Quality of Care and Satisfaction With Care on Palliative Care Units

Objectives:During the final period of life, patients with cancer in the Basque Country are given treatment in different types of hospital care. This study compared the quality of care according to the type of care in one of the autonomous communities in Spain.Methods:A retrospective study was carried out of cancer patients who died in conventional hospital services, home hospitalization services, and palliative care units. In addition to hospital stay and readmission number, variables based on the recommendations of Spanish Society for Palliative Care were studied.Results:End-of-life was diagnosed in 57 percent of a sample of 486 patients, 3 days before death (median). The use of symptom control scales was only documented in the clinical records of eight patients. Sociofamily evaluation was not found. Patients in conventional hospital services were less frequently diagnosed with end-of-life and agony and were significantly different from the rest in the reasons for admission, symptoms assessed, drugs used, administration routes, and dosage forms. Pain was evaluated in 50 percent of the patients and was better controlled in palliative care units. Patients not diagnosed with agony (52 percent) were more frequently not given specific treatment.Conclusions:End-of-life in cancer patients was diagnosed too late. The quality of care in palliative care units and by home hospitalization service was better than that in conventional hospitalization. Nevertheless, there were areas for improvement in the three modalities of care.

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Regional Differences in Quality of Care at Palliative Care Units (PCUs), and Complicated Grief and Depression of Bereaved Family Members: Results from a Nationwide Bereavement Survey in Japan

Palliative Care Research ◽

10.2512/jspm.13.235 ◽

2018 ◽

Vol 13 (3) ◽

pp. 235-243

Author(s):

Yuki Yonenaga ◽

Maho Aoyama ◽

Yuka Moriya ◽

Naoko Igarashi ◽

Kento Masukawa ◽

...

Keyword(s):

Palliative Care ◽

Quality Of Care ◽

Regional Differences ◽

Family Members ◽

Complicated Grief ◽

Palliative Care Units ◽

Bereaved Family

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Communication and Quality of Care on Palliative Care Units: A Qualitative Study

Journal of Palliative Medicine ◽

10.1089/jpm.2014.0408 ◽

2015 ◽

Vol 18 (9) ◽

pp. 758-764 ◽

Cited By ~ 25

Author(s):

Dori Seccareccia ◽

Kirsten Wentlandt ◽

Nanor Kevork ◽

Kevin Workentin ◽

Susan Blacker ◽

...

Keyword(s):

Palliative Care ◽

Quality Of Care ◽

Qualitative Study ◽

Palliative Care Units

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Quality of life change and response shift in patients admitted to palliative care units: a pilot study

Palliative Medicine ◽

10.1191/0269216305pm1029oa ◽

2005 ◽

Vol 19 (5) ◽

pp. 381-388 ◽

Cited By ~ 26

Author(s):

Michael A Echteld ◽

Luc Deliens ◽

Marcel E Ooms ◽

Miel W Ribbe ◽

Gerrit van der Wal

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Pilot Study ◽

Response Shift ◽

Life Change ◽

Palliative Care Units

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Hospital end-of-life care: families’ free-text notes

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-00239 ◽

2020 ◽

pp. bmjspcare-2020-00239

Author(s):

Sandra Kurkowski ◽

Johannes Radon ◽

Annika R Vogt ◽

Martin Weber ◽

Stephanie Stiel ◽

...

Keyword(s):

