1
|
Agar M, Xuan W, Lee J, Barclay G, Oloffs A, Jobburn K, Harlum J, Maurya N, Chow JSF. Longitudinal symptom profile of palliative care patients receiving a nurse-led end-of-life (PEACH) programme to support preference to die at home. BMJ Open 2024; 14:e058448. [PMID: 38167283 PMCID: PMC10773358 DOI: 10.1136/bmjopen-2021-058448] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES Tailored models of home-based palliative care aimed to support death at home, should also ensure optimal symptom control. This study aimed to explore symptom occurrence and distress over time in Palliative Extended And Care at Home (PEACH) model of care recipients. DESIGN This was a prospective cohort study. SETTING AND PARTICIPANTS Participants were consecutive recipients of the PEACH rapid response nurse-led model of care in metropolitan Sydney (December 2013-January 2017) who were in the last weeks of life with a terminal or deteriorating phase of illness and had a preference to be cared or die at home. OUTCOME MEASURES Deidentified data including sociodemographic and clinical characteristics, and symptom distress scores (Symptom Assessment Score) were collected at each clinical visit. Descriptive statistics and forward selection logistic regression analysis were used to explore influence of symptom distress levels on mode of separation ((1) died at home while still receiving a PEACH package, (2) admitted to a hospital or an inpatient palliative care unit or (3) discharged from the package (alive and no longer requiring PEACH)) across four symptom distress level categories. RESULTS 1754 consecutive clients received a PEACH package (mean age 70 years, 55% male). 75.7% (n=1327) had a home death, 13.5% (n=237) were admitted and 10.8% (n=190) were still alive and residing at home when the package ceased. Mean symptom distress scores improved from baseline to final scores in the three groups (p<0.0001). The frequency of no symptom distress score (0) category was higher in the home death group. Higher scores for nausea, fatigue, insomnia and bowel problems were independent predictors of who was admitted. CONCLUSION Tailored home-based palliative care models to meet preference to die at home, achieve this while maintaining symptom control. A focus on particular symptoms may further optimise these models of care.
Collapse
Affiliation(s)
- Meera Agar
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Wei Xuan
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Jessica Lee
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Gregory Barclay
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Alan Oloffs
- Nepean Blue Mountains Local Health District, Nepean, New South Wales, Australia
| | - Kim Jobburn
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Janeane Harlum
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Nutan Maurya
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Josephine Sau Fan Chow
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| |
Collapse
|
2
|
Agar MR, Xuan W, Lee J, Barclay G, Oloffs A, Jobburn K, Harlum J, Maurya N, Chow JSF. Factors Associated With Mode of Separation for People With Palliative Diagnoses With Preference for Home Death Receiving Care From a Nurse-Led End of Life (Palliative Extended and Care at Home) Program. J Hosp Palliat Nurs 2023; 25:215-223. [PMID: 37379347 DOI: 10.1097/njh.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Palliative Extended and Care at Home (PEACH) is a rapid response nurse-led package of care mobilized for palliative care patients who have an expressed preference to die at home. This study aimed to identify the demographic and clinical predictors of home death for patients receiving the package. Deidentified data were used from administrative and clinical information systems. Univariate and multivariate analyses were conducted to assess association of sociodemographic factors with mode of separation. Furthermore, 1754 clients received the PEACH package during the study period. Mode of separation was home death (75.7%), hospital/palliative care unit admission (13.5%), and alive/discharged from the PEACH Program (10.8%). Of participants with clear preference to die at home, 79% met their wish. Multivariate analysis demonstrated cancer diagnosis, patients who wished to be admitted when death was imminent, and patients with undecided preference for location of death were associated with an increased likelihood of being admitted to the hospital. Compared with those with spousal caregivers, those cared for by their child/grandchild and other nonspouse caregivers were significantly associated with a decreased likelihood of being admitted to the hospital/palliative care unit. Our results show that opportunities to tailor home care based on referral characteristics to meet patient preference to die at home, at individual, system, and policy levels, exist.
