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Marano G, Mazza M. Territories of mourning: Addressing submerged problems of grief through multidisciplinary care. World J Clin Cases 2025; 13:98271. [DOI: 10.12998/wjcc.v13.i16.98271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 12/20/2024] [Accepted: 01/07/2025] [Indexed: 02/10/2025] Open
Abstract
Mourning and grief are natural responses to loss and can be especially complex and prolonged in the context of end-of-life care. Caregivers play a crucial role in supporting individuals through this difficult journey, often balancing their own grief with the need to provide care. This paper explores the experiences of mourning and grief in hospice settings, with a focus on the emotional challenges faced by both patients and caregivers during the grieving process. Psychological support plays a crucial role at the end of life in a multidisciplinary care approach. By addressing the complex interplay between biological disease and psychological well-being, healthcare professionals can provide more comprehensive and compassionate care. A deep understanding of mourning and elaboration of grief would improve the implementation of suitable support interventions and facilitate collaboration among family members and healthcare teams, ultimately improving the quality of end-of-life care and promoting the well-being of both patients and their families.
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Affiliation(s)
- Giuseppe Marano
- Department of Neurosciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Marianna Mazza
- Department of Neurosciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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2
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McDarby M, Silverstein HI, Rosa WE, Parker PA, Carpenter BD. Patient and caregiver questions and clinician responses during initial outpatient neuropalliative care appointments. PEC INNOVATION 2023; 3:100207. [PMID: 37700766 PMCID: PMC10494256 DOI: 10.1016/j.pecinn.2023.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
Objective Open communication during appointments exemplifies person-centered care. The current study characterized questions asked by persons with neurologic illnesses and their caregivers-and clinicians' responses to those questions-during initial outpatient palliative care appointments. Methods We coded type (direct or indirect) and topic of questions stated by patients and their caregivers in audio recordings from 38 initial outpatient palliative care appointments. We also coded the completeness and quality features of clinicians' responses. Results Patients and caregivers stated 556 total questions; most were direct questions (79.7%) and primarily about symptoms, treatment, and lifestyle issues. Clinicians responded to more than 90% of all questions. Responses to both question types were similar in completeness and quality, but clinicians more frequently offered support in response to direct questions and gave recommendations in response to indirect questions. Conclusion Persons with neurologic illnesses and their caregivers use different question types to obtain information about symptoms and treatment during initial palliative care appointments. Results may guide clinician training and patient education for optimizing information exchange in palliative care. Innovation This study is the first to explore patient and caregiver use of indirect questions in neuropalliative care appointments and the quality of clinicians' responses to those questions.
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Affiliation(s)
- Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Hannah I. Silverstein
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, United States of America
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Patricia A. Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Brian D. Carpenter
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, United States of America
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3
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Alladin A, Khawand-Azoulai M, Lipman K, Bland S, Ferrari C, Drice J, Van Zuilen MH. Analysis of Student Reflections on "What Matters Most" to Palliative Care Patients: A Narrative Medicine Exercise. J Palliat Med 2023; 26:1115-1120. [PMID: 37083420 DOI: 10.1089/jpm.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Background: Effective communication with ill patients requires practice, yet, the traditional history overlooks patients' personal stories. This information is vital to determining goals of care and facilitates partnership by building trust. Objective: We implemented a narrative medicine exercise for students during their palliative medicine rotation to highlight humanism. Impact was determined through thematic analysis of students' reflections. Design: Students elicited "what matters most" to patients, transcribing this plus a personal reflection. Using an inductive and iterative approach, 100 reflections were analyzed, developing codes then broader themes. Results: Four main themes (Getting to know the patient, Student Reaction, Building-blocks of patient-physician relationship, Student Personal Insights) were identified, with 15 subthemes. Conclusion: The power of uncovering patients' backgrounds and values was demonstrated, reinforcing a palliative medicine approach. Analysis showed a positive impact and the possibility of change to future practice. The intervention was feasible, well received, and encouraged reflection on the physician-patient relationship beyond the medical domain.
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Affiliation(s)
- Amanda Alladin
- Division of Pediatric Critical Care, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mariana Khawand-Azoulai
- Division of Geriatrics and Palliative Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kyra Lipman
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sarah Bland
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Corinne Ferrari
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jenny Drice
- Division of Geriatrics and Palliative Medicine, Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
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Sultan L, de Jong N, Alsaywid BS, de Nooijer J. A Qualitative Study of Stakeholders' Perspectives of Implementing Interprofessional Shared Decision-Making Education in Palliative Care. Cureus 2023; 15:e44039. [PMID: 37638267 PMCID: PMC10448927 DOI: 10.7759/cureus.44039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Shared decision-making (SDM) in palliative care is a highly complex process that requires an interdisciplinary team. Interprofessional team members need education on how to facilitate discussion of patient/family wishes at the end of life in hospital settings. So far, interprofessional shared decision-making (IP-SDM) education frameworks have been used to a limited extent in the area of education on palliative care. The aim of this study was to explore policymakers', health professionals', faculty members', and students' perspectives on implementing an IP-SDM educational framework in palliative care to identify aspects that should be prioritized to further develop interprofessional education for SDM in palliative care. Methods We used the qualitative method to capture the micro, meso, and macro factors using Oandasan and Reeves' model for the implementation of IP-SDM education regarding palliative care. Data collection tools included in-depth, face-to-face interviews with individual policymakers and focus group interviews with health professionals, faculty members, and undergraduate health professionals. The interview guide explores the teaching of SDM in palliative care, factors that could facilitate or hinder the implementation of IP-SDM education for health professions students in palliative care, and interventions to facilitate the implementation of this approach. This study was conducted at the Oncology and Palliative Care Department at King Abdulaziz Medical City in the Ministry of National Guard Health Affairs and at King Saud bin Abdulaziz University for Health Sciences in Jeddah, Saudi Arabia. Results The results indicated a high demand for IP-SDM in palliative care. The findings revealed factors that can facilitate or hinder the implementation of IP-SDM education in palliative care for undergraduate health professions students that is going to the local community. Factors include culture, religion, gender, power issues, team hierarchy, and respect among team members. Also, our findings have revealed potential solutions to the hindering factors. Conclusions IP-SDM education in palliative care is a highly relevant topic for improving patient outcomes. However, it might be a complex process to implement, especially given the challenges of palliative care settings. We recommend starting such a course in the early clinical phases of undergraduate health professional education.
