scholarly journals Fully Integrated Oncology and Palliative Care Services at a Local Hospital in Mid-Norway: Development and Operation of an Innovative Care Delivery Model

2020 ◽  
Vol 9 (1) ◽  
pp. 297-318 ◽  
Author(s):  
Anne-Tove Brenne ◽  
Anne Kari Knudsen ◽  
Sunil Xavier Raj ◽  
Laila Skjelvan ◽  
Jo-Åsmund Lund ◽  
...  
2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 279-279
Author(s):  
Kuei-Min Chen ◽  
Hui-Fen Hsu

Abstract The effectiveness of sufficient care coordination for high-need community-dwelling older adults has not been discussed. This study aimed to examine the effectiveness of a newly-developed care delivery model for high-need community-dwelling older adults. A cluster randomized controlled trial with repeated measures design was employed. A total of 145 high-need older adults participated in the study and were randomly assigned to either the intervention group or comparison group. A categorized list of care services based on the types of high-need older adults as the intervention allowed care coordinators to make adequate care service linkages. The intervention period ranged over 6 months with regulated home visits and assesssments. Functional ability, quality of life, depressive symptoms, and healthcare and social service utilizations were measured at baseline, and at 3 and 6 months into the intervention. The participants’ satisfaction with care delivery was measured at the end of 6-month intervention. Results showed that the intervention group had a better functional ability, a higher quality of life, reduced depressive symptoms, and more efficient healthcare and social service utilizations than the comparison group at both the 3-month and 6-month intervals (all p < .05). By the end of the 6-month study, the intervention group were more satisfied with the care service linkages than the comparison group (p < .05). The positive effects of providing a categorized list of care services for care coordinators to make service linkages have been evidenced by the outcomes. The promising findings supported a further longer-term implementation of the care delivery model.


2020 ◽  
Author(s):  
Simen A Steindal ◽  
Andréa Aparecida Goncalves Nes ◽  
Tove E. Godskesen ◽  
Susanne Lind ◽  
Alfhild Dhle ◽  
...  

BACKGROUND Due to the increasing number of people in need of palliative care services and the current health care professional workforce strain, providing equitable, quality palliative care has become a challenge. Telehealth could be an innovative approach to palliative care delivery, enabling patients to spend more time or even remain at home, if they wish, throughout the illness trajectory. However, no previous systematic mixed studies reviews have synthesized evidence on patients’ experiences of the advantages and challenges of telehealth for home-based palliative care. OBJECTIVE The aim of this systematic mixed studies review is to critically appraise and synthesize findings from studies that investigated patients’ use of telehealth in home-based palliative care with a focus on the advantages and challenges experienced by the patients. METHODS This article describes the protocol for a systematic mixed studies review with a convergent design. The reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. A systematic search was performed in eight databases for studies published from January 2010 to June 2020. The search will be updated in 2021. Pairs of authors will independently assess eligibility, extract data and assess methodological quality. The data will then be analyzed using thematic synthesis. RESULTS We described the rationale and design of a systematic mixed studies review. The database searches were performed on June 25, 2020. Assessment of eligibility and further steps have not yet been performed. Results are anticipated by August 2021. CONCLUSIONS Following the ethos of patient-centered palliative care, this systematic mixed studies review could contribute recommendations for practice and policy enabling the development of telehealth applications and services that align with patients’ preferences and needs when using telehealth applications and services at home.


2021 ◽  
pp. 13-22
Author(s):  
Britni Lookabaugh ◽  
Charles von Gunten

In caring for patients with chronic complex and life-limiting illness, models of palliative care delivery have developed across the care continuum. While many palliative care services are provided by hospital-based consult teams, palliative care is also delivered in the home, including independent living, assisted living, and group homes; in skilled nursing facilities; and in the outpatient office setting. While high variability exists for delivery of palliative care across the globe, there have been many studies reflecting the value of palliative care across these settings, for quality of end-of-life care as well as for the financial implications in the complex medical care for patients with palliative care needs.


