; effect size = 0.13), PCDS total scores of 3.0 vs. 2.5 (P < 0.001; effect size = 0.76), 3.4 vs. 2.8 (P < 0.001, effect size = 0.91), and 3.2 vs. 2.9 (P < 0.001; effect size = 0.53), and PCPS total scores of 3.7 vs. 4.0 (P < 0.001; effect size = 0.13), 3.5 vs. 3.8 (P < 0.001; effect size = 0.42), and 3.8 vs. 4.0 (P < 0.011; effect size = 0.21) in designated cancer hospitals, community hospitals, and district nurse services, respectively. CONCLUSION Nurses' palliative care knowledge, difficulties, and self-reported practices improved over the seven-year study period, especially in terms of expert support in designated cancer hospitals and knowledge among nurses in designated cancer hospitals.
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Affiliation(s)
- Yoko Nakazawa
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan; Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Masashi Kato
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, 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, Japan
| | - Yoshiyuki Kizawa
- Division of Palliative Medicine, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Siouta N, Van Beek K, Payne S, Radbruch L, Preston N, Hasselaar J, Centeno C, Menten J. Is the content of guidelines/pathways a barrier for the integration of palliative Care in Chronic Heart Failure (CHF) and chronic pulmonary obstructive disease (COPD)? A comparison with the case of cancer in Europe. BMC Palliat Care 2017; 16:62. [PMID: 29179703 PMCID: PMC5704525 DOI: 10.1186/s12904-017-0243-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a notable inequity in access to palliative care (PC) services between cancer and Chronic Heart Failure (CHF)/Chronic Obstructive Pulmonary Disease (COPD) patients which also translates into discrepancies in the level of integration of PC. By cross-examining the levels of PC integration in published guidelines/pathways for CHF/COPD and cancer in Europe, this study examines whether these discrepancies may be attributed to the content of the guidelines. DESIGN A quantitative evaluation was made between integrated PC in published guidelines for cancer and CHF/COPD in Europe. The content of integrated PC in guidelines/pathways was measured using an 11 point integrated PC criteria tool (IPC criteria). A statistical analysis was carried out to detect similarities and differences in the level of integrated PC between the two groups. RESULTS The levels of integration between CHF/COPD and cancer guidelines/pathways have been shown to be statistically similar. Moreover, the quality of evidence utilized and the date of development of the guidelines/pathways appear not to impact upon the PC integration in the guidelines. CONCLUSION In Europe, the empirically observed imbalance in integration of PC for patients with cancer and CHF/COPD may only partially be attributed to the content of the guidelines/pathways that are utilized for the PC implementation. Given the similarities detected between cancer and CHF/COPD, other barriers appear to play a more prominent role.
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Affiliation(s)
- Naouma Siouta
- Dept. of Radiation-Oncology and Palliative Medicine, KU Leuven, Leuven, Belgium
| | - Karen Van Beek
- Dept. of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Sheila Payne
- International Observatory on End of Life Care Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Nancy Preston
- International Observatory on End of Life Care Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jeroen Hasselaar
- Anesthesiology, Pain and Palliative Care, UMC St Radboud, Nijmegen, The Netherlands
| | - Carlos Centeno
- Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Johan Menten
- Dept. of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
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Nakazawa Y, Yamamoto R, Kato M, Miyashita M, Kizawa Y, Morita T. Improved knowledge of and difficulties in palliative care among physicians during 2008 and 2015 in Japan: Association with a nationwide palliative care education program. Cancer 2017; 124:626-635. [DOI: 10.1002/cncr.31071] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/10/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Yoko Nakazawa
- Division of Medical Support and Partnership; Center for Cancer Control and Information Services, National Cancer Center; Tokyo Japan
- Department of Palliative Nursing, Health Sciences; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Ryo Yamamoto
- Department of Palliative Medicine; Saku Central Hospital Advanced Care Center; Nagano Japan
| | - Masashi Kato
- Division of Medical Support and Partnership; Center for Cancer Control and Information Services, National Cancer Center; Tokyo Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Yoshiyuki Kizawa
- Division of Palliative Medicine; Kobe University Hospital, Kobe University School of Medicine; Hyogo Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care; Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital; Shizuoka Japan
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Martins Pereira S, Hernández-Marrero P. Palliative care nursing education features more prominently in 2015 than 2005: Results from a nationwide survey and qualitative analysis of curricula. Palliat Med 2016; 30:884-8. [PMID: 26994120 DOI: 10.1177/0269216316639794] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Making palliative care accessible to all citizens who are in need of this type of care requires effective policies and education. Moreover, healthcare professionals have an ethical and legal responsibility to ensure quality palliative care. Nevertheless, palliative care has had traditionally a limited emphasis in healthcare professionals' undergraduate education. AIM To study the current status of palliative care education in nursing undergraduate curricula and compare 2005 and 2015 findings. DESIGN An online survey was sent to all state schools providing nursing undergraduate education in Portugal (N = 21). The survey assessed if and how palliative care was included in the curricula, and whether or not national and international recommendations for palliative care nursing education were followed. Further analysis included the content of available curricula/syllabi. SETTING/PARTICIPANTS A total of 19 schools completed the survey (90% of response rate). These institutions are geographically dispersed and representative of state nursing educational institutions in Portugal. RESULTS In 2015, all participant schools integrated palliative care in their curricula; nine schools had palliative care as an independent curricular unit (an 800% increase compared to 2005). While in 2005, only 14 out of 23 (61%) schools included palliative care explicitly in their curricula; in 2015, all 19 participant schools did so. National and international recommendations were followed. CONCLUSION The inclusion of palliative care within nursing undergraduate curricula strongly increased from 2005 to 2015. Further research is needed to understand the contribution of education in the access, care provision, quality and development of palliative care in this country.