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Affiliation(s)
- Lama Sultan
- Department of Clinical Nutrition, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
- Department of Medicine, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NLD
| | - Nynke de Jong
- Department of Health Services Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NLD
| | - Basim S Alsaywid
- Directorate of Education and Research Skills, Saudi National Institute of Health, Riyadh, SAU
- Department of Urology, Pediatric Urology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Jascha de Nooijer
- Department of Health Promotion, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NLD
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5
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Ann-Yi S, Bruera E. Psychological Aspects of Care in Cancer Patients in the Last Weeks/Days of Life. Cancer Res Treat 2022; 54:651-660. [PMID: 35790196 PMCID: PMC9296948 DOI: 10.4143/crt.2022.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/25/2022] [Indexed: 11/30/2022] Open
Abstract
Palliative care is comprised of an interdisciplinary team (IDT) approach with members from different disciplines who collaboratively work together to reduce multidimensional components of pain and suffering and improve quality of life for patients coping with a terminal illness. Psychosocial team members are integral to the palliative care IDT and provide expertise in assessment and empirically validated interventions to address psychological distress. The following paper will provide a review of different facets of psychological distress experienced by advanced cancer patients such as psychological disorders, existential distress, spiritual distress, caregiver distress, parental distress, and grief. Finally, an overview of commonly used screening and assessment tools as well as psychological interventions relevant for the palliative care population is presented.
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Kluger BM, Miyasaki JM. Key concepts and opportunities. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:3-15. [PMID: 36055718 DOI: 10.1016/b978-0-323-85029-2.00014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuropalliative care is an emerging field dedicated to applying palliative care approaches to meet the needs of persons living with neurologic illness and their families. The development of this field acknowledges the unique needs of this population, including in terms of neuropsychiatric symptoms, the impact of neurologic illness on personhood, and the logistics of managing neurologic disability. In defining the goals of this field, it is important to distinguish between neuropalliative care as an approach to care, as a skillset, as a medical subspecialty, and as a public health goal as each of these constructs offers their own contributions and opportunities. As a newly emerging field, there are nearly unlimited opportunities to improve care through research, clinical care, education, and advocacy.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Schweighoffer R, Blaese R, Liebig B. Organizational determinants of information transfer in palliative care teams: A structural equation modeling approach. PLoS One 2021; 16:e0252637. [PMID: 34081729 PMCID: PMC8174710 DOI: 10.1371/journal.pone.0252637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/19/2021] [Indexed: 11/18/2022] Open
Abstract
Several organizational factors facilitate or hinder information transfer in palliative care teams. According to past research, organizational factors that reduce information transfer include the inconsistent use of shared electronic patient files, frequent changes of healthcare staff, a lack of opportunities for personal exchange, and a lack of evaluation of collaborative processes. Insufficient information sharing between professionals can negatively impact patient safety, whereas studies have shown that some organizational factors improve collaboration between professionals and thus contribute to improved patient outcomes. The main purpose of this study is thus to investigate whether, and if so how, organizational factors contribute to successful information exchange in palliative care teams in Switzerland, while also accounting for the different care contexts of primary and specialized palliative care. A nationwide survey was aimed at medical professionals working in palliative care. In total, 379 participants (mean age = 49.8 years, SD = 10.3) were included in this study. Two main outcome variables were examined: healthcare providers' satisfaction with information transfer in their team and their overall satisfaction with communication in their team. Hypotheses were tested by employing structural equation modeling. Findings revealed that the strongest predictors for effective information transfer in palliative care teams were sufficient opportunities for face-to-face meetings and supervision alongside feedback tools to improve collaborative practices and the application of guidelines and standards for collaboration. Face-to-face meetings were an even greater contributor to information transfer in specialized settings, whereas sharing the same work-based values with colleagues was considered more important in primary settings. Results from this study contribute to the existing literature elucidating how information transfer is facilitated in the field of palliative care. If proposed measures are implemented, this could possibly improve patient outcomes in palliative care. Furthermore, the findings can be useful for healthcare organizations and associations to make more efficient resource allocation decisions with the aim to optimize information transfer within the workforce.
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Affiliation(s)
- Reka Schweighoffer
- Department of Psychology, University of Basel, Basel, Switzerland
- School of Applied Psychology, University of Applied Sciences Northwestern Switzerland, Olten, Switzerland
| | - Richard Blaese
- Department of Psychology, University of Basel, Basel, Switzerland
- School of Applied Psychology, University of Applied Sciences Northwestern Switzerland, Olten, Switzerland
| | - Brigitte Liebig
- School of Applied Psychology, University of Applied Sciences Northwestern Switzerland, Olten, Switzerland
- Department of Sociology, University of Basel, Basel, Switzerland
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8
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Okoh AE, Akinrolie O, Bell-Gam HI, Adandom I, Ibekaku MC, Kalu ME. Nigerian healthcare workers’ perception of transdisciplinary approach to older adults’ care: A qualitative case study. INTERNATIONAL JOURNAL OF CARE COORDINATION 2020. [DOI: 10.1177/2053434520954362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction There is a growing interest in collaborative care for older adults in Nigeria; however, little is known about the application of a transdisciplinary approach to care in a typical Nigerian geriatric unit. Therefore, we described healthcare professionals’ (HCPs’) perception of a transdisciplinary approach to older adults’ care in Southern Nigeria. Methods Using Stakian’s approach to a qualitative case study, we purposively invited 16 HCPs working in the geriatric unit of a teaching hospital in Nigeria to a single, in-depth, semi-structured interview. We analysed data using Stakian’s approach of categorical aggregation and direct interpretation. Results Our participants identified five-key features of a transdisciplinary approach to care: consolidated consultation, consolidated care documentation, care files accessibility, shared care decision and a designated care manager. HCPs stated that transdisciplinary approach to care allowed for a consolidated consultation of patients, with all the HCPs (in the same room or via telehealth/telemedicine) and care decisions should be shared between all stakeholders and documented in an accessible unified electronic care document that is managed by a care manager. Factors ranging from lack of consensus on time for a consolidation consultation to inter-professional conflicts were perceived as possible hindrances to a transdisciplinary approach to older adults’ care. Discussion The features of transdisciplinary care described in this study partly aligned with the WHO’s integrated care for older people (ICOPE). Additional components not captured in ICOPE were found. While the description of transdisciplinary was from the perceptive of our study participant, caution should be applied when interpreting these findings.
