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Hudson BF, Dzeng E, Burnett A, Yeung M, Shulman C. Palliative care, homelessness, and restricted or uncertain immigration status. Palliat Care Soc Pract 2023; 17:26323524231216993. [PMID: 38144973 PMCID: PMC10748891 DOI: 10.1177/26323524231216993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background People experiencing homelessness have limited access to palliative care support despite high levels of ill health and premature mortality. Most research exploring these challenges in the United Kingdom has focused on people living in hostels or temporary accommodation. People with uncertain or restricted immigration status are often unable to access this accommodation due to lack of entitlement to benefits. There is little research about the experiences of those in the United Kingdom who cannot access hostels or temporary accommodation due to restricted or uncertain immigration status with regards to palliative and end-of-life care access. Aim To explore the barriers to palliative and end-of-life care access for people with uncertain or restricted immigration status, who are experiencing homelessness and have advanced ill health, and the experiences of UK hospices of supporting people in this situation. Design A multi-method cross-sectional study. Setting/participants An online survey for hospice staff followed by online focus groups with staff from inclusion health, homelessness and palliative care services, charities and interviews with people experiencing homelessness. Results Fifty hospice staff responded to the online survey and 17 people participated in focus groups and interviews (focus groups: n = 10; interviews: n = 7). The survey demonstrated how hospices are not currently supporting many people with restricted or uncertain immigration status who are homeless and that hospice staff have received limited training around eligibility for entitlements or National Health Service (NHS) care. Interview and focus group data demonstrated high levels of unmet need. Reasons for this included a lack of consistency around eligibility for support from local authorities, issues relating to NHS charging, and mistrust and limited knowledge of the UK health and social care system. These barriers leave many people unable to access care toward the end of their lives. Conclusion To advocate for and provide compassionate palliative and end-of-life care for people with uncertain immigration status, there is need for more legal literacy, with training around people's entitlement to care and support, as well as easier access to specialist legal advice.
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Affiliation(s)
- Briony F. Hudson
- Marie Curie, One Embassy Gardens, 8 Viaduct Gardens, London SW11 7BW, UK
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK Pathway, London, UK
| | - Elizabeth Dzeng
- Department of Global Health and Social Medicine, King’s College London, London, UK
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Michelle Yeung
- Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Caroline Shulman
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
- Pathway, London, UK
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Chatland LE, Harvey C, Kelly K, Paradine S, Bhagat M, Hudson BF. Research participation in palliative medicine-benefits and barriers for patients and families: rapid review and thematic synthesis. BMJ Support Palliat Care 2023; 13:35-44. [PMID: 34404745 PMCID: PMC9985719 DOI: 10.1136/bmjspcare-2021-003093] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/16/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Research is essential for gathering evidence to inform best practice and clinical decision making, for developing and testing new treatments and services in palliative and end-of-life care (PEoLC). The participation of patients, carers and family members is essential, however, personal and ethical concerns are often cited by professionals as barriers to recruitment. There is evidence that patients and family members can benefit from participation in PEoLC research. AIM To synthesise the evidence regarding patients', family members' and carers' experiences of participating in PEoLC research. To identify recommendations for enhancing the experience of participants. DESIGN A qualitative rapid review and thematic synthesis. DATA SOURCES MEDLINE, PsycINFO and PubMed were searched from 2010 to 2020. Studies reporting patients', family members' or carers' experiences of participating in PEoLC research were included. RESULTS 4 studies were included and 7 themes identified relating to the benefits of, and barriers to, participation in PEoLC research. Both altruistic and personal benefits of participation were reported. Barriers (negative aspects) to participation included feeling overwhelmed, practical issues, reminders of being a patient, not seeing the research as relevant to them and unmet needs. CONCLUSIONS A number of benefits (positive aspects) surround participation in PEoLC research. However, several barriers (negative aspects) can prevent or discourage participation. This review has identified recommendations for research teams to enhance the experience, and number of people who those participating in research in this field.