Collapse
|
3
|
Chow J, Harley A, Chroinin DN, Kohler F, Harlum J, Jobburn K, Keech P, Williams R, Fraser S, Hillman K. Understanding of advance care planning in primary care: a gap analysis. Aust J Prim Health 2022; 28:344-349. [PMID: 35605984 DOI: 10.1071/py21253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although primary care is a well suited context for conducting advance care planning (ACP), there are many barriers to initiating discussions regarding future health preference and end-of-life conversations. METHODS This qualitative study conducted 30 detailed individual interviews with senior administrators, medical and nurse practitioners of a local health district, NSW Ambulance, e-Health NSW, general practitioners and practice nurses to find out about barriers to ACP in South Western Sydney. RESULTS Thematic analysis was conducted on the interviews. Six major themes were identified: Prevalence; Empowerment of roles and responsibilities; Lack of training/knowledge/confidence; Fragmentation of care; Patient/family readiness; and Prognostication. Half of the participants were willing to use a prognostic tool to identify when a patient was likely to be at the end of their life and provide a prompt to initiate ACP. CONCLUSION In addition to addressing training and acknowledging resource constraints, these findings suggest that if a prognostic tool was validated and practical in a primary care setting, it may provide valuable assistance to encourage everyone in society to begin discussing this issue and completing ACP.
Collapse
Affiliation(s)
- Josephine Chow
- South Western Sydney Local Health District, Sydney, NSW, Australia; and Clinical Stream Office, Don Everett Building, Locked Bag 7103, BC 1871, Liverpool, NSW 2170, Australia; and University of Sydney, Sydney, NSW, Australia; and University of New South Wales, Sydney, NSW, Australia; and Western Sydney University, Sydney, NSW, Australia
| | - Ann Harley
- South Western Sydney Primary Health Network, Sydney, NSW, Australia
| | | | - Friedbert Kohler
- South Western Sydney Local Health District, Sydney, NSW, Australia; and University of New South Wales, Sydney, NSW, Australia; and HammodCare, Sydney, NSW, Australia
| | - Janeane Harlum
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Kim Jobburn
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Pamela Keech
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Rachael Williams
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Susan Fraser
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Ken Hillman
- South Western Sydney Local Health District, Sydney, NSW, Australia; and University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
4
|
Chow JSF, Barclay G, Harlum J, Swierczynski J, Jobburn K, Agar M. Palliative Care Home Support Packages (PEACH): a carer cross-sectional survey. BMJ Support Palliat Care 2021; 12:e68-e74. [PMID: 33579795 DOI: 10.1136/bmjspcare-2020-002294] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND In December 2013, a partnership between five local health districts and a non-governmental organisation implemented the Palliative Care Home Support Packages (PEACH) Program. The PEACH Program aims to support palliative care clients in their last days of life at their own home. This study sought to evaluate the quality of care delivered by the service from the perspective of clients' primary carers. METHODS A letter was sent to carers of clients 6-10 weeks after the client's death, inviting them to participate in an anonymous survey. The survey measured the level of satisfaction on various aspects of the service using FAMCARE and Likert scales, and invited for comments about the care received and suggestions for improvement. RESULTS Out of 17 aspects of care provided by the PEACH Program, 13 were scored with 'exceptional' or 'acceptable performance'. The highest satisfaction was observed in meeting clients' physical needs and providing pain relief. The most dissatisfaction was observed in addressing spiritual matters, family conferences and information about treatment side effects. Ninety-five per cent of responses were either 'satisfied' or 'very satisfied' with the overall care provided at home during the last week of the client's life. CONCLUSION The results of this research provide further evidence to the field of what constitutes a good home death and the support mechanisms required to enable this. The results also have strong implications on how local services provided by the PEACH Program are delivered in the future.
Collapse
Affiliation(s)
- Josephine Sau Fan Chow
- Clinical Innovation and Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Greg Barclay
- Palliative Care, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Janeane Harlum
- Palliative Care, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Jolanta Swierczynski
- Social Work, South Western Sydney Local Health District, Fairfield, New South Wales, Australia
| | - Kim Jobburn
- Clinical Innovation and Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Meera Agar
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | | | | |
Collapse
|
5
|
Sau Fan Chow J, Jobburn K, Chapman M, Suranyi M. RENEW-a renal redesign project in predialysis patient care. Clin Kidney J 2016; 9:748-54. [PMID: 27679723 PMCID: PMC5036908 DOI: 10.1093/ckj/sfw081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/12/2016] [Accepted: 07/06/2016] [Indexed: 12/02/2022] Open
Abstract
Background An ageing population and geographical growth, along with an increase in the number of people that reside in specific location, are increasing the demand for renal replacement therapies. Hospital-based haemodialysis units are struggling to cope with the associated physical, staffing and cost demands. Home-based dialysis therapies are known to be more cost effective with superior social, physical health and survival outcomes. Methods ‘RENEW, a renal redesign project, examined the pre-dialysis health care experience of renal patients to find opportunities to improve patient care outcomes and increase the uptake of home-based dialysis therapies. This article details two crucial parts of the approach to change management: (i) diagnostics—an inclusive, client focused, multidisciplinary approach to identify issues relating to the pre-dialysis journey—and (ii) solution design—an inclusive problem-solving approach to identify and marry solutions to the issues identified during diagnostics. Results Based on feedback from patients/caregivers and staff interviews, utilizing a clinical redesign methodology, a new model of care was developed, implemented and subsequently embedded into clinical practice. The results have been evident via improved care coordination, enhanced patient preparation for dialysis, improved patient psychosocial welfare and, importantly, an increased number of patients planned for and commencing home dialysis. This has empowered patients by giving them the confidence, knowledge and skills to be actively engaged in their own care. The project resulted in significant expenditure avoidance. Conclusion Change management strategies with successful implementation are vital components of evolving clinical practice to achieve both clinical and organizational goals.