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Affiliation(s)
- Augustine E Okoh
- University of Southampton, UK
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria
| | - Olayinka Akinrolie
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria
- University of Manitoba, Canada
| | | | - Isreal Adandom
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria
- Cedacrest Hospitals, Abuja
| | - Michael C Ibekaku
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria
- University of Nigeria, Nigeria
| | - Michael Ebe Kalu
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria
- McMaster University, Canada
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Agom DA, Ominyi J, Onyeka TC, Anyigor CN. Exploring Organizational Culture Regarding Provision and Utilization of Palliative Care in a Nigerian Context: An Interpretive Descriptive Study. Indian J Palliat Care 2020; 26:358-364. [PMID: 33311880 PMCID: PMC7725171 DOI: 10.4103/ijpc.ijpc_39_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Palliative care (PC) continues to be underutilized in Nigeria, but there is a lack of studies that explore organizational cultural dynamics regarding PC in Nigeria. The study aimed to understand the organizational culture in order to identify organizational enablers and inhibitors of the provision and utilization of PC in a Nigerian context. Methods: Identification of the organizational culture was developed using a qualitative interpretive descriptive design. Cultural enablers and inhibitors were mapped out using semi-structured interviews with 38 participants, consisting of medical staff, patients, and their relatives. Thematic analysis was used to identify and analyze patterns within the collected data. Results: Three themes were identified: cross-departmental collaborative practice, financial support practice, and continuity of care. The findings suggest that fundamental cultural changes, such as a policy for intradepartmental referral practices, telemedicine, and a welfare support system, are typically required as remedies for the failure to use PC in Nigeria and other similar contexts. Conclusions: This study offered a new understanding that not revealing deeper shared assumptions, and a shared way of thinking that underpins the PC practice within an organization, will have a negative bearing on organizational PC outcomes.
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Affiliation(s)
- David A Agom
- Department of Health and Social Science, London School of Science and Technology, Buckinghamshire New University, UK.,Department of Nursing, Ebonyi State University, Abakaliki, Nigeria
| | - Jude Ominyi
- Department of Nursing, Ebonyi State University, Abakaliki, Nigeria
| | - Tonia C Onyeka
- Department of Anaesthesia, Pain and Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
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Santivasi WL, Partain DK, Whitford KJ. The role of geriatric palliative care in hospitalized older adults. Hosp Pract (1995) 2020; 48:37-47. [PMID: 31825689 DOI: 10.1080/21548331.2019.1703707] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
Take-Away Points:1. Geriatric palliative care requires integrating the disciplines of hospital medicine and palliative care in pursuit of delivering comprehensive, whole-person care to aging patients with serious illnesses.2. Older adults have unique palliative care needs compared to the general population, different prevalence and intensity of symptoms, more frequent neuropsychiatric challenges, increased social needs, distinct spiritual, religious, and cultural considerations, and complex medicolegal and ethical issues.3. Hospital-based palliative care interdisciplinary teams can take many forms and provide high-quality, goal-concordant care to older adults and their families.
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Affiliation(s)
- Wil L Santivasi
- Center for Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel K Partain
- Center for Palliative Medicine & Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kevin J Whitford
- Center for Palliative Medicine & Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Mohammed S, Savage P, Kevork N, Swami N, Rodin G, Zimmermann C. "I'm going to push this door open. You can close it": A qualitative study of the brokering work of oncology clinic nurses in introducing early palliative care. Palliat Med 2020; 34:209-218. [PMID: 31659940 DOI: 10.1177/0269216319883980] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early palliative care improves quality of life during life-prolonging treatment for patients with cancer, but the role of nurses in facilitating the early involvement of palliative care is unclear. AIM To conceptualize the psychosocial processes involved in the introduction and provision of palliative care by oncology nurses. DESIGN A constructivist qualitative grounded theory study was conducted. SETTING/PARTICIPANTS A total of 20 nurses (6 staff nurses, 10 nurse practitioners, and 4 advanced practice nurses) completed semi-structured interviews. Participants were from multiple ambulatory care oncology clinics (i.e. breast, pancreatic, hematology) in a comprehensive cancer center. RESULTS The core category, brokering palliative care, represented the overarching concept of the study that linked other subcategories. The other subcategories were as follows: opening the door-creating the possibility of discussing early palliative care at a time when patients show signs of being receptive to this discussion; building trust-establishing relationships with patients as a starting point for open discussions about palliative care; tackling misconceptions-addressing patients' assumptions about palliative care as signifying death; and advocating with oncologists-seeding the process of referral by bringing patients' concerns forward. CONCLUSION Oncology nurses play a central role in "brokering" the introduction of early palliative care; this process is supported by their relational proximity to patients and their location "in between" the patient and the oncologist. Training all nurses in palliative care and empowering them to have proactive discussions in a collaborative practice context would allow greater access to early palliative care.
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Affiliation(s)
- Shan Mohammed
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Pamela Savage
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nanor Kevork
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nadia Swami
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Divisions of Palliative Medicine and Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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12
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Montano AR. "All for One" experiences of interprofessional team members caring for older adults: A metasynthesis. Int J Older People Nurs 2019; 15:e12290. [PMID: 31782246 DOI: 10.1111/opn.12290] [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] [Received: 02/16/2019] [Revised: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is some evidence that healthcare professionals prefer an interprofessional approach to care and this approach is of particular importance to older people due to their complex needs and multitude of chronic conditions. OBJECTIVE This metasynthesis aimed to synthesise and unearth new understandings of the experiences of interprofessional team members that are caring for older people from a variety of qualitative studies. DESIGN This review is designed as a metasynthesis based on the method put forth by Noblit and Hare for synthesising qualitative research. DATA SOURCES A search for qualitative and mixed methods articles that included healthcare professionals' experiences of caring for older people as a member of an interprofessional team was conducted via an electronic database search of CINAHL, PubMed, SCOPUS and PsycINFO. REVIEW METHODS The inclusion criteria were as follows: (a) the method of the study was qualitative or included a qualitative component, (b) an interprofessional team cared for an older person, (c) data regarding interprofessional team members' experiences were gathered, (d) published in English and (e) between the period of 2000 and 2019. Key metaphors were extracted from the data and juxtaposed until themes emerged. RESULTS A total of 1807 full-text articles were retrieved and screened via their titles and abstracts. Nine studies were included in this metasynthesis based upon full-text relevance and meeting the inclusion criteria. Six themes emerged describing the experience of interprofessional team members caring for older people: All for One: Unifying the Team for a Meaningful Purpose; The Cast; A Shared Vocabulary; Collaboration and Integration; A Functional-Dysfunctional Family and Appreciate the Lifeworld. Team members appreciated this model of care. CONCLUSIONS The emergent themes suggest potential buy-in from interprofessional team members to this care model for older people. Nursing can assert their unique knowledge and practice into the role as the team leader to mitigate potential barriers and team conflicts. IMPLICATIONS FOR PRACTICE Interprofessional team members caring for older people can improve their experience. Improved experiences for interprofessional team members can lead to better care for older people. Professionals need specialized training prior to practicing interprofessionally.