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Affiliation(s)
| | | | | | | | - Meena Bhagat
- Research and Policy Team, Marie Curie, London, UK
| | - Briony F Hudson
- Research and Policy Team, Marie Curie, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Abstract
OBJECTIVE To identify and synthesise existing literature exploring the impact of relational and informational continuity of care on preferred place of death, hospital admissions and satisfaction for palliative care patients in qualitative, quantitative and mixed methods literature. DESIGN A mixed methods rapid review. METHODS PUBMED, PsychINFO, CINAHL were searched from June 2008 to June 2018 in order to identify original peer reviewed, primary qualitative, quantitative or mixed methods research exploring the impact of continuity of care for people receiving palliative care. Synthesis methods as outlined by the Cochrane Qualitative and Implementation Methods Group were applied to qualitative studies while meta-analyses for quantitative data were planned. OUTCOMES The impact of interventions designed to promote continuity of care for people receiving palliative care on the following outcomes was explored: achieving preferred place of death, satisfaction with care and avoidable hospital admissions. RESULTS 18 eligible papers were identified (11 qualitative, 6 quantitative and 1 mixed methods papers). In all, 1951 patients and 190 family caregivers were recruited across included studies. Meta-analyses were not possible due to heterogeneity in outcome measures and tools used. Two studies described positive impact on facilitating preferred place of death. Four described a reduction in avoidable hospital admissions. No negative impacts of interventions designed to promote continuity were reported. Patient satisfaction was not assessed in quantitative studies. Participants described a significant impact on their experiences as a result of the lack of informational and relational continuity. CONCLUSIONS This rapid review highlights the impact that continuity of care can have on the experiences of patients receiving palliative care. The evidence for the impact of continuity on place of death and hospital admissions is limited. Methods for enhancing, and recording continuity should be considered in the design and development of future healthcare interventions to support people receiving palliative care.
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Affiliation(s)
- Briony F Hudson
- Marie Curie, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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Shulman C, Hudson BF, Kennedy P, Brophy N, Stone P. Evaluation of training on palliative care for staff working within a homeless hostel. Nurse Educ Today 2018; 71:135-144. [PMID: 30286371 DOI: 10.1016/j.nedt.2018.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In the UK, many people experiencing homelessness whose health is deteriorating remain in homeless hostels due to few suitable alternative places of care. Hostel staff struggle to support residents with deteriorating health and palliative care services are rarely involved. There is recognition of the need for multiagency working to support this group. OBJECTIVES To pilot and evaluate the impact of a two-day training course for hostel staff around supporting clients with palliative care needs, and increasing multiagency working. DESIGN Mixed methods evaluation using pre-and-post training data collection. SETTINGS AND PARTICIPANTS Frontline staff from two London homeless hostels. METHODS Staff from two hostels attended a two day training course. Self-perceived confidence in supporting residents with deteriorating health, knowledge of palliative care, openness to discussing deteriorating health and work related stress were assessed at baseline and immediately after training using a novel questionnaire. Qualitative data was collected via focus groups immediately after and three months post-training. RESULTS Twenty four participants attended at least one day of training, 21 (87%) completed the course. Training was reported to be useful and relevant. Modest improvements in self-perceived work related stress, knowledge, confidence and openness were observed following training. At three months, qualitative data indicated the beginnings of a shift in how palliative care was conceptualised and an increase in knowledge and confidence around supporting residents. Anxiety regarding the role of the hostel in palliative care, the recovery focused ethos of homelessness services and fragmented systems and services presented challenges to establishing changes. CONCLUSIONS Training can be useful for improving knowledge, confidence, openness and work related stress. Recommendations for implementing changes in how people experiencing homelessness are supported include embedding training into routine practice, promoting multidisciplinary working, incorporating flexibility within the recovery focused approach of services and recognising the need for emotional support for staff.