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Affiliation(s)
| | - Pablo Hernández-Marrero
- Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Rabow MW, Dahlin C, Calton B, Bischoff K, Ritchie C. New Frontiers in Outpatient Palliative Care for Patients With Cancer. Cancer Control 2016; 22:465-74. [PMID: 26678973 DOI: 10.1177/107327481502200412] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although much evidence has accumulated demonstrating its benefit, relatively little is known about outpatient palliative care in patients with cancer. METHODS This paper reviews the literature and perspectives from content experts to describe the current state of outpatient palliative care in the oncology setting and current areas of innovation and promise in the field. RESULTS Evidence, including from controlled trials, documents the benefits of outpatient palliative care in the oncology setting. As a result, professional medical organizations have guidelines and recommendations based on the key role of palliative care in oncology. Six elements of the practice sit at the frontier of outpatient oncology palliative care, including the setting and timing of palliative care integration into outpatient oncology, the relationships between primary and specialty palliative care, quality and measurement, research, electronic and technical innovations, and finances. CONCLUSIONS Evidence of clinical and health care system benefits supports the recommendations of professional organizations to integrate palliative care into the routine treatment of patients with advanced cancer.
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Abstract
Palliative care is given to improve the quality of life of patients who have a serious or life-threatening disease. The role of the advanced practice nurse (APN) has significant value in this speciality. APNs provide holistic care, along with diagnostic and treatment expertise, and at the same time evaluate cost-effective use of resources. Palliative care APNs are specialists and leaders in disease-modifying care, pain and symptom management, giving attention to highest quality of life possible, and compassionate end-of-life care. The role of the APN has been highly recognised in the US and the aim of this article is to investigate this role. The article explores background, significance and a review of the literature. It concludes by emphasising the importance of APNs.
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Affiliation(s)
- Tintu George
- Adult Acute Nurse Practitioner, Thomas Jefferson College of Nursing, Philadelphia, US
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20
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Bergman J, Laviana AA. Opportunities to maximize value with integrated palliative care. J Multidiscip Healthc 2016; 9:219-26. [PMID: 27226721 PMCID: PMC4863682 DOI: 10.2147/jmdh.s90822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Palliative care involves aggressively addressing and treating psychosocial, spiritual, religious, and family concerns, as well as considering the overall psychosocial structures supporting a patient. The concept of integrated palliative care removes the either/or decision a patient needs to make: they need not decide if they want either aggressive chemotherapy from their oncologist or symptom-guided palliative care but rather they can be comanaged by several clinicians, including a palliative care clinician, to maximize the benefit to them. One common misconception about palliative care, and supportive care in general, is that it amounts to “doing nothing” or “giving up” on aggressive treatments for patients. Rather, palliative care involves very aggressive care, targeted at patient symptoms, quality-of-life, psychosocial needs, family needs, and others. Integrating palliative care into the care plan for individuals with advanced diseases does not necessarily imply that a patient must forego other treatment options, including those aimed at a cure, prolonging of life, or palliation. Implementing interventions to understand patient preferences and to ensure those preferences are addressed, including preferences related to palliative and supportive care, is vital in improving the patient-centeredness and value of surgical care. Given our aging population and the disproportionate cost of end-of-life care, this holds great hope in bending the cost curve of health care spending, ensuring patient-centeredness, and improving quality and value of care. Level 1 evidence supports this model, and it has been achieved in several settings; the next necessary step is to disseminate such models more broadly.