Author(s):  
Kristopher Hartwig ◽  
Mervyn Dean ◽  
Kari Hartwig ◽  
Paul Z. Mmbando ◽  
Abduraoof Sayed ◽  
...  

Background: In Tanzania, a country of 42 million, access to oral morphine is rare.Aim: To demonstrate the effectiveness of palliative care teams in reducing patients’ pain and in increasing other positive life qualities in the absence of morphine; and to document the psychological burden experienced by their clinical providers, trained in morphine delivery, as they observed their patients suffering and in extreme pain.Setting: One hundred and forty-fie cancer patients were included from 13 rural hospitals spread across Tanzania.Method: A mixed method study beginning with a retrospective quantitative analysis of cancer patients who were administered the APCA African POS tool four times. Bivariate analyses of the scores at time one and four were compared across the domains. The qualitative arm included an analysis of interviews with six nurses, each with more than fie years’ palliative care experience and no access to strong opioids.Results: Patients and their family caregivers identifid statistically signifiant (p < 0.001) improvements in all of the domains. Thematic analysis of nurse interviews described the patient and family benefis from palliative care but also their great distress when ‘bad cases’ arose who would likely benefi only from oral morphine.Conclusion: People living with chronic cancer-related pain who receive palliative care experience profound physical, spiritual and emotional benefis even without oral morphine. These results demonstrate the need for continued advocacy to increase the availability of oral morphine in these settings in addition to palliative care services.


2021 ◽  
Vol 9 (T4) ◽  
pp. 6-17
Author(s):  
Madihah Binti Abdullah ◽  
Titih Huriah ◽  
Arianti Arianti ◽  
Rosnani Binti Sarkasi

BACKGROUND: The limited palliative care services can affect the late in palliative care management, such as late in decision making. Decision making is one of the crucial processes that every patient with life-threatening health life-limiting illness needs to overcome. Nurses can be the third party between the patients and physicians in helping them with decision making. AIM: The aim of this study was to explore the differences perspectives of palliative care decision making for palliative patients and families in Indonesia and Malaysia. METHODOLOGY: The study design used qualitative method with the phenomenology approach. The sample size of this study was 12 participants from two different study settings. They were three palliative nurses and three physicians from each country, selected by purposive sampling. The study was carried out at PKU Muhammadiyah Yogyakarta Hospital and Tuanku Fauziah Hospital Kangar, Perlis, Malaysia. Data collection used in-depth interview. The interpretative phenomenology analysis was used to analyze the data. RESULTS: There were differences in the perspectives of palliative care services in Indonesia and Malaysia based on the culture form each of the countries. Nurses played a supportive role in ensuring that the care delivered to the patients and families were effective and efficient. Lack of staff was one of the challenges for Indonesia and Malaysia palliative care services need to face. CONCLUSION: Three themes emerged from the collected data; there were views on palliative care, nurses’ supportive roles, and limited resources. To encounter the challenges and difficulties that interrupt the care delivery to the patients, nurses need to improve knowledge about palliative and their skills.


2019 ◽  
Vol 24 (2) ◽  
pp. 108-115 ◽  
Author(s):  
Arlanna Pugh ◽  
Heather Castleden ◽  
Melissa Giesbrecht ◽  
Colleen Davison ◽  
Valorie Crooks

