scholarly journals Home-Based Palliative Care for Children With Incurable Cancer: Long-term Perspectives of and Impact on General Practitioners

2017 ◽  
Vol 53 (3) ◽  
pp. 578-587 ◽  
Author(s):  
Ivana M.M. van der Geest ◽  
Patrick J.E. Bindels ◽  
Saskia M.F. Pluijm ◽  
Erna M.C. Michiels ◽  
Agnes van der Heide ◽  
...  
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Incurable Cancer ◽  
Home Based

General practitioners (GPs) and end-of-life care: a qualitative study of Australian GPs and specialist palliative care clinicians

2018 ◽  
pp. bmjspcare-2018-001531 ◽  
Author(s):  
Joel J Rhee ◽  
Patrick C K Teo ◽  
Geoffrey K Mitchell ◽  
Hugh E Senior ◽  
Aaron J H Tan ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
General Practitioners ◽  
Continuity Of Care ◽  
End Of Life Care ◽  
Significant Proportion ◽  
Qualitative Description ◽  
Life Care ◽  
Specialist Palliative Care

ObjectivesGeneral practitioners (GPs) are well placed to be involved in end-of-life care for patients with life-limiting illnesses. However, differing views exist regarding their role. This study aims to explore the views of GPs and specialist palliative care clinicians (SPCCs) on the role that GPs should play in the planning and provision of end-of-life care and important barriers and facilitators to GPs’ involvement in end-of-life care including suggestions for improvement.MethodsQualitative description methodology using semistructured interviews of 11 GPs and 10 SPCCs.ResultsThe participants identified two key roles that GPs should play in the planning and provision of end-of-life care: care planning and referring to palliative care services and being the primary clinician in charge of patient care. GPs and SPCCs expressed similar views; however, a significant proportion of the GP participants were not actively involved in end-of-life care. Factors affecting GPs’ involvement in end-of-life care included: (1) GP and practice factors including continuity of care, long-term relationships with patients, knowledge and skills in end-of-life care, resource limitations and work patterns; (2) communication and collaboration between GPs and the acute healthcare system and (3) communication and collaboration between GPs and SPCCs.ConclusionGPs have a key role in the planning and provision of end-of-life care. GPs could be encouraged in this role by providing them with education and practical experience in end-of-life care, making changes to remuneration structure, formalised arrangements for shared care and encouraging continuity of care and developing long-term relationship with their patients.

scholarly journals Home-based palliative care management: what are the useful resources for general practitioners? a qualitative study among GPs in France

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Carol-Anne Boudy ◽  
Tiphanie Bouchez ◽  
Didier Caprini ◽  
Isabelle Pourrat ◽  
Stéphane Munck ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
General Practitioners ◽  
Real Life ◽  
Continuous Medical Education ◽  
Care Practice ◽  
Multidisciplinary Teams ◽  
Structured Interviews ◽  
Home Based ◽  
At Home

Abstract Background Most French people (71%) would like to die at home, but only one out of four actually do. While the difficulties inherent in the practice of home-based palliative care are well described, few studies highlight the resources currently used by general practitioners (GPs) in real life. We have therefore sought to highlight the resources actually used by GPs providing home-based palliative care. Methods Twenty-one GPs of different ages and practice patterns agreed to participate to this qualitative study based upon semi-structured interviews. They were recruited according to a purposive sampling. Transcripts analysis was based upon General Inductive Analysis. Results The resources highlighted have been classified into two main categories according to whether they were internal or external to the GPs. The internal resources raised included the doctor’s practical experience and continuous medical education, personal history, work time organization and a tacit moral contract related to the referring GP’s position. External resources included resource personnel, regional assistance platforms and health facilities, legislation. Conclusion This study provides a simple list that is easy to share and pragmatic solutions for GPs and policymakers. Home-based palliative care practice can simultaneously be burdensome and yet a fulfilling, meaningful activity, depending on self-efficacy and professional exhaustion (burnout), perhaps to a greater extent than on medical knowledge. Home-based palliative care promotion is a matter of social responsibility. The availability of multidisciplinary teams such as regional assistance platforms and Hospitalization at Home is particularly important for the management of palliative care. Policymakers should consolidate these specific resources out of hospitals, in community settings where the patients wish to end their life.

scholarly journals Analytical study of short- and long-term results of home-based palliative care services to cancer patients

2017 ◽  
Vol 23 (3) ◽  
pp. 331
Author(s):  
Dhritiman Datta ◽  
Gautam Majumdar ◽  
Shiromani Debbarma ◽  
Badan Janapati ◽  
AmitKumar Datta
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Analytical Study ◽  
Long Term Results ◽  
Care Services ◽  
Home Based ◽  
Palliative Care Services ◽  
Short And Long Term

Dyadic psychological intervention for patients with cancer and caregivers in home-based specialized palliative care: The Domus model