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Affiliation(s)
- Caroline Shulman
- Pathway, 5th Floor East, 250 Euston Road, London NW1 2PG, UK; Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Kings Health Partners, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Briony F Hudson
- Pathway, 5th Floor East, 250 Euston Road, London NW1 2PG, UK; Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Peter Kennedy
- St Mungos, 3 Thomas More Square, Tower Hill, London E1W 1YW, UK
| | - Niamh Brophy
- St Mungos, 3 Thomas More Square, Tower Hill, London E1W 1YW, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
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Hudson BF, Shulman C, Kennedy P, Brophy N, Stone P. 25 Evidence based training for hostel staff around supporting homeless people with deteriorating health. BMJ Support Palliat Care 2018. [DOI: 10.1136/bmjspcare-2018-mariecurie.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionMany people experiencing homelessness remain in homeless hostels as their health deteriorates due to lack of alternative places of care (Shulman et al. 2017). Palliative care services are rarely involved and hostel staff face significant emotional and practical difficulties (Hudson et al. 2017). We developed evidence-based training for hostel staff around supporting residents with deteriorating health.AimsTo pilot and evaluate the impact of training.MethodsMixed methods pre-and-post training evaluation. Knowledge of palliative care confidence in and openness to supporting residents with deteriorating health and work-related stress were assessed at baseline and immediately post-training using a novel questionnaire. Following training group discussions were facilitated and participants identified team goals for implementation. Additional focus groups were held after three months.ResultsAll staff from two hostels attended 87% completed the course (n=21). Modest improvements in knowledge confidence openness and work-related stress were observed. Participants particularly valued the inclusion of strategies for identifying and addressing their emotional needs. At three months team goals were partially met. Identification and recognition of palliative care needs had improved. However the recovery focused ethos of hostels and significant staff turnover limited change. Systems designed to monitor ‘recovery’ did not accommodate or encourage a person-centred approach for people with deteriorating health.ConclusionsTraining in isolation is not enough for system change. Recommendations include embedding ongoing training into routine practice identifying champions to promote multidisciplinary working and incorporating flexibility in outcome measures to reflect complexity in person-centred care including where recovery may not be realistic.References. Hudson BF, Shulman C, Low J, Hewett N, Daley J, Davis S, Brophy N, Howard D, Vivat B, Kennedy P, Stone P. Challenges to discussing palliative care with people who are homeless: A qualitative study. BMJ Open2017;7:e017502. doi:10.1136/bmjopen-2017-017502. Shulman C, Hudson BF, Low J, Hewett N, Daley J, Kennedy P, et al. Homelessness at the end of life: A qualitative analysis of the barriers in providing palliative care for people who are homeless. Palliative Medicine2017. https://doi.org/10.1177/0269216317717101
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Peake JN, Beecham E, Oostendorp LJM, Hudson BF, Stone P, Jones L, Lakhanpaul M, Bluebond-Langner M. Research barriers in children and young people with life-limiting conditions: a survey. BMJ Support Palliat Care 2018; 12:e715-e721. [PMID: 30065044 PMCID: PMC9606545 DOI: 10.1136/bmjspcare-2018-001521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/13/2018] [Accepted: 07/04/2018] [Indexed: 11/20/2022]
Abstract
Studies indicate research ethics committee (REC) approval and clinician gatekeeping are two key barriers in recruiting children and young people (CYP) with life-limiting conditions (LLCs) and life-threatening illnesses (LTIs) and their families to research.
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Affiliation(s)
- Jordana Natalie Peake
- The Louis Dundas Centre for Children's Palliative Care, UCL Institute of Child Health, London, UK
| | - Emma Beecham
- The Louis Dundas Centre for Children's Palliative Care, UCL Institute of Child Health, London, UK.,Marie Curie Palliative Care Research Department, University College London Division of Psychiatry, London, UK
| | - Linda J M Oostendorp
- The Louis Dundas Centre for Children's Palliative Care, UCL Institute of Child Health, London, UK.,Marie Curie Palliative Care Research Department, University College London Division of Psychiatry, London, UK
| | - Briony F Hudson
- Marie Curie Palliative Care Research Department, University College London Division of Psychiatry, London, UK.,Pathway, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, University College London Division of Psychiatry, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, University College London Division of Psychiatry, London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Myra Bluebond-Langner
- The Louis Dundas Centre for Children's Palliative Care, UCL Institute of Child Health, London, UK
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Shulman C, Hudson BF, Low J, Hewett N, Daley J, Kennedy P, Davis S, Brophy N, Howard D, Vivat B, Stone P. End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care. Palliat Med 2018; 32:36-45. [PMID: 28672115 PMCID: PMC5758927 DOI: 10.1177/0269216317717101] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Being homeless or vulnerably housed is associated with death at a young age, frequently related to medical problems complicated by drug or alcohol dependence. Homeless people experience high symptom burden at the end of life, yet palliative care service use is limited. AIM To explore the views and experiences of current and formerly homeless people, frontline homelessness staff (from hostels, day centres and outreach teams) and health- and social-care providers, regarding challenges to supporting homeless people with advanced ill health, and to make suggestions for improving care. DESIGN Thematic analysis of data collected using focus groups and interviews. PARTICIPANTS Single homeless people ( n = 28), formerly homeless people ( n = 10), health- and social-care providers ( n = 48), hostel staff ( n = 30) and outreach staff ( n = 10). RESULTS This research documents growing concern that many homeless people are dying in unsupported, unacceptable situations. It highlights the complexities of identifying who is palliative and lack of appropriate places of care for people who are homeless with high support needs, particularly in combination with substance misuse issues. CONCLUSION Due to the lack of alternatives, homeless people with advanced ill health often remain in hostels. Conflict between the recovery-focused nature of many services and the realities of health and illness for often young homeless people result in a lack of person-centred care. Greater multidisciplinary working, extended in-reach into hostels from health and social services and training for all professional groups along with more access to appropriate supported accommodation are required to improve care for homeless people with advanced ill health.
