Best practices for educating NICU nurses about palliative care: A rapid review

This article examines five different Medical-Legal Partnerships (MLPs) associated with Yale Law School in New Haven, Connecticut to illustrate how MLP addresses the social determinants of poor health. These MLPs address varied and distinct health and legal needs of unique patient populations, including: 1) children; 2) immigrants; 3) formerly incarcerated individuals; 4) patients with cancer in palliative care; and 5) veterans. The article charts a research agenda to create the evidence base for quality and evaluation metrics, capacity building, sustainability, and best practices; it also focuses specifically on a research agenda that identifies the value of the lawyers in MLP. Such a focus on the “L” has been lacking and is overdue.

Download Full-text

Developing a virtual collaborative to facilitate palliative care and quality improvement learning in oncology.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.252 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 252-252 ◽

Cited By ~ 1

Author(s):

Arif Kamal ◽

Kristen McNiff ◽

Ann A. Prestrud ◽

Dale Lupu ◽

Molly Gavigan ◽

...

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Best Practices ◽

Technology Development ◽

Evidence Base ◽

Evaluation Methods ◽

Quality Improvement Intervention ◽

Learning Collaborative ◽

Care Needs ◽

Oncology Practice

252 Background: Despite a strong evidence base and increasing calls for integration, oncologists find it difficult to deliver primary palliative care concurrent with standard oncology care. Solutions that promote practical integration of palliative care in oncology are needed. In an AHRQ-funded pilot, ASCO and the American Academy of Hospice and Palliative Medicine are developing the Virtual Learning Collaborative (VLC) to develop and test a scalable model for quality improvement and dissemination of best practices in palliative care within the oncology setting. Methods: The VLC will be a web-based learning and collaboration system built upon existing ASCO technology resources. We will select at least 25 oncology practices to participate in regular, facilitated learning sessions, collaborative discussions, and sharing of best practices. The VLC will equip each practice with the knowledge, tools, and coaching to select, test, and adopt a quality improvement intervention relevant to their own palliative care needs. Development of the VLC is ongoing; oncology practices begin participation in Spring 2014. Results: We will assess the VLC using protocol-driven evaluation methods common to technology development, quality improvement, implementation science, and educational initiatives. VLC usability, feasibility, and acceptability will be assessed through surveys of participating practices and focus groups. Longitudinal changes in conformance to palliative care metrics will be assessed using ASCO’s Quality Oncology Practice Initiative (QOPI) system. We will use mixed qualitative and quantitative evaluation methods to assess ongoing changes in clinician knowledge and self-efficacy in applying palliative care principles. Conclusions: We aim to develop and test a novel method for facilitating quality improvement and palliative care learning in oncology. Through this pilot, we will refine the VLC for implementation in the greater oncology community. Ultimately, this effort supports other ASCO and AAHPM quality improvement initiatives focused on clinician education and dissemination of best practices.

Download Full-text

Improving palliative care with machine learning and routine data: a rapid review

HRB Open Research ◽

10.12688/hrbopenres.12923.2 ◽

2019 ◽

Vol 2 ◽

pp. 13 ◽

Cited By ~ 3

Author(s):

Virginia Storick ◽

Aoife O’Herlihy ◽

Sarah Abdelhafeez ◽

Rakesh Ahmed ◽

Peter May

Keyword(s):