2017 ◽  
Vol 16 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Annika B. von Heymann-Horan ◽  
Louise B. Puggaard ◽  
Kathrine G. Nissen ◽  
Kirstine Skov Benthien ◽  
Pernille Bidstrup ◽  
...  
Keyword(s):  
Palliative Care ◽  
Psychological Intervention ◽  
Interdisciplinary Collaboration ◽  
Controlled Trial ◽  
Psychological Support ◽  
Psychosocial Needs ◽  
Incurable Cancer ◽  
Home Based ◽  
Specialized Palliative Care ◽  
At Home

ABSTRACTObjective:Patients with incurable cancer and their informal caregivers have numerous psychological and psychosocial needs. Many of these patients wish to receive their care and die at home. Few home-based specialized palliative care (SPC) interventions systematically integrate psychological support. We present a psychological intervention for patient–caregiver dyads developed for an ongoing randomized controlled trial (RCT) of home-based SPC, known as Domus, as well as the results of an assessment of its acceptability and feasibility.Method:The Domus model of SPC for patients with incurable cancer and their caregivers offered systematic psychological assessment and dyadic intervention as part of interdisciplinary care. Through accelerated transition to SPC, the aim of the model was to enhance patients' chances of receiving care and dying at home. Integration of psychological support sought to facilitate this goal by alleviating distress in patients and caregivers. Psychologists provided needs-based sessions based on existential-phenomenological therapy. Feasibility and acceptability were investigated by examining enrollment, nonparticipation, and completion of psychological sessions.Results:Enrollment in the RCT and uptake of the psychological intervention indicated that it was feasible and acceptable to patients and caregivers. The strengths of the intervention included its focus on dyads, psychological distress, and existential concerns, as well as interdisciplinary collaboration and psychological interventions offered according to need. Its main limitation was a lack of an intervention for other family members.Significance of Results:Our results show that psychological intervention can be systematically integrated into SPC and that it appears feasible to provide dyadic needs-based sessions with an existential therapeutic approach. The Domus RCT will provide evidence of the efficacy of a novel model of multidisciplinary SPC.

scholarly journals Home-Based Care Practitioners: A Strategy for Continuum of Care for Very Ill Patient

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 121s-121s
Author(s):  
D. Mukasahaha ◽  
F. Uwinkindi ◽  
L. Grant ◽  
J. Downing ◽  
J. Turyahikayo ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Quality Care ◽  
Economic Cost ◽  
Supervisory Relationship ◽  
Home Based ◽  
Implementation Period ◽  
Hospital To Home ◽  
Home Based Care

Background: Rwanda Ministry of Health in collaboration with partners has initiated an innovative initiative named Home Based Care Practitioners (HBCPs) to respond to the burden of long-term hospitalization for end of life patients. Aim: The program aims at providing home-based care to accompany patients and their families in their home, reduce unnecessary pain and suffering for those with chronic or terminal conditions, provide counseling to the patients and their families, early diagnosis of NCDs and improve awareness on prevention of NCDs risk factors and effectively refer them to either health facilities or community-based resources that can be of further help. Methods: The HBCPs is implemented into phases; phase one has started with a pilot of 200 HBCPs in 100 cells surrounding nine provincial and referral hospitals of Rwanda; 2 practitioners for both gender in each cell, with a criteria of completion at least secondary school. They have undergone a training of 120 credits (900 hours), equivalent of four months for theory and two months of practice. After training they have been deployed into the community with a supervision of health centers in collaboration with hospitals and Rwanda Biomedical Center. Results: During the implementation period of 6 months, 1663 NCDs patients have been transferred from health facility (OPD) to HBCPs for routine follow-up, 482 palliative care patients have been reported on end of life care by HBCPs, there is a remarkable linkage between facilities and community care ensured by supervisory relationship between health services providers and home based care practitioners, long-term admission has reduced the cost for the family and the facility due to the discharge of care from hospital to home. Conclusion: In a limited setting of social and economic cost of providing frivolous care in an expensive hospital for chronic or terminal conditions that would be better managed through treatment or palliative care at home (or less acute setting) home based care effort can better meet the needs of Rwandans at the community level and has started to show the efficiency in providing quality care to people in need of palliative care.

scholarly journals Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers

2021 ◽  
pp. 104990912110126
Author(s):  
Valeria Cardenas ◽  
Anna Rahman ◽  
Yujun Zhu ◽  
Susan Enguidanos
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Insurance Coverage ◽  
Healthcare Providers ◽  
Health Condition ◽  
Insurance Companies ◽  
Structured Interviews ◽  
Care Services ◽  
Home Based ◽  
Palliative Care Services

Background: Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. Aim: To identify patients’ and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. Design: We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. Setting/Participants: Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. Results: Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. Conclusion: Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.

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