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Affiliation(s)
- Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA, USA
| | - Aaron A Laviana
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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21
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Van Beek K, Siouta N, Preston N, Hasselaar J, Hughes S, Payne S, Radbruch L, Centeno C, Csikos A, Garralda E, van der Eerden M, Hodiamont F, Radvanyi I, Menten J. To what degree is palliative care integrated in guidelines and pathways for adult cancer patients in Europe: a systematic literature review. BMC Palliat Care 2016; 15:26. [PMID: 26940753 PMCID: PMC4778279 DOI: 10.1186/s12904-016-0100-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/23/2016] [Indexed: 12/25/2022] Open
Abstract
Background Palliative Care (PC) aims to improve the quality of life for patients with cancer and their families and its benefits have been demonstrated by several studies. The objective of this systematic review is to assess the integration of PC in the content of guidelines/pathways of adult cancer patients in Europe. Methods We included studies of adult patients with cancer published from 01/01/1995 and 31/12/2013 in Europe in six languages. We searched nine electronic databases, hand-searched six journals and also performed citation tracking. Studies were ranked using Emanuel’s Integrated Palliative Care (IPC) criteria, a tool containing 11 domains to assess PC content in guidelines. Two reviewers screened the results and narrative synthesis has been employed. Results We identified a total of 28,277 potentially relevant articles from which 637 were eligible for full-text screening. The final review included 60 guidelines and 14 pathways. Eighty percent (80 %) of the guidelines/pathways emphasize a holistic approach and 66 % focus on PC interventions aimed at reducing suffering. Fifty seven percent (57 %) did not discuss referral criteria for PC. Of all studies, five fulfilled at least 10/11 IPC criteria. Differences existed with regard to the referral criteria for bereavement care and the continuous adjustment of goals of care. Conclusion Overall, most of the identified guidelines/pathways highlighted the importance of the holistic approach of IPC. The studies that were found to fulfil at least 10/11 Emanuel’s IPC criteria could serve as benchmarks of IPC.
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Affiliation(s)
- Karen Van Beek
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
| | - Naouma Siouta
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Sean Hughes
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
| | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain.
| | - Agnes Csikos
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary.
| | - Eduardo Garralda
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain.
| | - Marlieke van der Eerden
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
| | - Ildiko Radvanyi
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary.
| | - Johan Menten
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
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Nathanson BH, McGee WT, Dietzen DL, Chen Q, Young J, Higgins TL. A State-Level Assessment of Hospital-Based Palliative Care and the Use of Life-Sustaining Therapies in the United States. J Palliat Med 2016; 19:421-7. [PMID: 26871522 DOI: 10.1089/jpm.2015.0233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is unknown how the prevalence of hospitals with palliative care programs (PCPs) at the state level in the United States correlates with the treatment of critically ill patients. OBJECTIVE We examined the relationship between state-level PCP prevalence and commonly used treatments for critically ill patients as well as other public health metrics. METHODS We compiled state-level data for the year 2011 from multiple published sources. These included the poverty rate from the U.S. Census, public health measures such as the number of primary care physicians per 100,000 persons from America's Health Ranking website, and state-level rates for a series of validated ICD-9 (International Classification of Diseases, 9th Revision) procedure codes used for critically ill patients (e.g., prolonged acute mechanical ventilation [PAMV]) from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality. State-level percentages of PCPs came from a published report by the Center to Advance Palliative Care (CAPC). We used the Kruskal-Wallis test and Pearson's correlation coefficient for statistical inference. RESULTS State-level poverty rates were negatively correlated with the percent of hospitals with PCPs: r = -0.39, p = 0.005. States with more hospital-based PCPs had significantly lower rates of PAMV, tracheostomies, and hemodialysis but higher rates of nutritional support than states with fewer PCPs. CONCLUSIONS States with more poverty and/or at high risk for delivering inefficient health care had fewer hospital PCPs. Hospital-based PCPs may influence the frequency of some interventions for critically ill patients.
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Affiliation(s)
| | - William T McGee
- 2 Department of Medicine, Division of Critical Care, Baystate Medical Center , Springfield, Massachusetts.,4 Tufts University School of Medicine , Boston, Massachusetts
| | - Diane L Dietzen
- 3 Division of Geriatrics and Post Acute Medicine, Baystate Medical Center , Springfield, Massachusetts.,4 Tufts University School of Medicine , Boston, Massachusetts
| | - Quenica Chen
- 5 SCMDP at Newell Rubbermaid , East Longmeadow, Massachusetts
| | - Jared Young
- 6 School of Engineering, University of Massachusetts at Amherst , Amherst, Massachusetts
| | - Thomas L Higgins
- 2 Department of Medicine, Division of Critical Care, Baystate Medical Center , Springfield, Massachusetts.,4 Tufts University School of Medicine , Boston, Massachusetts
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Abstract
The World Health Organization estimated that more than 60% of the 14 million new cancer cases worldwide in 2012 were reported in the developing part of the world, including Asia, Africa, Central and South America. Cancer survival rate is poorer in developing countries due to diagnosis at late stage and limited access to timely treatment. Since the disease per se cannot be treated even with the best available treatment modalities, what remains important is symptom management and providing comfort care to these patients. The incidence of pain in advanced stages of cancer approaches 70-80%. Lack of preventive strategies, poverty, illiteracy, and social stigma are the biggest cause of pain suffering and patient presenting in advance stage of their disease. The need for palliative care is expanding due to aging of world's population and increase in the rate of cancer in developed and developing countries. A huge gap remains between demand and current palliative care services. Overcoming barriers to palliative care is a major global health agenda that need immediate attention. Main causes of inadequate pain relief remain lack of knowledge among physician and patients, lack of adequate supply of opioids and other drugs for pain relief, strong bureaucracy involved in terms of procurement, and dispensing of opioids. Beside this, poverty and illiteracy remain the most important factors of increased suffering.