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Affiliation(s)
- Anna-Rae Montano
- School of Nursing, University of Connecticut, Mansfield, Connecticut, USA
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13
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Abstract
Pain is one of the most feared symptoms experienced by patients at the end of life and one of the most difficult to manage. Families identify patient comfort as a priority in hospice, yet many have concerns regarding pain management and medication side effects. Timely, open, and ongoing communication with hospice teams can assuage concerns to improve care and outcomes relevant to pain medication use in hospice. A pilot project was undertaken to improve the patient and family/caregiver experience in end-of-life care relevant to communication regarding pain medication side effects and management within an inpatient hospice. A 5% improvement in the Consumer Assessment of Healthcare Providers & Services (CAHPS) Hospice quality indicator 18 (Understanding Side Effects) was sought. An evidence-based, interprofessional educational protocol and tool were designed and implemented to guide pertinent conversations. A 6.6% increase in favorable responses to the CAHPS Hospice target indicator occurred over the course of the pilot. Feedback from staff revealed positive responses to the tool with recommended expansion of use across hospice settings. Educational programming holds promise to support communication with hospice patients and families regarding pain medication side effects and management to improve experiential care quality as reflected in CAHPS Hospice surveys.
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DeMiglio L, Williams A. Factors Enabling Shared Care with Primary Healthcare Providers in Community Settings: The experiences of Interdisciplinary Palliative Care Teams. J Palliat Care 2018. [DOI: 10.1177/082585971202800407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Interdisciplinary palliative care (PC) teams experience a number of barriers in their efforts to establish and maintain shared care partnerships with primary health care providers (PHCPs) in caring for patients in community settings. A qualitative study was undertaken in southern Ontario to examine how teams negotiate barriers in order to share mutual responsibility for patients with PHCPs (i.e., family physicians and community nurses). Over a one-year period, focus group interviews (n=15) were conducted with five teams to explore their experiences to better understand the factors that enable shared care. Using a conceptual framework put forth by Williams et al. (2010), the findings reveal that teams circumvent local level barriers through four enabling factors: team characteristics, geography, adaptation of practice, and relationship building. Understanding these factors and strategies to foster them will assist other jurisdictions wanting to establish a similar shared care service delivery model.
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Affiliation(s)
- Lily DeMiglio
- L DeMiglio (corresponding author): School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1l
| | - Allison Williams
- A Williams: School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
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15
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Ronald AH, Hooper LM, Head BA, Evans-Andris M, Estes EO. Insights and experiences of chaplain interns and social work interns on palliative care teams. DEATH STUDIES 2018; 44:141-151. [PMID: 30526429 DOI: 10.1080/07481187.2018.1527414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Interdisciplinary palliative care teams provide critical, comprehensive end-of-life care, although the accumulated literature points toward barriers that impede their effectiveness. The current phenomenological qualitative study presents perceptions of chaplaincy interns (N = 24) and social work interns (N = 23) after a semester-long end-of-life clinical training experience with interdisciplinary palliative care teams. Analysis of the end of semester reflections resulted in seven themes, which are fairly consistent with the literature base. The described experiential learning and reflections in the current study are powerful and can inform how to prepare practitioners for teamwork and compassionate end-of-life care.
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Affiliation(s)
- Ann H Ronald
- Department of Counseling and Human Development, The University of Louisville, Louisville, KY, USA
| | - Lisa M Hooper
- Department of Counseling and Human Development, The University of Louisville, Louisville, KY, USA
| | - Barbara A Head
- Department of Counseling and Human Development, The University of Louisville, Louisville, KY, USA
| | - Melissa Evans-Andris
- Department of Counseling and Human Development, The University of Louisville, Louisville, KY, USA
| | - Eileen O Estes
- Department of Counseling and Human Development, The University of Louisville, Louisville, KY, USA
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Martin L, Patel A, Piggott K, Wong A, Patel A, Patel M, Liu Y, Dhesy-Thind S, Wasi P, You JJ. Role of allied health care professionals in goals-of-care discussions with hospitalized patients and perceived barriers: a cross-sectional survey. CMAJ Open 2018; 6:E241-E247. [PMID: 29934292 PMCID: PMC7868088 DOI: 10.9778/cmajo.20170162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Allied health care professionals can contribute meaningfully to goals-of-care discussions with seriously ill hospitalized patients and their families. We sought to explore the perspective of hospital-based allied health care professionals on their role in goals-of-care discussions and to identify barriers to their participation. METHODS We surveyed allied health care professionals (social workers, physiotherapists, occupational therapists, registered dietitians, speech-language pathologists and pharmacists) on internal medicine, hematology-oncology, medical oncology and radiation oncology wards at 2 tertiary care hospitals in Hamilton, Ontario, from April 2013 to May 2014. We modified a validated questionnaire originally designed to assess barriers to discussing goals of care from the perspective of nurses, residents and staff physicians on hospital medical wards. Respondents rated the questionnaire items on a 7-point Likert scale. RESULTS Of the 47 allied health care professionals invited, 32 (68%) participated: 9 physiotherapists, 7 social workers, 6 occupational therapists, 4 registered dietitians, 3 pharmacists and 2 speech-language pathologists; in 1 case, the profession was unknown. The greatest perceived barriers to engaging in goals-of-care discussions were lack of patient decision-making capacity (mean rating 5.9 [standard error (SE) 0.3]), lack of awareness of patients' previous discussions with other team members (mean rating 5.7 [SE 0.3]) and family members' difficulty accepting a poor prognosis (mean rating 5.6 [SE 0.2]). Although the respondents felt it was most acceptable for staff physicians, residents and advanced practice nurses to exchange information and reach a final decision during goals-of-care discussions, they felt it was acceptable for a broader range of allied health care professionals to initiate discussions (mean rating 4.7-5.8) and to act as decision coaches (clarifying values, weighing options) with patients and families (mean rating 5.3-6.1). INTERPRETATION Allied health care professionals are willing to initiate goals-of-care discussions and to act as a decision coach with seriously ill hospitalized patients and their families. By improving interprofessional collaboration, we can engage the entire health care team in this process.
