A Hospital-Based Palliative Care Service for Patients With Advanced Organ Failure in Sub-Saharan Africa Reduces Admissions and Increases Home Death Rates

Background: Palliative care has been developed in recent years in many sub-Saharan countries in Africa due to activities of African Association for Palliative Care. Palliative care units have been established also in most hospitals in Tanzania. Yet very little is known about their functions. Long-term studies about the sustainability of palliative care have not been carried out. Methods: The attitudes of 101 members of hospital staff and persons in charge of palliative care services of Ilembula District Designated Hospital (IDDH), Tanzania, were assessed using a modified and prevalidated questionnaire annually in 2014 to 2017. The inquiries were executed on randomly allocated days. Also, the patient and economy registries were analyzed. Additional qualitative data were obtained in personal interviews and during observational visits twice a year at the IDDH. Results: Ilembula District Designated Hospital has a true multiprofessional palliative care team, which provides services in the hospital, in the villages, and at homes. The activities are based on careful 5-year planning and budgeting. Up to 17 villages have been included in the services. Ninety-five percent of the patients were HIV infected. Short-acting morphine oral solution was the only available strong opioid. The hospital staff evaluated palliative care as good or excellent; 50% of the staff would need more support in the end-of-life care. Conclusions: A sustainable palliative care service can be built in a Tanzanian rural hospital if an advanced planning and budgeting are made. In Tanzania, the biggest group of palliative care patients are still HIV-infected individuals. There is a lack of opioids in the country.

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Factors that Promote Success in Home Palliative Care: A Study of a Large Suburban Palliative Care Practice

Journal of Palliative Care ◽

10.1177/082585970201800406 ◽

2002 ◽

Vol 18 (4) ◽

pp. 282-286 ◽

Cited By ~ 19

Author(s):

Vincent Maida

Keyword(s):

Palliative Care ◽

Home Ownership ◽

Care Service ◽

Palliative Care Service ◽

Care Physician ◽

Care Practice ◽

Evaluation Tool ◽

Home Death ◽

Home Based ◽

At Home

It has been repeatedly shown that most people would prefer to die in their own homes. However, many factors affect the feasibility of this choice. This study retrospectively examined the medical and nursing charts of 402 cancer patients who wished to die at home and had been referred to a palliative care service. Of those reviewed, 223 (55%) died at home, while 179 died in hospitals. The presence of more than one caregiver, an increased length of time between diagnosis and referral to a palliative care physician, an increased length of time under that physician's care, older age at referral, home ownership, and race were all significantly associated with home death, as were certain cancer diagnoses. The most compelling of these predictive factors have formed the basis for an evaluation tool, soon to be validated, to help palliative health professionals assess the viability of home-based palliative care culminating in a home death.

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Healthcare professionals’ perspectives of patient and family preferences of patient place of death: a qualitative study

BMC Palliative Care ◽

10.1186/s12904-021-00842-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Manjusha K. Sathiananthan ◽

Gregory B. Crawford ◽

Jaklin Eliott

Keyword(s):

Palliative Care ◽

Healthcare Professionals ◽

Care Service ◽

Palliative Care Service ◽

Public Hospitals ◽

Place Of Death ◽

Hospital Death ◽

Home Death ◽

Service Staff ◽

The Ideal

Abstract Background Home death is one of the key performance indicators of the quality of palliative care service delivery. Such a measure has direct implications on everyone involved at the end of life of a dying patient, including a patient’s carers and healthcare professionals. There are no studies that focus on the views of the team of integrated inpatient and community palliative care service staff on the issue of preference of place of death of their patients. This study addresses that gap. Methods Thirty-eight participants from five disciplines in two South Australian (SA) public hospitals working within a multidisciplinary inpatient and community integrated specialist palliative care service, participated in audio-recorded focus groups and one-on-one interviews. Data were transcribed and thematically analysed. Results Two major and five minor themes were identified. The first theme focused on the role of healthcare professionals in decisions regarding place of death, and consisted of two minor themes, that healthcare professionals act to: a) mediate conversations between patient and carer; and b) adjust expectations and facilitate informed choice. The second theme, healthcare professionals’ perspectives on the preference of place of death, comprised three minor themes, identifying: a) the characteristics of the preferred place of death; b) home as a romanticised place of death; and c) the implications of idealising home death. Conclusion Healthcare professionals support and actively influence the decision-making of patients and family regarding preference of place of death whilst acting to protect the relationship between the patient and their family/carer. Further, according to healthcare professionals, home is neither always the most preferred nor the ideal place for death. Therefore, branding home death as the ideal and hospital death as a failure sets up families/carers to feel guilty if a home death is not achieved and undermines the need for and appropriateness of death in institutionalised settings.