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Affiliation(s)
- Shalini Saini
- Department of Anesthesiology, BLK Super Speciality Hospital, New Delhi, India
| | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, BRAIRCH, AIIMS, New Delhi, India
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Khoshnazar TAK, Rassouli M, Akbari ME, Lotfi-Kashani F, Momenzadeh S, Haghighat S, Sajjadi M. Structural Challenges of Providing Palliative Care for Patients with Breast Cancer. Indian J Palliat Care 2016; 22:459-466. [PMID: 27803569 PMCID: PMC5072239 DOI: 10.4103/0973-1075.191828] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: To establish a palliative care system (PCS) in Iran, it is necessary to identify the potential barriers. Aim: This study aims to highlight the views of stakeholders to know the challenges of providing palliative care for women with breast cancer. Materials and Methods: Semi-structured in-depth interviews are used with purposeful sampling conducted in Tehran, Iran; from January to June 2015. Twenty participants were included in the study: nine patients with breast cancer and ten health-care providers. The interviews were analyzed using qualitative directed content analysis based on Donabedian model. Data credibility was examined using the criteria of Lincoln and Guba. Results: Based on the pattern of Avedis Donabedian model, two main categories were identified: (1) palliative care services in the health system still remain undefined and (2) lack of adequate care providers. The subcategories emerged from the main categories are: (1) Inexistent home care, (2) specialized palliative care being in high demand, lack of: (a) Rehabilitation program and guidelines, (b) treatment/training protocols, (c) inefficient insurance and out-of-pocket costs, (d) patient referral system, (e) nontransparency of job description, and (f) weakness of teamwork. Discussion: The findings of the study identify views and perceptions of patients as well as the health professionals around the challenges of providing palliative care. To establish a structured PCS, we need to meet the challenges and remove perceived barriers to, including but not limited to, building up knowledge and awareness of health professionals, educating professional, and developing updated, well-defined, and standard treatment protocols, tailored to local conditions.
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Affiliation(s)
| | - Maryam Rassouli
- Department of Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Farah Lotfi-Kashani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Psychology, Islamic Azad University, Roudehen Branch, Roudehen, Iran
| | - Syrus Momenzadeh
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Moosa Sajjadi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
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25
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Khoshnazar TAK, Rassouli M, Akbari ME, Lotfi-Kashani F, Momenzadeh S, Rejeh N, Mohseny M. Communication Needs of Patients with Breast Cancer: A Qualitative Study. Indian J Palliat Care 2016; 22:402-409. [PMID: 27803561 PMCID: PMC5072231 DOI: 10.4103/0973-1075.191763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Introduction: Since communication is considered to be one of the central concepts in caregiving practices, this study aims to examine the perception of women with breast cancer in terms of their communication needs. Methods: In this qualitative study, 20 participants (9 women with breast cancer, 10 of health-care professionals, and one family caregiver) were selected through purposive sampling, and a face-to-face semi-structured interview was conducted with each of them. After data collection, all interviews were transcribed and reviewed, and categories were extracted. The data were analyzed with Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Results: The analysis resulted in two extracted categories: “therapeutic communication” and “facilitating empathy”, and five subcategories: “trust-building therapist”, “crying out to be heard,” “seeking a soothing presence,” “sharing knowledge,” and “supportive peers”. Conclusion: Identifying and promoting the communicative needs of patients could lead to a considerably better care of patients under treatment. Therefore, therapeutic communication, as an integral part, should be incorporated into the care plan for patients with breast cancer and their families in the Oncology and Palliative Care wards.
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Affiliation(s)
- Tahereh Alsadat Khoubbin Khoshnazar
- Department of Nursing, School of Nursing and Midwifery, Tehran, Iran; Cancer Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mrayam Rassouli
- Department of Nursing, School of Nursing and Midwifery, Tehran, Iran
| | | | - Farah Lotfi-Kashani
- Cancer Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Psychology, Islamic Azad University, Roudehen Branch, Tehran, Iran
| | - Syrus Momenzadeh
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahid Rejeh
- Department of Nursing, Eldery Care Research Center, Shahed University, Faculty of Nursing and Midwifery, Tehran, Iran
| | - Maryam Mohseny
- Department of Community Medicine, Shahid Behrshti University of Medical Sciences, Tehran, Iran
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Montgomery K, Sawin KJ, Hendricks-Ferguson VL. Experiences of Pediatric Oncology Patients and Their Parents at End of Life. J Pediatr Oncol Nurs 2015. [DOI: 10.1177/1043454215589715] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Improvement in pediatric palliative and end-of-life care has been identified as an ongoing research priority. The child and parent experience provides valuable information to guide how health care professionals can improve the transition to end of life and the care provided to children and families during the vulnerable period. The purpose of this systematic review was to describe the experience of pediatric oncology patients and their parents during end of life, and identify gaps to be addressed with interventions. A literature search was completed using multiple databases, including CINAHL, PubMed, and PsycInfo. A total of 43 articles were included in the review. The analysis of the evidence revealed 5 themes: symptom prevalence and symptom management, parent and child perspectives of care, patterns of care, decision making, and parent and child outcomes of care. Guidelines for quality end-of-life care are needed. More research is needed to address methodological gaps that include the pediatric patient and their sibling’s experience.