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Affiliation(s)
- Caroline Shulman
- Pathway Charity, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- King’s Health Partners, King’s College Hospital, London, UK
| | - Briony F Hudson
- Pathway Charity, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Joseph Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | | | | | - Sarah Davis
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | - Diana Howard
- Coordinate My Care, The Royal Marsden NHS Foundation Trust, London, UK
| | - Bella Vivat
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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Hudson BF, Shulman C, Low J, Hewett N, Daley J, Davis S, Brophy N, Howard D, Vivat B, Kennedy P, Stone P. Challenges to discussing palliative care with people experiencing homelessness: a qualitative study. BMJ Open 2017; 7:e017502. [PMID: 29183927 PMCID: PMC5719327 DOI: 10.1136/bmjopen-2017-017502] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To explore the views and experiences of people who are homeless and those supporting them regarding conversations and approaches to palliative care SETTING: Data were collected between October 2015 and October 2016 in homeless hostels and day centres and with staff from primary and secondary healthcare providers and social care services from three London boroughs. PARTICIPANTS People experiencing homelessness (n=28), formerly homeless people (n=10), health and social care providers (n=48), hostel staff (n=30) and outreach staff (n=10). METHODS: In this qualitative descriptive study, participants were recruited to interviews and focus groups across three London boroughs. Views and experiences of end-of-life care were explored with people with personal experience of homelessness, health and social care professionals and hostel and outreach staff. Saturation was reached when no new themes emerged from discussions. RESULTS 28 focus groups and 10 individual interviews were conducted. Participants highlighted that conversations exploring future care preferences and palliative care with people experiencing homelessness are rare. Themes identified as challenges to such conversations included attitudes to death; the recovery focused nature of services for people experiencing homelessness; uncertainty regarding prognosis and place of care; and fear of negative impact. CONCLUSIONS This research highlights the need for a different approach to supporting people who are homeless and are experiencing advanced ill health, one that incorporates uncertainty and promotes well-being, dignity and choice. We propose parallel planning and mapping as a way of working with uncertainty. We acknowledge that these approaches will not always be straightforward, nor will they be suitable for everyone, yet moving the focus of conversations about the future away from death and dying, towards the present and the future may facilitate conversations and enable the wishes of people who are homeless to be known and explored.
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Affiliation(s)
- Briony F Hudson
- Pathway, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Caroline Shulman
- Pathway, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
- Kings Health Partners, Kings College Hospital, London, UK
| | - Joseph Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | | | | | - Sarah Davis
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | | | - Diana Howard
- Coordinate My Care, The Royal Marsden NHS Foundation Trust, London, UK
| | - Bella Vivat
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | | | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
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Hudson BF, Oostendorp LJ, Candy B, Vickerstaff V, Jones L, Lakhanpaul M, Bluebond-Langner M, Stone P. The under reporting of recruitment strategies in research with children with life-threatening illnesses: A systematic review. Palliat Med 2017; 31:419-436. [PMID: 27609607 PMCID: PMC5405809 DOI: 10.1177/0269216316663856] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Researchers report difficulties in conducting research with children and young people with life-limiting conditions or life-threatening illnesses and their families. Recruitment is challenged by barriers including ethical, logistical and clinical considerations. AIM To explore how children and young people (aged 0-25 years) with life-limiting conditions or life-threatening illnesses and their families were identified, invited and consented to research published in the last 5 years. DESIGN Systematic review. DATA SOURCES MEDLINE, PsycINFO, Web of Science, Sciences Citation Index and SCOPUS were searched for original English language research published between 2009 and 2014, recruiting children and young people with life-limiting conditions or life-threatening illness and their families. RESULTS A total of 215 studies - 152 qualitative, 54 quantitative and 9 mixed methods - were included. Limited recruitment information but a range of strategies and difficulties were provided. The proportion of eligible participants from those screened could not be calculated in 80% of studies. Recruitment rates could not be calculated in 77%. A total of 31% of studies recruited less than 50% of eligible participants. Reasons given for non-invitation included missing clinical or contact data, or clinician judgements of participant unsuitability. Reasons for non-participation included lack of interest and participants' perceptions of potential burdens. CONCLUSION All stages of recruitment were under reported. Transparency in reporting of participant identification, invitation and consent is needed to enable researchers to understand research implications, bias risk and to whom results apply. Research is needed to explore why consenting participants decide to take part or not and their experiences of research recruitment.