Objectives In Canada, the rural elderly population is increasing in size, as is their need for palliative care services in these settings. This analysis aims to identify awareness-associated barriers to delivering rural palliative care services, along with suggestions for improving service delivery from the perspective of local health care providers. Methods A total of 40 semi-structured interviews with various formal and informal health care providers were conducted in four rural and/or remote Canadian communities with limited palliative care resources. Interview data were thematically coded using Penchansky and Thomas’ five dimensions of access (i.e. availability, (geographic) accessibility, accommodation, acceptability and affordability). Saurman’s recently added sixth dimension of access – awareness – was also identified while coding and subsequently became the primary focus of this analysis. Results Identified barriers to palliative care awareness and suggestions on how to enhance this awareness, and ultimately palliative care delivery, corresponded with three key themes arising from the data: limited palliative care knowledge/education, communication and coordination. Participants recognized the need for more palliative care education, open lines of communication and better coordination of palliative care initiatives and local resources in their communities. Conclusions These findings suggest that identifying the barriers to palliative care awareness in rural communities may be foundational to addressing barriers to the other five dimensions of access. A thorough understanding of these three areas of awareness knowledge, communication and coordination, as well as the connections between them, may help enhance how rural palliative care is delivered in the future.


2021 ◽  
Vol 16 (1) ◽  
pp. 40-46
Author(s):  
Yuk Chiu Yip ◽  
Wai-King Tsui ◽  
Ka-Huen Yip

This viewpoint paper explores the growing emphasis and social need for palliative care from a global perspective, juxtaposed against the Hong Kong status quo and its increasing need for such services. It further highlights that the role of nursing within palliative care is central to patients receiving the best quality of care. Hong Kong’s current delivery models are generally insufficient and can be improved by the adoption of five recommended policy changes, which reinforce the position of nurses as vital to creating a better service. These recommendations will enable nurses to take the lead in future palliative care delivery frameworks, enabling more efficient planning of future management of patients’ pain and other symptoms, social, spiritual, or emotional needs that arise during assessment. Its value may extend to other countries and settings.


2021 ◽  
pp. 1020-1026
Author(s):  
Anne Wilkinson ◽  
Marianne Matzo

Both catastrophic disasters and humanitarian crises can have widespread, long-term, and often unpredictable negative impacts, causing shortages of safe water, food, shelter, transportation, and sanitation as well as the displacement of large numbers of people and the loss of many lives. Routinely ignored in disaster and humanitarian planning are those socially and medically vulnerable populations living in the affected community who are dependent on the existing healthcare system for survival, making them particularly predisposed to the risk of harm or death due to the event. Because of their unique needs, extra steps need to be taken in order to reduce the likelihood that vulnerable populations will suffer injury, disease, or even death. Serious health-related suffering resulting from illness or injury stemming from a natural or man-made crisis could be ameliorated by the inclusion of palliative care services in planning and response activities. While the primary goal of disaster medicine is to maximize the number of lives saved and to ensure the best outcomes for the community as a whole, a holistic and fully compassionate response necessitates a secondary goal of minimizing the physical and psychological suffering of those whose lives may be shortened by a crisis event. In order to effectively provide palliative care services in crisis situations, all care delivery sites, especially triage and alternative care sites, will need clearly articulated protocols, trained staff (including personnel with palliative care, mental health, and spiritual counselling skills), supplies (including those necessary for appropriate pharmacological treatment), and appropriate space for dying patients.


2018 ◽  
Vol 10 (2) ◽  
pp. 191-195
Author(s):  
Naomi Taylor ◽  
Yi Fan Liang ◽  
Robert Tinnion

ObjectivesFollowing publication of detailed national neonatal palliative care guidance, practical regional guidance, in the form of multidisciplinary ‘checklists’, was implemented aiming to improve the quality of neonatal palliative care.MethodsCase note audit was used to examine the quality of locally delivered neonatal palliative care before and after regional guidance implementation.Results27 patients were allocated to the ‘before’ cohort and 10 to the ‘after’ cohort. Introduction of the checklists was apparently associated with improvements in domains of pain relief and comfort care, monitoring, fluids and nutrition, completion of diagnostics, treatment ceiling decisions, resuscitation status and discussion with parents. Other support for parents was poorly adhered to.ConclusionRegional guidance improved some aspects of palliative care delivery though other areas remained suboptimal. Other strategies, for example, consultation with paediatric palliative care services, need to be considered to further improve the quality of palliative care delivered to babies with life-limiting illnesses.


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