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Affiliation(s)
| | - Kathleen J. Sawin
- University of Wisconsin–Milwaukee, Milwaukee, WI, USA
- Children’s Hospital of Wisconsin, Milwaukee, WI, USA
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Prihodova L, Guerin S, Kernohan WG. Knowledge transfer and exchange frameworks in health and their applicability to palliative care: scoping review protocol. J Adv Nurs 2015; 71:1717-25. [DOI: 10.1111/jan.12642] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Suzanne Guerin
- School of Psychology; University College Dublin; Ireland
| | - W. George Kernohan
- Institute of Nursing and Health Research; School of Nursing; Ulster University; Newtownabbey Co Antrim Northern Ireland UK
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Shaheen AW, Denton GD, Stratton TD, Hoellein AR, Chretien KC. End-of-life and palliative care curricula in internal medicine clerkships: a report on the presence, value, and design of curricula as rated by clerkship directors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1168-1173. [PMID: 24853196 DOI: 10.1097/acm.0000000000000311] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE End-of-life and palliative care (EOL/PC) education is a necessary component of undergraduate medical education. The extent of EOL/PC education in internal medicine (IM) clerkships is unknown. The purpose of this national study was to investigate the presence of formal EOL/PC curricula within IM clerkships; the value placed by IM clerkship directors on this type of curricula; curricular design and implementation strategies; and related barriers and resources. METHOD The Clerkship Directors in Internal Medicine conducted its annual survey of its institutional members in April 2012. The authors analyzed responses to survey items pertaining to formal EOL/PC curriculum and content using descriptive statistics. The authors used qualitative techniques to analyze free-text responses. RESULTS The response rate was 77.0% (94/122). Of those responding, 75.8% (69/91) believed such training should occur in the IM clerkship, and 43.6% (41/94) reported formal curricula in EOL/PC. Multiple instructional modalities were used to deliver this content, with the majority of programs dedicating four or more hours to the curriculum. Curricula covered a wide range of topics, and student assessment tools were varied. Most felt that students valued this education. The qualitative analysis revealed differences in the values clerkship directors placed on teaching EOL/PC within the IM clerkship. CONCLUSIONS Although many IM clerkship directors have implemented formal curricula in EOL/PC, a substantial gap remains between those who have implemented and those who believe it belongs in the clerkship. Time, faculty, cost, and competing demands are the main barriers to implementation.
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Affiliation(s)
- Amy W Shaheen
- Dr. Shaheen is clerkship director for the ambulatory internal medicine rotation and clinical associate professor of medicine, University of North Carolina, Chapel Hill, North Carolina. Dr. Denton is clerkship director, Primary Care Clerkship, Ochsner Clinical School-University of Queensland, New Orleans, Louisiana. Dr. Stratton is assistant dean, Assessment and Quality Management, Office of Medical Education, University of Kentucky College of Medicine, Lexington, Kentucky. Dr. Hoellein is clerkship director of internal medicine and associate professor of medicine, University of Kentucky Department of Internal Medicine, Lexington, Kentucky. Dr. Chretien is chief, Hospitalist Section, Washington DC VA Medical Center, and associate professor of medicine, George Washington University, Washington, DC
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Manjiani D, Paul DB, Kunnumpurath S, Kaye AD, Vadivelu N. Availability and utilization of opioids for pain management: global issues. Ochsner J 2014; 14:208-15. [PMID: 24940131 PMCID: PMC4052588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns, fatigue, and impairment of daily living activities. Pain can cause psychological impairment and decrease healing and recovery from injuries and illness. A hallmark of many chronic conditions, pain affects more patients' lives than diabetes mellitus, heart disease, and cancer combined. However, many chronic sufferers do not have access to effective pain management for a variety of reasons, including limited access, restrictions, and personal and cultural biases. METHODS This review summarizes issues of access, distribution, and cultural bias with regard to opioid agents and seeks to clarify the challenges related to opioid delivery. The considerable negative physical and mental consequences of chronic pain are discussed for the general and palliative care population. RESULTS Opioids are an effective treatment for various intractable painful conditions, but problems in global opioid access for safe and rational use in pain management contribute to unnecessary suffering. These problems persist despite increased understanding in recent years of the pathophysiology of pain. CONCLUSIONS Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy will potentially enhance the outlook for future chronic pain management. The improvement of pain education in undergraduate and postgraduate training will benefit patients and clinicians. The promise of new medications, along with the utilization of multimodal approaches, has the potential to provide effective pain relief to future generations of sufferers.