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The Impact of Socioeconomic Status on Place of Death Among Patients Receiving Home Palliative Care in Toronto, Canada: A Retrospective Cohort Study

Journal of Palliative Care ◽

10.1177/0825859719855020 ◽

2019 ◽

Vol 35 (3) ◽

pp. 167-173

Author(s):

Joshua Wales ◽

Sumeet Kalia ◽

Rahim Moineddin ◽

Amna Husain

Keyword(s):

Socioeconomic Status ◽

Palliative Care ◽

Acute Care ◽

Care Service ◽

Palliative Care Service ◽

Place Of Death ◽

Income Quintile ◽

Home Death ◽

Home Based ◽

The Impact

Background: Socioeconomic disparities in home death have been noted in the literature. Home-based palliative care increases access to home death and has been suggested as a means to decrease these disparities. Aim: Our study examines the association between socioeconomic status and other demographic factors on place of death in a population receiving home palliative care in Toronto, Canada. Design: This is a retrospective chart review of patients who died between August 2013 and August 2015 when admitted to a home-based palliative care service. Multivariate multinomial regression examined the relationship between the place of death (home, palliative care unit [PCU], or acute care) with age, gender, primary diagnosis, and income quintile. Bivariate logistic regression was fitted to calculate the odds ratio (OR) and probability of preference for home death. Setting/Participants: Patients receiving home-based palliative care services from the Latner Centre for Palliative Care in Toronto, Canada. Results: A total of 2066 patients were included in multivariate analysis. Patients in the lowest income quintile had increased odds of dying in acute care (OR = 2.41, P < .001) or dying in PCU (OR = 1.64, P = .008) than patients in highest income quintile. Patients in the next lowest income quintiles 2 and 3 were also more likely to die in acute care. The rate of preference for home death was significantly lower in the lowest income quintile (OR = 0.47, P = .0047). Conclusions: Patients in lower income quintiles are less likely to die at home, despite receiving home-based palliative care, although they may also be less likely to prefer home death.

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QOLP-03. NEURO-ONCOLOGY PALLIATIVE CARE SURVEY OF PHYSICIANS IN SUB-SAHARAN AFRICA

Neuro-Oncology ◽

10.1093/neuonc/noaa215.728 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii175-ii175

Author(s):

Ramya Tadipatri ◽

Amir Azadi ◽

Madison Cowdrey ◽

Samuel Fongue ◽

Paul Smith ◽

...

Keyword(s):

Palliative Care ◽

Care Delivery ◽

Cultural Beliefs ◽

Oral Feeding ◽

Statistical Testing ◽

Sub Saharan Africa ◽

Neurological Deficits ◽

Survey Study ◽

Prior Training ◽

Sub Saharan

Abstract BACKGROUND Early access to palliative care is a critical component of treating patients with advanced cancer, particularly for glioblastoma patients who have low rates of survival despite optimal therapies. Additionally, there are unique considerations for primary brain tumor patients given the need for management of headaches, seizures, and focal neurological deficits. METHODS We conducted a survey of 109 physicians in Sub-Saharan Africa in order to determine level of understanding and skill in providing palliative care, types of palliative care therapies provided, role of cultural beliefs, availability of resources, and challenges faced. Demographic data including age, gender, and prior training was collected and analyzed using ANOVA statistical testing. RESULTS Among the participants, 48% felt comfortable in providing palliative care consultations, 62% have not had prior training, 52% believed that palliative care is only appropriate when there is irreversible deterioration, 62% expressed having access to palliative care, 49% do not have access to liquid opioid agents, 50% stated that cultural beliefs held by the patient or family prevented them from receiving, palliative care, and 23% stated that their own beliefs affected palliative care delivery. Older providers (age > 30) had a clearer understanding of palliative care (p = 0.004), were more comfortable providing consultation (p = 0.052), and were more likely to address mental health (p < 0.001). CONCLUSIONS Palliative care delivery to glioblastoma patients in Sub-Saharan Africa is often delayed until late in the disease course. Barriers to adequate palliative care treatment identified in this survey study include lack of training, limited access to liquid opioid agents, and cultural beliefs. Challenges most often identified by participants were pain management and end-of-life communication skills, but also included patient spirituality and psychological support, anxiety and depression, terminal dyspnea, ethics, and intravenous hydration and non-oral feeding.

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Collateral Damage of the COVID-19 Pandemic: Isolation, Rapid Decision Making and Multifaceted Distress as Observed by an Inpatient Palliative Care Service

Journal of Social Work in End-of-Life & Palliative Care ◽

10.1080/15524256.2021.1894311 ◽

2021 ◽

pp. 1-9

Author(s):

Alissa A. Ulanday ◽

Lindsay B. Minter

Keyword(s):

Decision Making ◽

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Collateral Damage

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77 National Audit of Care At the End of Life (NACEL)—Round Two Findings

Age and Ageing ◽

10.1093/ageing/afab030.38 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

D Hibbert

Keyword(s):