Collapse
Affiliation(s)
- Josephine Sau Fan Chow
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Clinical Stream Office, Liverpool Hospital,Reception Point 101, Clinical Building, Locked Bag 7103, BC1871, Liverpool, NSW 2170, Australia; University of Sydney, Sydney, NSW, Australia; University of Tasmania, Hobart, TAS, Australia
| | - Kim Jobburn
- Clinical Innovation & Business Unit , South Western Sydney Local Health District, Clinical Stream Office, Liverpool Hospital, Reception Point 101, Clinical Building, Locked Bag 7103, BC1871, Liverpool, NSW 2170 , Australia
| | - Margaret Chapman
- Clinical Innovation & Business Unit , South Western Sydney Local Health District, Clinical Stream Office, Liverpool Hospital, Reception Point 101, Clinical Building, Locked Bag 7103, BC1871, Liverpool, NSW 2170 , Australia
| | - Michael Suranyi
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Clinical Stream Office, Liverpool Hospital,Reception Point 101, Clinical Building, Locked Bag 7103, BC1871, Liverpool, NSW 2170, Australia; University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
6
|
Crowther HJ, Lindeman R, Ho PJ, Allen E, Waite C, Matthews S, Jobburn K, Teo J, Day S, Seldon M, Rosenfeld D, Kerridge I. Health of adults living with a clinically significant haemoglobinopathy in New South Wales, Australia. Intern Med J 2013; 43:1103-10. [PMID: 23834206 DOI: 10.1111/imj.12231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/15/2012] [Accepted: 07/03/2013] [Indexed: 01/19/2023]
Abstract
AIM To comprehensively review the health needs of patients living with clinically significant haemoglobinopathies (thalassaemia and sickle-cell disease (SCD)) in New South Wales, Australia. METHODS A survey-based health needs assessment was undertaken in outpatients cared for at five tertiary institutions in metropolitan and regional centres. Sixty-three of 121 adults (approximately 80-90% of adult patients with transfusion-requiring haemoglobinopathies in New South Wales) completed an in-house and commercial health-related quality assessment survey (SF-36v2). RESULTS Subjects came from more than eight world regions, with those with SCD being more likely to be born outside of Australia than subjects with thalassaemia (P < 0.001, likelihood ratio 20.64) as well as more likely to have been refugees (26% vs 2%). The population contained socially disadvantaged subjects with 13 subjects (20.6%) having incomes below the Australian poverty line. Complications of thalassaemia were comparable to previous international reports although our subjects had a high rate of secondary amenorrhea (>12 months = 27%) and surgical splenectomy (55.6%). Use of hydroxyurea in SCD was less than expected with only 46.6% of subjects having prior use. Lack of universal access to magnetic resonance imaging-guided chelation (international best practice) was evident, although 65.5% had been able to access magnetic resonance imaging through clinical trial, or self-funding. CONCLUSIONS Patients with SCD and thalassaemia experience considerable morbidity and mortality and require complex, multidisciplinary care. This study revealed both variance from international best practice and between specialist units. The results of this research may provide the impetus for the development of clinical and research networks to enable the uniform delivery of health services benchmarked against international standards.
Collapse
Affiliation(s)
- H J Crowther
- Westmead Hospital, Sydney , New South Wales, Australia; Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney , New South Wales, Australia; University of Western Sydney, Sydney , New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|