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Affiliation(s)
- Leslie Martin
- Department of Medicine (Martin, Ameen Patel, Wong, Wasi, You), McMaster University, Hamilton, Ont.; Department of Geriatric Medicine (Piggott), University of Toronto; Victoria College (Alexandra Patel), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (M. Patel), Dublin, Ireland; Schulich School of Dentistry & Medicine (Liu), Western University, London, Ont.; Departments of Oncology (Dhesy-Thind) and Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont.
| | - Ameen Patel
- Department of Medicine (Martin, Ameen Patel, Wong, Wasi, You), McMaster University, Hamilton, Ont.; Department of Geriatric Medicine (Piggott), University of Toronto; Victoria College (Alexandra Patel), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (M. Patel), Dublin, Ireland; Schulich School of Dentistry & Medicine (Liu), Western University, London, Ont.; Departments of Oncology (Dhesy-Thind) and Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont
| | - Katrina Piggott
- Department of Medicine (Martin, Ameen Patel, Wong, Wasi, You), McMaster University, Hamilton, Ont.; Department of Geriatric Medicine (Piggott), University of Toronto; Victoria College (Alexandra Patel), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (M. Patel), Dublin, Ireland; Schulich School of Dentistry & Medicine (Liu), Western University, London, Ont.; Departments of Oncology (Dhesy-Thind) and Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont
| | - Arthur Wong
- Department of Medicine (Martin, Ameen Patel, Wong, Wasi, You), McMaster University, Hamilton, Ont.; Department of Geriatric Medicine (Piggott), University of Toronto; Victoria College (Alexandra Patel), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (M. Patel), Dublin, Ireland; Schulich School of Dentistry & Medicine (Liu), Western University, London, Ont.; Departments of Oncology (Dhesy-Thind) and Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont
| | - Alexandra Patel
- Department of Medicine (Martin, Ameen Patel, Wong, Wasi, You), McMaster University, Hamilton, Ont.; Department of Geriatric Medicine (Piggott), University of Toronto; Victoria College (Alexandra Patel), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (M. Patel), Dublin, Ireland; Schulich School of Dentistry & Medicine (Liu), Western University, London, Ont.; Departments of Oncology (Dhesy-Thind) and Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont
| | - Matthew Patel
- Department of Medicine (Martin, Ameen Patel, Wong, Wasi, You), McMaster University, Hamilton, Ont.; Department of Geriatric Medicine (Piggott), University of Toronto; Victoria College (Alexandra Patel), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (M. Patel), Dublin, Ireland; Schulich School of Dentistry & Medicine (Liu), Western University, London, Ont.; Departments of Oncology (Dhesy-Thind) and Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont
| | - Yudong Liu
- Department of Medicine (Martin, Ameen Patel, Wong, Wasi, You), McMaster University, Hamilton, Ont.; Department of Geriatric Medicine (Piggott), University of Toronto; Victoria College (Alexandra Patel), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (M. Patel), Dublin, Ireland; Schulich School of Dentistry & Medicine (Liu), Western University, London, Ont.; Departments of Oncology (Dhesy-Thind) and Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont
| | - Sukhbinder Dhesy-Thind
- Department of Medicine (Martin, Ameen Patel, Wong, Wasi, You), McMaster University, Hamilton, Ont.; Department of Geriatric Medicine (Piggott), University of Toronto; Victoria College (Alexandra Patel), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (M. Patel), Dublin, Ireland; Schulich School of Dentistry & Medicine (Liu), Western University, London, Ont.; Departments of Oncology (Dhesy-Thind) and Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont
| | - Parveen Wasi
- Department of Medicine (Martin, Ameen Patel, Wong, Wasi, You), McMaster University, Hamilton, Ont.; Department of Geriatric Medicine (Piggott), University of Toronto; Victoria College (Alexandra Patel), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (M. Patel), Dublin, Ireland; Schulich School of Dentistry & Medicine (Liu), Western University, London, Ont.; Departments of Oncology (Dhesy-Thind) and Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont
| | - John J You
- Department of Medicine (Martin, Ameen Patel, Wong, Wasi, You), McMaster University, Hamilton, Ont.; Department of Geriatric Medicine (Piggott), University of Toronto; Victoria College (Alexandra Patel), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (M. Patel), Dublin, Ireland; Schulich School of Dentistry & Medicine (Liu), Western University, London, Ont.; Departments of Oncology (Dhesy-Thind) and Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont
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Joseph R, Brown-Manhertz D, Ikwuazom S, Singleton JK. The effectiveness of structured interdisciplinary collaboration for adult home hospice patients on patient satisfaction and hospital admissions and re-admissions: a systematic review. ACTA ACUST UNITED AC 2018; 14:108-39. [PMID: 26878925 DOI: 10.11124/jbisrir-2016-2254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Patient satisfaction and hospital re-admission rates are the two major outcomes for measuring quality of healthcare delivery. Interdisciplinary collaboration, a concept that describes coordination of care between multiple healthcare professionals and patients and families to deliver the highest quality of care across settings, is fundamental to improving patient outcomes. Home hospice care is palliative in nature and is a critical segment of patient care. To date, no systematic review has been undertaken to determine the effectiveness of structured interdisciplinary collaboration in the home hospice setting in relation to patient satisfaction and hospital readmission. OBJECTIVE The aim of the review was to synthesize the best available evidence on the effectiveness of structured interdisciplinary collaboration on patient satisfaction and hospital admission and re-admission rates for adults receiving home hospice services. INCLUSION CRITERIA Adults, male and female (18 years old or older), receiving home hospice services or transitioning from hospital to home hospice servicesThe studies that evaluate interdisciplinary collaboration among the hospice team providing home hospice services in the home care settingsIn this review, randomized controlled trials and quasi-experimental studies were considered for inclusion.Patient satisfaction and all cause hospital admissions and re-admission rates. SEARCH STRATEGY Published and unpublished literature in the English language was sought from the inception of the databases through August 15, 2014. The databases searched included: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Nursing & Allied Health Source, Health Source: Nursing/Academic Edition and ProQuest Health Management. A search of grey literature and any relevant homecare/hospice websites was also performed. RESULTS There were no studies located that met the inclusion requirements of this review. There were no text or opinion pieces that were specific to structured interdisciplinary collaboration among the hospice team in home care settings on patient satisfaction and hospital readmission. CONCLUSION There is currently no evidence available to determine the effectiveness of structured interdisciplinary collaboration among hospice teams in home care settings in regard to patient satisfaction and hospital readmission. IMPLICATIONS FOR PRACTICE No conclusive recommendations can be made regarding the effectiveness of structured interdisciplinary collaboration among home hospice teams in home care settings in regard to patient satisfaction and hospital readmission. IMPLICATIONS FOR RESEARCH Quantitative and qualitative research studies are urgently required to determine the effectiveness of structured interdisciplinary collaboration among home hospice teams in home care settings in regard to patient satisfaction and hospital readmission.