Machine Learning ◽

Palliative Care ◽

Full Text ◽

Clinical Decision Making ◽

Grey Literature ◽

Routine Data ◽

Adverse Outcomes ◽

Rapid Review ◽

Current Evidence ◽

Cochrane Library

Introduction: Improving palliative care is a priority worldwide as this population experiences poor outcomes and accounts disproportionately for costs. In clinical practice, physician judgement is the core method of identifying palliative care needs but has important limitations. Machine learning (ML) is a subset of artificial intelligence advancing capacity to identify patterns and make predictions using large datasets. ML has the potential to improve clinical decision-making and policy design, but there has been no systematic assembly of current evidence. Methods: We conducted a rapid review, searching systematically seven databases from inception to December 31st, 2018: EMBASE, MEDLINE, Cochrane Library, PsycINFO, WOS, SCOPUS and ECONLIT. We included peer-reviewed studies that used ML approaches on routine data to improve palliative care for adults. Our specified outcomes were survival, quality of life (QoL), place of death, costs, and receipt of high-intensity treatment near end of life. We did not search grey literature. Results: The database search identified 426 citations. We discarded 162 duplicates and screened 264 unique title/abstracts, of which 22 were forwarded for full text review. Three papers were included, 18 papers were excluded and one full text was sought but unobtainable. One paper predicted six-month mortality, one paper predicted 12-month mortality and one paper cross-referenced predicted 12-month mortality with healthcare spending. ML-informed models outperformed logistic regression in predicting mortality where data inputs were relatively strong, but those using only basic administrative data had limited benefit from ML. Identifying poor prognosis does not appear effective in tackling high costs associated with serious illness. Conclusion: While ML can in principle help to identify those at risk of adverse outcomes and inappropriate treatment, applications to policy and practice are formative. Future research must not only expand scope to other outcomes and longer timeframes, but also engage with individual preferences and ethical challenges.

Download Full-text

Coordination of Care Within a Mobile Palliative Care Team and Organization of a Continuing Education Program for Health Professionals in Palliative Care

Journal of Global Oncology ◽

10.1200/jgo.18.36800 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 62s-62s

Author(s):

A. Mubeneshayi Kananga

Keyword(s):

Palliative Care ◽

Best Practices ◽

Continuing Education ◽

Health Professionals ◽

National Policy ◽

Palliative Care Team ◽

Care Team ◽

Terminal Phase ◽

Dr Congo ◽

Mobile Team

Background: In DR Congo (DRC), many cancer patients in the terminal phase of their condition have minimal access to palliative care. There is a combined effect of poverty, the deterioration of the health system and the absence of a well-defined national policy on palliative care. Patients are for the most part abandoned to the care of inexperienced family members. Founded in 2009, Palliafamilli aims to improve the quality of life of patients requiring palliative care in the DRC by providing visits and care for patients, by striving to increase access to palliative care in the region and by informing, raising awareness and mobilizing key national stakeholders. In September 2018, Palliafamilli will launch a mobile palliative care team (MPCT) in partnership with the general hospital of Ndjili in Kinshasa. The MPCT is an interdisciplinary team consisting of physicians, nurses, a psychologist and a project manager; all experienced in accompaniment, symptom management and palliative emergency. It has a consultancy role for professionals, patients and their caregivers. Aim: Through a African Cancer Fellowship award, I will visit a mobile team of palliative care from CHRU Besançon, France, for one month in May 2018 to gain experience in designing and implementing best practices for a mobile palliative care team. Methods: I will work closely with the mobile palliative care team of the Besançon Regional Hospital Center to gain experience regarding the coordination and care administration of palliative care within a mobile team. I will also learn about the different programs of continuing education for health professionals, make comparisons and adapt the programs to the reality of DR Congo. Results: With a view to promoting access to palliative care patients, I intend to learn from the host organization the best practices that they apply to overcome communication difficulties with the patient and their relatives which can constitute delays to access to adequate care. This delay is more marked for patients suffering from cancer because the evolution of their pathology is unpredictable. The main barriers are the insufficient knowledge of patients' needs and the opportunities offered by palliative care. Upon my return, I will adapt the best practices learned in France to the DRC context during the launch of the new mobile palliative care team. Conclusion: In Congo, a cross-cutting approach is required to provide patients with palliative care and pain relief, as resources are limited, many people are in need of care, and there are few nurses and doctors empowered to provide care. An effective approach is to involve community or volunteer caregivers supervised by health professionals, and Palliafamilli is successful due in its multidisciplinary and multisectoral approach, with adaptation to cultural, social and economic specificities and its integration with existing health systems, focusing on primary health care and community and home care.