Palliative Care ◽

End Of Life ◽

Care Service ◽

Palliative Care Service ◽

Care Plan ◽

Specialist Palliative Care ◽

Experience Of Care ◽

Outcomes Of Care ◽

Specialist Palliative Care Service ◽

The Right

Abstract NACEL is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the final admission in acute and community hospitals in England and Wales. Mental health inpatient providers participated in the first round but excluded from the second round. NACEL round two, undertaken during 2019/20, comprised: Data was collected between June and October 2019. 175 trusts in England and 8 Welsh organisations took part in at least one element of NACEL (97% of eligible organisations). Key findings include Recognising the possibility of imminent death: The possibility that the patient may die was documented in 88% of cases. The median time from recognition of dying to death was 41 hours (36 hours in the first round). Individual plan of care: 71% of patients, where it had been recognised that the patient was dying (Category 1 deaths), had an individualised end of life care plan. Of the patients who did not have an individualised plan of care, in 45% of these cases, the time from recognition of dying to death was more than 24 hours. Families’ and others’ experience of care: 80% of Quality Survey respondents rated the quality of care delivered to the patient as outstanding/excellent/good and 75% rated the care provided to families/others as outstanding/excellent/good. However, one-fifth of responses reported that the families’/others’ needs were not asked about. Individual plan of care: 80% of Quality Survey respondents believed that hospital was the “right” place to die; however, 20% reported there was a lack of peace and privacy. Workforce Most hospitals (99%) have access to a specialist palliative care service. 36% of hospitals have a face-to-face specialist palliative care service (doctor and/or nurse) available 8 hours a day, 7 days a week. NACEL round three will start in 2021.

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The association between ethnicity, socioeconomic deprivation and receipt of hospital-based palliative care for people with Covid-19: A dual centre service evaluation

Palliative Medicine ◽

10.1177/02692163211022959 ◽

2021 ◽

pp. 026921632110229

Author(s):

Sabrina Bajwah ◽

Polly Edmonds ◽

Emel Yorganci ◽

Rosemary Chester ◽

Kirsty Russell ◽

...

Keyword(s):

Palliative Care ◽

Ethnic Minority ◽

Primary Outcome ◽

Minority Groups ◽

Care Service ◽

Palliative Care Service ◽

Service Evaluation ◽

Socioeconomic Deprivation ◽

Black British ◽

Multivariable Regression

Background: People from ethnic minority groups and deprived socioeconomic backgrounds have worse outcomes from COVID-19. Aim: To examine associations between ethnicity and deprivation with timing of palliative care referral for inpatients with COVID-19. Design: Service evaluation of consecutive patients with COVID-19 referred to palliative care. Sociodemographic (including age, sex, Index of Multiple Deprivation, ethnicity coded as White/non-White) and clinical variables were described. The primary outcome was timing of referral to palliative care. Associations between ethnicity and socioeconomic deprivation with the primary outcome were explored using multivariable regression. Setting/participants: Patients with COVID-19 referred to a hospital palliative care service across two London hospitals February–May 2020. Results: A total of 334 patients were included. 119 (36%) were from a non-White ethnic group; most commonly Black British (77, 23%) and Asian British (26, 8%). A longer time between admission and palliative care referral was associated with male gender (IRR 1.23, 95% CI 1.14–1.34) and lower levels of socioeconomic deprivation (IRR 1.61, 95% CI 1.36–1.90) but not ethnicity (IRR = 0.96, 95% CI 0.87–1.06). Conclusions: This large service evaluation showed no evidence that patients from ethnic minority or more deprived socioeconomic groups had longer time to palliative care referral. Ongoing data monitoring is essential for equitable service delivery.

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54 Developing a palliative care service at Nightingale North West

10.1136/leader-2020-fmlm.54 ◽

2020 ◽

Author(s):

Ben Anderosn

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

North West

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Use of Alfentanil in Palliative Care

Pharmacy ◽

10.3390/pharmacy8040240 ◽

2020 ◽

Vol 8 (4) ◽

pp. 240

Author(s):

José António Ferraz Gonçalves ◽

Filipa Sousa ◽

Lucy Alves ◽

Patrícia Liu ◽

Sara Coelho

Keyword(s):

Chronic Pain ◽

Palliative Care ◽

Retrospective Study ◽

Pain Relief ◽

Renal Impairment ◽

Care Service ◽

Palliative Care Service ◽

Median Number ◽

Second Line ◽

Induction Of Tolerance

Alfentanil is used for chronic pain relief in palliative care. However, there is a dearth of data on its use. For this reason, a decision was made to review the use of alfentanil in palliative care. Retrospective study was carried out in a palliative care service. The files of patients who received alfentanil as an intravenous or subcutaneous continuous infusion for pain relief, between January 2018 and April 2019. In total, 111 patients received alfentanil out of 113 admissions. Of them, 56 were male, and the median age was 70 years. The median number of days on alfentanil was 6 (range 1 to 129). The most frequent primary reasons for switching to alfentanil was uncontrolled pain in 52 (46%) patients and renal impairment in 24 (21%) patients. The median 24-h initial dose of alfentanil was 4 mg (1–20), and the median final 24-h dose of alfentanil was 5 mg (1–60), (p < 0.001). The initial 24-h median number of rescue doses was 2 (0–8), and the final median number of rescue doses was 1 (0 to 8), (p = 0.025). In 56 patients who were on alfentanil for at least 7 days, the dose decreased in 3 (5%), remained stable in 10 (18%) and increased in 43 (77%). The patient on alfentanil for 129 days maintained the same dose throughout that period. Alfentanil can be a useful second-line opioid. The induction of tolerance does not seem to be particularly rapid with alfentanil.

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