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Affiliation(s)
- Rincy Joseph
- 1. College of Health Professions, Pace University, New York, NY, USA2. The Northeast Institute for Evidence Synthesis and Translation (NEST): a Collaborating Center of the Joanna Briggs Institute
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Mehta AK, Wilks S, Cheng MJ, Baker K, Berger A. Nurses' Interest in Independently Initiating End-of-Life Conversations and Palliative Care Consultations in a Suburban, Community Hospital. Am J Hosp Palliat Care 2017; 35:398-403. [PMID: 28413929 DOI: 10.1177/1049909117704403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients who receive early palliative care consults have clinical courses and outcomes more consistent with their goals. Nurses have been shown to be advocates for early palliative care involvement and are able to lead advanced care planning discussions. OBJECTIVE The purpose of this study was to assess whether after a brief educational session, nurses at a suburban, community hospital could demonstrate knowledge of palliative care principles, would want to independently initiate end-of-life conversations with patients and families, and would want to place specialty palliative care consults. DESIGN Four 1 hour presentations were made at 4 nursing leadership council meetings from November through December 2015. Anonymous pre- and post-presentation surveys were distributed and collected in person. Setting/Participant: Nonprofit, suburban, community hospital in Maryland. Participants were full-time or part-time hospital employees participating in a nursing leadership council who attended the presentation. MEASUREMENTS We compared responses from pre- and post-presentation surveys. RESULTS Fifty nurses (19 departments) completed pre-presentation surveys (100% response rate) and 49 nurses completed post-presentation surveys (98% response rate). The average score on 7 index questions increased from 71% to 90%. After the presentations, 86% strongly agreed or agreed that nurses should be able to independently order a palliative care consult and 88% strongly agreed or agreed with feeling comfortable initiating an end-of-life conversation. CONCLUSION Brief educational sessions can teach palliative care principles to nurses. Most participants of the study would want to be able to directly consult palliative care and would feel comfortable initiating end-of-life conversations after this educational session.
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Affiliation(s)
- Ambereen K Mehta
- 1 Division of General Medicine, Geriatrics, and Palliative Care, University of Virginia Health System, Charlottesville, VA, USA.,2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Steven Wilks
- 3 Palliative Care Service, Johns Hopkins Suburban Hospital, Bethesda, MD, USA
| | - M Jennifer Cheng
- 2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Karen Baker
- 2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ann Berger
- 2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Myers J, Krueger P, Webster F, Downar J, Herx L, Jeney C, Oneschuk D, Schroder C, Sirianni G, Seccareccia D, Tucker T, Taniguchi A. Development and Validation of a Set of Palliative Medicine Entrustable Professional Activities: Findings from a Mixed Methods Study. J Palliat Med 2015; 18:682-90. [PMID: 26061030 DOI: 10.1089/jpm.2014.0392] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Entrustable professional activities (EPAs) are routine tasks considered essential to a professional practice. An EPA can serve as a performance-based outcome that a clinical supervisor would progressively entrust a learner to perform. OBJECTIVE Our aim was to identify, develop, and validate a set of EPAs for the palliative medicine discipline. METHODS The design was a sequential qualitative and quantitative mixed methods study. A working group was convened to develop a set of EPAs. Focus groups and surveys were used for validation purposes. Palliative medicine educators and content experts from across Canada participated in both the working group as well as the focus groups. Attendees of the 2014 Canadian Society of Palliative Care Physicians (CSPCP) annual conference completed surveys. A questionnaire was used to collect survey participant sociodemographic, clinical, and academic information along with ratings of the importance of the EPAs individually and collectively. Cronbach's alpha examined internal consistency of the set of EPAs. RESULTS Focus group participants strongly endorsed the 12 EPAs. Virtually all survey participants rated the individual EPAs as being "fairly/very important" (range 94% to 100%). Of the participants, 97% agreed that residents able to perform the set of EPAs would be practicing palliative medicine and 87% indicated strong agreement that this collective set of EPAs captures activities that all palliative medicine physicians must be able to perform. A Cronbach's alpha of 0.841 confirmed good internal consistency. CONCLUSIONS Near uniform agreement from a national group of palliative medicine physicians provides strong validation for the set of 12 EPAs.