Download Full-text

The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics: A rapid review to inform practice and service delivery during the COVID-19 pandemic

Palliative Medicine ◽

10.1177/0269216320947623 ◽

2020 ◽

Vol 34 (9) ◽

pp. 1182-1192 ◽

Cited By ~ 2

Author(s):

Sarah Mitchell ◽

Victoria Maynard ◽

Victoria Lyons ◽

Nicholas Jones ◽

Clare Gardiner

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Service Delivery ◽

End Of Life ◽

Primary Healthcare ◽

End Of Life Care ◽

Healthcare Services ◽

Rapid Review ◽

Life Care ◽

Care Providers

Background: The increased number of deaths in the community happening as a result of COVID-19 has caused primary healthcare services to change their traditional service delivery in a short timeframe. Services are quickly adapting to new challenges in the practical delivery of end-of-life care to patients in the community including through virtual consultations and in the provision of timely symptom control. Aim: To synthesise existing evidence related to the delivery of palliative and end-of-life care by primary healthcare professionals in epidemics and pandemics. Design: Rapid systematic review using modified systematic review methods, with narrative synthesis of the evidence. Data sources: Searches were carried out in Medline, Embase, PsychINFO, CINAHL and Web of Science on 7th March 2020. Results: Only five studies met the inclusion criteria, highlighting a striking lack of evidence base for the response of primary healthcare services in palliative care during epidemics and pandemics. All were observational studies. Findings were synthesised using a pandemic response framework according to ‘systems’ (community providers feeling disadvantaged in terms of receiving timely information and protocols), ‘space’ (recognised need for more care in the community), ‘staff’ (training needs and resilience) and ‘stuff’ (other aspects of managing care in pandemics including personal protective equipment, cleaning care settings and access to investigations). Conclusions: As the COVID-19 pandemic progresses, there is an urgent need for research to provide increased understanding of the role of primary care and community nursing services in palliative care, alongside hospices and community specialist palliative care providers.

Download Full-text

The Role and Response of Palliative Care and Hospice Services in Epidemics and Pandemics: A Rapid Review to Inform Practice During the COVID-19 Pandemic

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2020.03.029 ◽

2020 ◽

Vol 60 (1) ◽

pp. e31-e40 ◽

Cited By ~ 44

Author(s):

Simon N. Etkind ◽

Anna E. Bone ◽

Natasha Lovell ◽

Rachel L. Cripps ◽

Richard Harding ◽

...

Keyword(s):

Palliative Care ◽

Rapid Review

Download Full-text

Formation of an international quality improvement collaborative for palliative care: The Global Palliative Care Quality Alliance (GPCQA).

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.91 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 91-91

Author(s):

Arif Kamal ◽

Jonathan Nicolla ◽

Fred Friedman ◽

Charles S. Stinson ◽

Laura Patel ◽

...

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Data Collection ◽

Best Practices ◽

Point Of Care ◽

Shared Vision ◽

Care Quality ◽

Quality Data ◽

Spiritual Assessment ◽

National Quality

91 Background: Formal mechanisms to share data on quality remain immature in specialty palliative care. As the field grows, infrastructure that promotes collaboration among academic and community-based practice will be required to foster comparisons and benchmarking of data to inform areas for quality improvement. Further, such relationships will create a palliative care “quality improvement laboratory”, where proposed guidelines and best practices can be developed, implemented, and tested. Methods: We set out to bring together specialty palliative care practices with a shared vision for collaborative quality improvement. We modeled our approach after the Institute for Healthcare Improvement Breakthrough Series alongside our Rapid Learning Quality Improvement paradigm. We use a set of common data collection procedures, across an electronic point-of-care platform called Quality Data Collection Tool (QDACT), alongside a centralized data registry. Further, we meet and discuss challenges and issues, compare best practices, and brainstorm new projects through biweekly conference calls. Results: We have created a multi-institutional collaboration for quality assessment and improvement in specialty palliative care. Termed the Global Palliative Care Quality Alliance, we have brought together 11 academic and community organizations, both general and oncology-specific, across six states to study various areas of quality practice. Short-term, we will conduct rapid-cycling quality improvement projects addressing National Quality Forum domains for quality palliative care, including documentation of spiritual assessment and timely advance care planning. Long-term, we aim to study the link between quality measure adherence and outcomes and further align our initiatives with those of other large consortia, like the Palliative Care Research Cooperative and Palliative Care Quality Network. Conclusions: Collaborative quality improvement is needed in specialty palliative care across a national platform. Developing the infrastructure to perform standardized quality improvement is achievable across multiple palliative care settings.

Download Full-text