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Affiliation(s)
- Briony F Hudson
- 1 Louis Dundas Centre for Children's Palliative Care, UCL Institute of Child Health, London, UK.,2 Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Linda Jm Oostendorp
- 1 Louis Dundas Centre for Children's Palliative Care, UCL Institute of Child Health, London, UK
| | - Bridget Candy
- 2 Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Victoria Vickerstaff
- 2 Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Louise Jones
- 2 Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Monica Lakhanpaul
- 3 Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Myra Bluebond-Langner
- 1 Louis Dundas Centre for Children's Palliative Care, UCL Institute of Child Health, London, UK
| | - Paddy Stone
- 2 Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
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Hudson BF, Flemming K, Shulman C, Candy B. Challenges to access and provision of palliative care for people who are homeless: a systematic review of qualitative research. BMC Palliat Care 2016; 15:96. [PMID: 27912748 PMCID: PMC5135820 DOI: 10.1186/s12904-016-0168-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/10/2016] [Indexed: 12/02/2022] Open
Abstract
Background People who are homeless or vulnerably housed are a marginalized group who often experience high rates of morbidity and die young as a result of complex problems. Access to health care and support can be challenging, with access to palliative care even more so. This review presents a synthesis of published qualitative research exploring from the perspective of homeless people and those working to support them, current challenges to palliative care access and provision, in addition to suggestions for what may improve palliative care for this population. Methods Systematic review of qualitative research analysed using thematic synthesis. PsycINFO, Medline, Sociological Abstracts, Social Services Abstracts, Science citations index and CINAHL were searched up to September 2016. Thematic synthesis involved a three-step inductive process to develop a deeper understanding of the challenges to and suggestions for the access and provision of palliative care for homeless people. Results Thirteen qualitative articles, reporting nine studies were identified. The challenges to access and provision to palliative care were drawn from the data covering three broad areas, namely “the chaotic lifestyles sometimes associated with being homeless”, “the delivery of palliative care within a hostel for homeless people” and provision within “mainstream health care systems”. Obstacles were related to homeless persons competing day-to-day priorities, their experience of stigma in mainstream settings, the high burden on hostel staff in supporting residents at the end of life and inflexibility in mainstream health care systems. Suggestions for improving access to palliative care include building trust between homeless persons and health professionals, increasing collaboration between and flexibility within services, and providing more training and support for all professionals. Conclusions The provision of palliative care can be complicated for all populations, however delivering palliative care for people who are homeless is influenced by a potentially greater and more varied range of factors, on both individual and systemic levels, than providing palliative care for the housed population. Careful consideration and potentially great changes will be needed within health care systems to ensure homeless populations have equitable access to palliative care.
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Affiliation(s)
- Briony F Hudson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK. .,Pathway, London, UK.
| | - Kate Flemming
- Department of Health Sciences, The University of York, York, UK
| | | | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
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Beecham E, Hudson BF, Oostendorp L, Candy B, Jones L, Vickerstaff V, Lakhanpaul M, Stone P, Chambers L, Hall D, Hall K, Ganeshamoorthy T, Comac M, Bluebond-Langner M. A call for increased paediatric palliative care research: Identifying barriers. Palliat Med 2016; 30:979-980. [PMID: 27178539 PMCID: PMC5117120 DOI: 10.1177/0269216316648087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Emma Beecham
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London (UCL), London, UK.,Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | - Briony F Hudson
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London (UCL), London, UK.,Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | - Linda Oostendorp
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London (UCL), London, UK
| | - Bridget Candy
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | - Louise Jones
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | - Vickey Vickerstaff
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Programme, Institute of Child Health, University College London (UCL), London, UK
| | - Paddy Stone
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | | | | | | | | | - Margaret Comac
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London (UCL), London, UK
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Hudson BF, Flemming K, Shulman C, Candy B. How can we facilitate access to palliative care for homeless people? A systematic review of qualitative research. BMJ Support Palliat Care 2016. [DOI: 10.1136/bmjspcare-2016-001204.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hudson BF, Ogden J. Exploring the Impact of Intraoperative Interventions for Pain and Anxiety Management During Local Anesthetic Surgery-A Systematic Review and Meta-Analysis. J Perianesth Nurs 2015; 31:118-33. [PMID: 27037166 DOI: 10.1016/j.jopan.2014.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 09/19/2014] [Accepted: 11/10/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the effectiveness of audiovisual and relaxation-based intraoperative interventions for their impact on intraoperative pain and anxiety. DESIGN Systematic review and meta-analysis. METHODS The following databases were searched for articles published between 1990 and January 2014: MEDLINE, PsychINFO, CINAHL, and Web of Science. Twenty randomized trials meeting the following inclusion criteria were included; adult participants undergoing elective outpatient surgery under local anesthetic using a form of distraction-based intraoperative intervention for the management of anxiety and pain. FINDING Thirty percent of studies reviewed found that intraoperative interventions improved patient experience in comparison to treatment as usual, 20% of studies were inconclusive, and 50% of studies found that interventions during surgery provided no benefit. CONCLUSIONS Both relaxation-based and audiovisual interventions were found to be efficacious for pain and anxiety management during surgery under local anesthetic. This review indicates that relaxation-based interventions could be more effective than audiovisual interventions for managing intraoperative anxiety.