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Affiliation(s)
- Jeff Myers
- 1 Division of Palliative Care, University of Toronto , Ontario, Canada
| | - Paul Krueger
- 2 Department of Family Medicine, University of Toronto , Ontario, Canada
| | - Fiona Webster
- 2 Department of Family Medicine, University of Toronto , Ontario, Canada
| | - James Downar
- 1 Division of Palliative Care, University of Toronto , Ontario, Canada
| | - Leonie Herx
- 3 University of Calgary , Calgary, Alberta, Canada
| | - Christa Jeney
- 1 Division of Palliative Care, University of Toronto , Ontario, Canada
| | | | | | - Giovanna Sirianni
- 1 Division of Palliative Care, University of Toronto , Ontario, Canada
| | - Dori Seccareccia
- 1 Division of Palliative Care, University of Toronto , Ontario, Canada
| | - Tara Tucker
- 6 University of Ottawa , Ottawa, Ontario, Canada
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Oishi A, Murtagh FEM. The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: a systematic review of views from patients, carers and health-care professionals. Palliat Med 2014; 28:1081-98. [PMID: 24821710 PMCID: PMC4232314 DOI: 10.1177/0269216314531999] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary care has the potential to play significant roles in providing effective palliative care for non-cancer patients. AIM To identify, critically appraise and synthesise the existing evidence on views on the provision of palliative care for non-cancer patients by primary care providers and reveal any gaps in the evidence. DESIGN Standard systematic review and narrative synthesis. DATA SOURCES MEDLINE, Embase, CINAHL, PsycINFO, Applied Social Science Abstract and the Cochrane library were searched in 2012. Reference searching, hand searching, expert consultations and grey literature searches complemented these. Papers with the views of patients/carers or professionals on primary palliative care provision to non-cancer patients in the community were included. The amended Hawker's criteria were used for quality assessment of included studies. RESULTS A total of 30 studies were included and represent the views of 719 patients, 605 carers and over 400 professionals. In all, 27 studies are from the United Kingdom. Patients and carers expect primary care physicians to provide compassionate care, have appropriate knowledge and play central roles in providing care. The roles of professionals are unclear to patients, carers and professionals themselves. Uncertainty of illness trajectory and lack of collaboration between health-care professionals were identified as barriers to effective care. CONCLUSIONS Effective interprofessional work to deal with uncertainty and maintain coordinated care is needed for better palliative care provision to non-cancer patients in the community. Research into and development of a best model for effective interdisciplinary work are needed.
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Affiliation(s)
- Ai Oishi
- Cicely Saunders Institute, King's College London, London, UK
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Blacker S, Deveau C. Social work and interprofessional collaboration in palliative care. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/096992610x12624290277141] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
Over the past two decades, paediatric palliative care has emerged as both a primary approach and as its own medical subspecialty, the overall aim of which is to ease suffering for children with life-threatening illness and their families through a concurrent model of care. However, most discussions have been focused on the transition to palliative care when no realistic hope for cure exists. We believe that, because the course of cancer is so unpredictable, this idea is misleading. Indeed, palliative care is increasingly being recognized as being about not just how to cope with the process of dying, but also about how to engage in living when faced with a life-threatening illness. This article will examine our current understanding of several areas of palliative care, with the ultimate message that palliative care is simply a novel term for the total care of a child and family, an approach that should be applied consistently and concurrently regardless of disease status. By improving familiarity with palliative care and building relationships with palliative care specialists, the paediatric oncology clinician will ensure that the best care possible for children and families is provided, regardless of outcome.
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Affiliation(s)
- Elisha Waldman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA 02215, USA
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Olshever A. Integration of groupwork theory and hospice interdisciplinary team practice. ACTA ACUST UNITED AC 2012. [DOI: 10.1921/095182411x636536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Edlynn ES, Derrington S, Morgan H, Murray J, Ornelas B, Cucchiaro G. Developing a pediatric palliative care service in a large urban hospital: challenges, lessons, and successes. J Palliat Med 2012; 16:342-8. [PMID: 23249403 DOI: 10.1089/jpm.2012.0187] [Citation(s) in RCA: 10] [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 AND AIM We report the process of creating a new palliative care service at a large, urban children's hospital. Our aim was to provide a detailed guide to developing an inpatient consultation service, along with reporting on the challenges, lessons, and evaluation. METHODS We examined the hiring process of personnel and marketing strategies, a clinical database facilitated ongoing quality review and identified trends, and a survey project assessed provider satisfaction and how referring physicians used the palliative care service. RESULTS AND CONCLUSION The pilot phase of service delivery laid the groundwork for a more effective service by creating documentation templates and identifying relevant data to track growth and outcomes. It also allowed time to establish a clear delineation of team members and distinction of roles. The survey of referring physicians proved a useful evaluation starting point, but conclusions could not be generalized because of the low response rate. It may be necessary to reconsider the survey technique and to expand the sample to include patients and families. Future research is needed to measure the financial benefits of a well-staffed inpatient pediatric palliative care service.
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Affiliation(s)
- Emily S Edlynn
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
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Pereira SM, Fonseca AM, Carvalho AS. Burnout in nurses working in Portuguese palliative care teams: a mixed methods study. Int J Palliat Nurs 2012; 18:373-81. [DOI: 10.12968/ijpn.2012.18.8.373] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sandra M Pereira
- University of Azores, Nursing School of Angra do Heroísmo, Catholic University of Portugal, Bioethics Research Center, Institute of Bioethics, Canada dos Melancólicos, 9700-878 Angra do Heroísmo, Portugal
| | - António M Fonseca
- Catholic University of Portugal, Faculty of Education and Psychology
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Pelant D, McCaffrey T, Beckel J. Development and implementation of a pediatric palliative care program. J Pediatr Nurs 2012; 27:394-401. [PMID: 22703687 DOI: 10.1016/j.pedn.2011.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 05/25/2011] [Accepted: 06/02/2011] [Indexed: 10/17/2022]
Abstract
Palliative care, long-used in the adult setting, is new to the pediatric setting. Research indicates that palliative care reduces length of stay and use of aggressive end-of-life interventions, improves quality of life, and provides hope. It balances provision of coordinated care with building of family memories and preparation for the child's death with celebration of the child's life. We advocate implementation of pediatric palliative care in any hospital that cares for children. This article provides a model outlining critical steps and considerations for establishing a successful pediatric palliative care program.
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DeMiglio L, Williams A. Shared care: the barriers encountered by community-based palliative care teams in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:420-429. [PMID: 22469189 DOI: 10.1111/j.1365-2524.2012.01060.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
To meet the complex needs of patients requiring palliative care and to deliver holistic end-of-life care to patients and their families, an interprofessional team approach is recommended. Expert palliative care teams work to improve the quality of life of patients and families through pain and symptom management, and psychosocial spiritual and bereavement support. By establishing shared care models in the community setting, teams support primary healthcare providers such as family physicians and community nurses who often have little exposure to palliative care in their training. As a result, palliative care teams strive to improve not only the end-of-life experience of patients and families, but also the palliative care capacity of primary healthcare providers. The aim of this qualitative study was to explore the views and experiences of community-based palliative care team members and key-informants about the barriers involved using a shared care model to provide care in the community. A thematic analysis approach was used to analyse interviews with five community-based palliative care teams and six key-informants, which took place between December 2010 and March 2011. Using the 3-I framework, this study explores the impacts of Institution-related barriers (i.e. the healthcare system), Interest-related barriers (i.e. motivations of stakeholders) and Idea-related barriers (i.e. values of stakeholders and information/research), on community-based palliative care teams in Ontario, Canada. On the basis of the perspective of team members and key-informants, it is suggested that palliative care teams experience sociopolitical barriers in an effort to establish shared care in the community setting. It is important to examine the barriers encountered by palliative care teams to address how to better develop and sustain them in the community.