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Affiliation(s)
- Deepak Manjiani
- Department of Pain Medicine, Epsom and St. Helier University Hospitals National Health Service Trust, Epsom, United Kingdom
| | - D. Baby Paul
- Department of Anesthetics, Royal Glamorgan Hospital, Ynysmaerdy, Wales, United Kingdom
| | - Sreekumar Kunnumpurath
- Department of Pain Medicine, Epsom and St. Helier University Hospitals National Health Service Trust, Epsom, United Kingdom
| | - Alan David Kaye
- Departments of Anesthesiology and Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT
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Raunkiaer M, Timm H. Interventions concerning competence building in community palliative care services--a literature review. Scand J Caring Sci 2013; 27:804-19. [PMID: 23289896 DOI: 10.1111/scs.12020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/07/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies establish that many incurably ill people would prefer to die at home, whether their final home is their own home or a nursing home. Experience shows that the professionals in palliative care at the basis level need to increase their competences. The purpose of this literature review is to examine experiences with interventions regarding the development of competencies within community palliative care services - in other words, at the individual work places. METHOD The study has been carried out as a literature review of international databases (PubMed/Medline, CHINAL, PsycInfo) with selected key words. RESULTS The review of the literature identified 15 publications which dealt with interventions regarding education and competence building. The publications represent individual studies, only two of which were controlled. All conclude that competence building has a positive effect according to the professionals. It is unknown whether or how patients and relatives feel a positive effect from the interventions just as it is unknown how the development of competencies has actually led to a more developed practice. The effect of local competence building in palliative care in the primary sector is lacking. Methods are needed to further examinations of how a competency has actually led to a more developed practice.
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Affiliation(s)
- Mette Raunkiaer
- Danish Knowlegde Center for Palliative Care, Copenhagen, Denmark
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Vissers KCP, van den Brand MWM, Jacobs J, Groot M, Veldhoven C, Verhagen C, Hasselaar J, Engels Y. Palliative Medicine Update: A Multidisciplinary Approach. Pain Pract 2012; 13:576-88. [DOI: 10.1111/papr.12025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/06/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Kris C. P. Vissers
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Maria W. M. van den Brand
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Jose Jacobs
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Carel Veldhoven
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | | | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
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Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, Ferrell BR, Loscalzo M, Meier DE, Paice JA, Peppercorn JM, Somerfield M, Stovall E, Von Roenn JH. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol 2012; 30:880-7. [PMID: 22312101 DOI: 10.1200/jco.2011.38.5161] [Citation(s) in RCA: 952] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offers timely clinical direction to ASCO's membership following publication or presentation of potentially practice-changing data from major studies. This PCO addresses the integration of palliative care services into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. CLINICAL CONTEXT Palliative care is frequently misconstrued as synonymous with end-of-life care. Palliative care is focused on the relief of suffering, in all of its dimensions, throughout the course of a patient's illness. Although the use of hospice and other palliative care services at the end of life has increased, many patients are enrolled in hospice less than 3 weeks before their death, which limits the benefit they may gain from these services. By potentially improving quality of life (QOL), cost of care, and even survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Until recently, data from randomized controlled trials (RCTs) demonstrating the benefits of palliative care in patients with metastatic cancer who are also receiving standard oncology care have not been available. RECENT DATA Seven published RCTs form the basis of this PCO. PROVISIONAL CLINICAL OPINION Based on strong evidence from a phase III RCT, patients with metastatic non-small-cell lung cancer should be offered concurrent palliative care and standard oncologic care at initial diagnosis. While a survival benefit from early involvement of palliative care has not yet been demonstrated in other oncology settings, substantial evidence demonstrates that palliative care-when combined with standard cancer care or as the main focus of care-leads to better patient and caregiver outcomes. These include improvement in symptoms, QOL, and patient satisfaction, with reduced caregiver burden. Earlier involvement of palliative care also leads to more appropriate referral to and use of hospice, and reduced use of futile intensive care. While evidence clarifying optimal delivery of palliative care to improve patient outcomes is evolving, no trials to date have demonstrated harm to patients and caregivers, or excessive costs, from early involvement of palliative care. Therefore, it is the Panel's expert consensus that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden. Strategies to optimize concurrent palliative care and standard oncology care, with evaluation of its impact on important patient and caregiver outcomes (eg, QOL, survival, health care services utilization, and costs) and on society, should be an area of intense research. NOTE ASCO's provisional clinical opinions (PCOs) reflect expert consensus based on clinical evidence and literature available at the time they are written and are intended to assist physicians in clinical decision making and identify questions and settings for further research. Because of the rapid flow of scientific information in oncology, new evidence may have emerged since the time a PCO was submitted for publication. PCOs are not continually updated and may not reflect the most recent evidence. PCOs cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient. Accordingly, adherence to any PCO is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. ASCO PCOs describe the use of procedures and therapies in clinical trials and cannot be assumed to apply to the use of these interventions in the context of clinical practice. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO's PCOs, or for any errors or omissions.