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Hudson BF, Davidson J, Whiteley MS. The impact of hand reflexology on pain, anxiety and satisfaction during minimally invasive surgery under local anaesthetic: a randomised controlled trial. Int J Nurs Stud 2015; 52:1789-97. [PMID: 26294281 DOI: 10.1016/j.ijnurstu.2015.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 07/17/2015] [Accepted: 07/17/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Elevated patient anxiety during surgery is linked to a range of suboptimal treatment outcomes. Reflexology has been reported to be effective in reducing pre and post-operative anxiety and post-operative pain. OBJECTIVES To explore whether the addition of hand reflexology to treatment as usual during minimally invasive varicose vein surgery under local anaesthetic impacted upon patient reported anxiety and pain during surgery, and patient satisfaction with treatment. DESIGN Randomised controlled trial. SETTING Private outpatient clinic specialising in venous conditions. PARTICIPANTS 137 participants were assessed for eligibility. One hundred patients were recruited (mean age 47.8 years, 83% female). Participants received endovenous thermal ablation and/or phlebectomy for the treatment of varicose veins. Inclusion criteria included age (between 18 and 80) and receiving endovenous thermal ablation and/or phlebectomy for the treatment of varicose veins under local anaesthetic. Exclusion criteria included the presence of leg ulcers and receiving microsclerotherapy or foam sclerotherapy treatments, being unwilling to enter into the randomisation process and arriving late at the clinic. METHODS Participants were randomly allocated to either treatment as usual (control group) or intra-operative hand reflexology during minimally invasive varicose vein surgery under local anaesthetic. Participants in the reflexology group received a session of intra-operative hand reflexology which began in the operating theatre, prior to analgesic injections and continued until surgery was complete. It was not possible to blind the participants, researchers or theatre staff to group allocation due to the modifications required to the operating theatre for participants in the reflexology group. The researcher could not be blinded due to the role they played in the trial organisation. RESULTS Of the 137 participants screened for eligibility, 7 participants declined to participate and a further 30 did not meet the inclusion criteria, giving a recruitment rate of 93%. Fifty participants were randomised to the reflexology group and fifty participants were randomised to the control group. Intra-operative anxiety was significantly lower in the reflexology group (mean score of 3.24 on an 11-point rating scale) than the control group (mean score of 5.0, p<.001). CONCLUSIONS Intra-operative hand reflexology is a useful adjunct to local anaesthetic varicose vein surgery, with participants in the reflexology group reporting significantly lower intra-operative anxiety and shorter pain duration than participants receiving treatment as usual.
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Affiliation(s)
- Briony F Hudson
- The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey GU2 7RF, UK; School of Psychology, University of Surrey, Guildford, UK
| | - Jade Davidson
- The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey GU2 7RF, UK; Rosey Feet, UK
| | - Mark S Whiteley
- The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey GU2 7RF, UK; Faculty of Health and Biomedical Sciences, University of Surrey, Guildford, UK.
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Hudson BF, Ogden J, Whiteley MS. A thematic analysis of experiences of varicose veins and minimally invasive surgery under local anaesthesia. J Clin Nurs 2015; 24:1502-12. [DOI: 10.1111/jocn.12719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Briony F Hudson
- School of Psychology; University of Surrey; Guildford Surrey
| | - Jane Ogden
- School of Psychology; University of Surrey; Guildford Surrey
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