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Affiliation(s)
- Lily DeMiglio
- School of Geography & Earth Sciences, McMaster University, Hamilton, ON, Canada.
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Abstract
In this article I analyze two brief case studies to propose that a "spiritual strength story" has five defining characteristics: (1) it is brief; (2) it is ontological; (3) it uses symbols and metaphors; (4) it is a "big story" or meta-narrative with a positive spiritual and/or religious focus that informs other narrative data; and (5) most conspicuously of all, it repeats. Cultivating awareness of the "spiritual strength" narrative type can help to improve the quality of inter-professional patient-centered care teamwork and understanding, especially in regard to the reflexive, embodied, and relational aspects of palliative and end-of-life care.
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Martins Pereira S, Fonseca AM, Sofia Carvalho A. Burnout in palliative care: A systematic review. Nurs Ethics 2011; 18:317-26. [DOI: 10.1177/0969733011398092] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Burnout is a phenomenon characterized by fatigue and frustration, usually related to work stress and dedication to a cause, a way of life that does not match the person’s expectations. Although it seems to be associated with risk factors stemming from a professional environment, this problem may affect any person. Palliative care is provided in a challenging environment, where professionals often have to make demanding ethical decisions and deal with death and dying. This article reports on the findings of a systematic review aimed at identifying described burnout levels in palliative care nurses and physicians, and the related risks and protective factors. The main findings indicate that burnout levels in palliative care, or in health care settings related to this field, do not seem to be higher than in other contexts.
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Youngwerth J, Twaddle M. Cultures of Interdisciplinary Teams: How to Foster Good Dynamics. J Palliat Med 2011; 14:650-4. [DOI: 10.1089/jpm.2010.0395] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Martha Twaddle
- Rush University School of Medicine, Midwest Palliative & Hospice CareCenter, Glenview, Illinois
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Complex, chronic, and end-of-life care: the interface between critical care and palliative care. Crit Care Nurs Q 2010; 33:265-72. [PMID: 20551741 DOI: 10.1097/cnq.0b013e3181e6606b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Palliative care is a medical subspecialty devoted to palliating symptoms and spending time communicating with patients from the onset of chronic illness through the end of life. Time is one of the gifts a palliative care team gives a patient and family. Ironically, adding time to care may help to decrease critical care costs and mortality. Although palliative care lacks specific funding and national recognition, inpatient, outpatient, hospice, and home palliative programs are emerging to provide coverage across the continuum.
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Wittenberg-Lyles E, Parker Oliver D, Demiris G, Regehr K. Interdisciplinary collaboration in hospice team meetings. J Interprof Care 2010; 24:264-73. [PMID: 19995271 PMCID: PMC2854854 DOI: 10.3109/13561820903163421] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hospice and palliative care teams provide interdisciplinary care to seriously-ill and terminally-ill patients and their families. Care teams are comprised of medical and non-medical disciplines and include volunteers and lay workers in healthcare. The authors explored the perception of collaboration among hospice team members and actual collaborative communication practices in team meetings. The data set consisted of videotaped team meetings, some of which included caregiver participation, and team member completion of a survey. Findings revealed that the team's reflection on process was most likely to occur in team meetings, however least likely to occur when caregivers were present. Although team members had a high perception of interdependence and flexibility of roles, this was less likely to be enacted in team meetings with and without the presence of caregivers. Caregiver participation in team meetings had a positive impact on collaborative communication and the potential benefit of caregiver inclusion in team meetings is explored.
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Affiliation(s)
- Elaine Wittenberg-Lyles
- Department of Communication Studies, University of North Texas, PO Box 305268, Denton, TX 76203-5268, USA.
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Goldsmith J, Wittenberg-Lyles E, Rodriguez D, Sanchez-Reilly S. Interdisciplinary geriatric and palliative care team narratives: collaboration practices and barriers. QUALITATIVE HEALTH RESEARCH 2010; 20:93-104. [PMID: 20019350 DOI: 10.1177/1049732309355287] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Despite the development and implementation of team training models in geriatrics and palliative care, little attention has been paid to the nature and process of teamwork. Geriatrics and palliative care in the clinical setting offer an interdisciplinary approach structured to meet the comprehensive needs of a patient and his or her family. Fellowship members of an interdisciplinary geriatric and palliative care team participated in semistructured interviews. Team members represented social work, chaplaincy, psychology, nursing, and medicine. A functional narrative analysis revealed four themes: voice of the lifeworld, caregiver teamwork, alone on a team, and storying disciplinary communication. The content-ordering function of narratives revealed a divergence in team members' conceptualization of teamwork and team effectiveness, and group ordering of narratives documented the collaborative nature of teams. The study findings demonstrate the potential for narratives as a pedagogical tool in team training, highlighting the benefits of reflective practice for improving teamwork and sustainability.
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Affiliation(s)
- Joy Goldsmith
- Young Harris College, Young Harris, Georgia 30582, USA.
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Bogucki S, Jubanyik K. Triage, Rationing, and Palliative Care in Disaster Planning. Biosecur Bioterror 2009; 7:221-4; discussion 224. [DOI: 10.1089/bsp.2009.0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sandy Bogucki
- Sandy Bogucki, MD, PhD, is Associate Professor and Karen Jubanyik, MD, is Co-Director of Medical Student Education, both in the Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Karen Jubanyik
- Sandy Bogucki, MD, PhD, is Associate Professor and Karen Jubanyik, MD, is Co-Director of Medical Student Education, both in the Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
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Cai L, Han Y, Ren S, Huang L. Dication C(R1)–N(R2)2 Synthons and their use in the Synthesis of Formamidines, Amidines, and α-Aminonitriles. Tetrahedron 2000. [DOI: 10.1016/s0040-4020(00)00785-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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