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Affiliation(s)
- Thomas J Smith
- Sidney Kimmel Cancer Center at Johns Hopkins Medicine, Baltimore, MD, USA
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Bracken M, McLoughlin K, McGilloway S, McMahon E. Use of dependency and prioritization tools by clinical nurse specialists in palliative care: an exploratory study. Int J Palliat Nurs 2012; 17:599-606. [PMID: 22240742 DOI: 10.12968/ijpn.2011.17.12.599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS The principal aim was to assess the utility of three needs assessment/dependency tools for use in community-based palliative care services. Specific objectives were to assess a sample of patients receiving specialist palliative care community nursing using these tools, to assess the predictive ability of each tool, and to explore the utility of prioritizing and measuring patient dependency from a clinical nurse specialist (CNS) perspective. METHOD In phase 1, 22 community-based CNSs completed the Vale prioritization tool for all patients visited during a 3-month period (n=162). They also completed either the Graves and Payne (2007) or the Birch et al (1997) dependency tool after each visit. In phase 2 a focus group (n=8) and two one-to-one interviews with CNS participants explored the perceived utility of all three tools. RESULTS The Vale prioritization tool appeared to be the most useful for prioritizing patient need and managing workload. Statistical analysis highlighted minimal differences between the two dependency tools, neither of which predicted length of visit. Three themes were identified from phase 2: difficulties with routine administration, points of divergence between the two dependency tools, and workload concerns. CONCLUSION While the Vale prioritization tool emerged as the most useful, the findings raise questions about the overall utility and practical application of these kinds of tools with community-based palliative care patients. Further research is needed to identify/develop, adapt, and evaluate appropriate, setting-specific dependency tools for use with this population.
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Abstract
This brief article on pre-conference CME topic ‘How to plan Research in Palliative Care’ is aimed to provide an overview of the background, concept, domains, present research activities and the future prospect for research opportunities. Advances in Palliative Care are made with a focus to address the quality of medical practice and ‘quality of death’, in those patients who have advanced stage diseases where cure may or may not be possible. The issues which can improve the palliative care delivery and the areas where evidence of practice is still weak can be identified by forming network and collaborative groups for the application of study and research methods in India.
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Affiliation(s)
- Bidhu K Mohanti
- Department of Surgical Oncology, IRCH All India Institute of Medical sciences, New Delhi, India
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Gaertner J, Wuerstlein R, Klein U, Scheicht D, Frechen S, Wolf J, Hellmich M, Mallmann P, Harbeck N, Voltz R. Integrating Palliative Medicine into Comprehensive Breast Cancer Therapy - a Pilot Project. ACTA ACUST UNITED AC 2011; 6:215-220. [PMID: 21779227 DOI: 10.1159/000328162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND: To comply with the World Health Organization (WHO) recommendations, our institution's administrative directives were adopted to advocate the provision of palliative care (PC) early in the disease trajectory of breast cancer (BC). To assess the outcome of this recommendation, this study evaluated the effects of this approach. METHODS: A retrospective systematic chart analysis of a 2-year period was performed. The first PC consultation of patients was analyzed according to (a) physical condition, (b) symptom burden of the patients, and (c) reasons for PC consultation. RESULTS: Many patients were already in a reduced physical state and experienced burdening symptoms when first counselled by PC. After a 1-year experience with PC consultations, the number of burdening symptoms identified at first PC consultation decreased and senologists increasingly requested PC support also for non-somatic issues. CONCLUSIONS: A development towards a better understanding of PC competencies after a 1-year initiation period could be demonstrated, but BC patients continued to be in late stages of the disease at the time of first PC contact. Disease-specific guidelines may facilitate and optimize the integration of PC into breast cancer therapy.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital, Cologne, Cologne, Germany
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Desai AK, Grossberg GT. Palliative and end-of-life care in psychogeriatric patients. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A rapidly growing number of elderly persons and their families are burdened by one or more terminal illnesses in the later years of their life. How best to support their quality of life is a major challenge for healthcare teams. Palliative and end-of-life (PEOL) care is well positioned to respond to this challenge. While the evidence of PEOL is just beginning, much of the suffering can be relieved by what is already known. PEOL care for the elderly needs to go beyond the focus on the patient and should rest on a broad understanding of the nature of suffering that includes family and professional caregivers in that experience of suffering. The dissemination of PEOL care principles should be a public health priority. This article aims to improve understanding of appropriate PEOL care in the elderly and discuss future perspectives.