Palliative Care ◽

Quality Of Care ◽

End Of Life ◽

End Of Life Care ◽

Qualitative Content Analysis ◽

Free Text ◽

Life Care ◽

Quality Aspects ◽

Care Of The Dying

BackgroundPalliative care strives to improve quality of life for patients with incurable diseases. This approach includes adequate support of the patients’ loved ones. Consequently, loved ones have personal experiences of providing end-of-life care for their next. This is a resource for information and may help to investigate the loved ones’ perspectives on need for improvements.AimTo identify further quality aspects considered important by loved ones to improve the quality of care at the end of life as an addition to quantitative results from the Care of the Dying Evaluation for the German-speaking area (CODE-GER) questionnaire.DesignWithin the validation study of the questionnaire ‘Care of the Dying Evaluation’ (CODETM) GER, loved ones were asked to comment (free text) in parallel on each item of the CODE-GER. These free-text notes were analysed with the qualitative content analysis method by Philipp Mayring.Setting/participantsLoved ones of patients (n=237), who had died an expected death in two university hospitals (palliative and non-palliative care units) during the period from April 2016 to March 2017.Results993 relevant paragraphs were extracted out of 1261 free-text notes. For loved ones, important aspects of quality of care are information/communication, respect of the patient’s and/or loved one’s will, involvement in decision-making at the end of life (patient’s volition) and having the possibility to say goodbye.ConclusionsIt is important for loved ones to be taken seriously in their sorrows, to be informed, that the caregivers respect the patients’ will and to be emotionally supported.Trial registration numberThis study was registered at the German Clinical Trials Register (DRKS00013916).

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Implementing a patient-centred outcome measure in daily routine in a specialist palliative care inpatient hospital unit: An observational study

Palliative Medicine ◽

10.1177/0269216316655349 ◽

2016 ◽

Vol 31 (3) ◽

pp. 275-282 ◽

Cited By ~ 5

Author(s):

Alze Pereira dos Santos Tavares ◽

Carolina Paparelli ◽

Carolina Sassaki Kishimoto ◽

Silvia Avo Cortizo ◽

Karen Ebina ◽

...

Keyword(s):

Palliative Care ◽

Quality Of Care ◽

Missing Data ◽

Outcome Measure ◽

Symptom Control ◽

Daily Practice ◽

Daily Routine ◽

Palliative Care Outcome Scale ◽

Care Outcome

Background: Gathering clinical evidence data on patients’ palliative care needs is paramount to identify changes in outcomes over time and maintaining on-going quality improvement. Implementation of patient-centred outcome measures has been widely recommended. The routine use of these instruments in daily practice is challenging and not widespread. Aim: To implement a patient-centred outcome measure in daily practice and fulfil one quality indicator: improve pain during the 72 h after admission, in at least 75% of patients. Design: An observational prospective study. The Palliative care Outcome Scale was used at admission (T0), third day (T1) and weekly. Setting/participants: Hospital palliative care unit with 17 individual rooms. All patients admitted to the unit were included in the study. Results: Preliminary results ( N = 84) revealed inconsistent and missing data (14%). Symptoms were sub-optimally controlled by T1. Processes changed, and only a team member could apply Palliative care Outcome Scale. Doctors were encouraged to grasp the meaning of Palliative care Outcome Scale results for each patient. The post-pilot included 317 patients. No missing data occurred. There was an improvement in most items between T0 and T1: ‘pain’ and ‘other symptoms’ presented statistical significant differences ( p < 0.05). Conclusion: Implementing a patient-centred outcome measure in a hospital palliative care service is feasible and improves quality of care. Controlling high pain at T0 improved (>80%) by T1. Results became more consistent and symptom control was improved overall. Patients are evaluated based on holistic domains by an interdisciplinary team and we have added a much needed measure to help guide improvement of the quality of care provided.

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Skin problems in palliative care

Oxford Handbook of Palliative Care ◽

10.1093/med/9780198745655.003.0012 ◽

2019 ◽

pp. 407-420

Keyword(s):

Palliative Care ◽

Wound Care ◽

Metastatic Cancer ◽

Physical Symptoms ◽

Skin Involvement ◽

Skin Disorders ◽

Advanced Malignancy ◽

Drug Treatments ◽

Palliative Care Units

This chapter discusses skin disorders. Skin disorders affect patients with early and advanced malignant and non-malignant disease. In addition to distressing physical symptoms, the appearance of pressure sores, malignant wounds, and lymphoedema impact on patients’ social functioning, mood, and quality of life. Meticulous and prompt management of symptoms can make a huge difference. There is a growing body of research into drug treatments for pruritus in palliative care, and interventions for managing lymphoedema and wounds more effectively. Key principles in the management of wound care, lymphoedema, and pruritus are examined. Skin wounds are common in advanced malignancy. Pressure ulcers are most frequently seen, affecting an estimated one-third or more of patients in palliative care units. Malignant/fungating wounds occur in approximately 5–10% patients with metastatic cancer and are associated with significant physical and psychological distress. Loco-regional skin involvement (e.g. breast fungation) should be distinguished from generalized skin metastases which imply advanced disease.

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