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Affiliation(s)
- Abhilash K Desai
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, 1438 S. Grand Blvd, St Louis, MO 63104, USA
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Shah T, Shah BK. 'Doc, is palliative care an option for me?'. ONKOLOGIE 2011; 34:337-338. [PMID: 21625190 DOI: 10.1159/000328786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Investment of palliative medicine in bridging the gap with academia: A call to action. Eur J Cancer 2011; 47:491-5. [DOI: 10.1016/j.ejca.2010.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 12/14/2010] [Indexed: 11/19/2022]
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Recommending early integration of palliative care — does it work? Support Care Cancer 2011; 20:507-13. [DOI: 10.1007/s00520-011-1111-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 02/02/2011] [Indexed: 11/26/2022]
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Kaur J, Mohanti BK. Transition from curative to palliative care in cancer. Indian J Palliat Care 2011; 17:1-5. [PMID: 21633614 PMCID: PMC3098537 DOI: 10.4103/0973-1075.78442] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jaspreet Kaur
- Department of Radiation Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail:
| | - Bidhu K Mohanti
- Department of Radiation Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail:
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Gaertner J, Wolf J, Scheicht D, Frechen S, Klein U, Hellmich M, Ostgathe C, Hallek M, Voltz R. Implementing WHO recommendations for palliative care into routine lung cancer therapy: a feasibility project. J Palliat Med 2010; 13:727-32. [PMID: 20597705 DOI: 10.1089/jpm.2009.0399] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) explicitly recommends the integration of palliative care (PC) early in the disease trajectory as part of the WHO definition of PC. Our comprehensive cancer centre decided to include this recommendation in the administrative directives for principles of cancer care. The aim of this study was to assess, for patients with lung cancer, (a) at what point in the disease trajectory the patients were first provided PC and (b) whether - over one year - an earlier integration of PC could be achieved. OBJECTIVE A retrospective systematic chart analysis of a two year period was performed. We assumed that seeing patients relatively early during the course of the illness would be reflected by seeing patients that would be not already (i) in a reduced performance status, (ii) experiencing symptoms that are indicators for advanced disease (e.g., dyspnoea and pain) and (iii) close to death. Therefore, the first PC consultation for every lung cancer patient was analyzed to assess in what physical condition patients receive first PC consultation, what burdening symptoms they already experienced and how long the patients lived after their first consultations. RESULTS Most patients were already in a reduced physical state, were experiencing burdening symptoms and many died shortly after the first PC consultation. After a one year period, the number of burdening symptoms identified at first PC consultation and the admissions to the in-patient PC was decreased while non-PC physicians increasingly requested PC support for psychosocial interventions. CONCLUSION Though some degree of development towards a better understanding of PC competencies and the "early integration" approach could be demonstrated, the adoption of the WHO recommendation alone did not suffice to integrate PC into routine cancer care early in the course of the illness. Therefore, the development of disease specific guidelines is advocated by our working group.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital, Cologne, Germany.
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Interconversion of three measures of performance status: an empirical analysis. Eur J Cancer 2010; 46:3175-83. [PMID: 20674334 DOI: 10.1016/j.ejca.2010.06.126] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 06/20/2010] [Accepted: 06/23/2010] [Indexed: 12/27/2022]
Abstract
PURPOSE To construct empirically a conversion table to convert performance status scores among the Eastern Cooperative Oncology Group (ECOG), Karnofsky Performance Status (KPS) and Palliative Performance Scale (PPS) measures, using a large sample of patients with advanced cancer. METHODS Seven physicians completed assessments on 1385 consecutive patients attending an oncology palliative care clinic, or admitted to an acute cancer palliative care unit. The three measures were distributed as a questionnaire package; the order in which they were presented was randomly assigned for each week. Scales were compared using the hit rate and the weighted kappa coefficient (κ(w)). The KPS and PPS were compared directly; for comparisons of either scale with the ECOG, all 70 possible categorisations of KPS and PPS were computed. An 'ideal' categorisation was selected based on maximisation of both statistical methods. RESULTS The KPS and PPS matched in 1209 out of 1385 assessments (hit rate 87%; κ(w) 0.97). For both the KPS and the PPS, the categorisation of 100 (ECOG 0), 80-90 (1), 60-70 (2), 40-50 (3), 10-30 (4) had the highest hit rate (75%), and the second highest κ(w) (0.84, p<0.0001). One other combination had a slightly higher κ(w) (0.85 for both KPS and PPS), but a lower hit rate (73% for KPS, 72% for PPS). CONCLUSIONS We have derived empirically a conversion scale among the ECOG, KPS and PPS scales. The proposed scale provides a means of translating amongst these measures, which may improve accuracy of communication about performance status amongst oncology clinicians and researchers.
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