Advancing Palliative Care in Long Term Care Facilities (LTCFs) in Europe Within the PACE Project: An Innovative Educational and Development Intervention

Abstract Background Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology. Aim To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above. Methods A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy. Results The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines. Conclusion Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.

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Combating Coronavirus Disease-2019 Outbreak in Long-Term Care Facilities for Frail Older Adults: Preventive Measures and Palliative Care Go Hand-in-Hand

Journal of Palliative Care ◽

10.1177/08258597211039364 ◽

2021 ◽

pp. 082585972110393

Author(s):

Hon Wai Benjamin Cheng

Keyword(s):

Palliative Care ◽

Long Term Care ◽

Care Delivery ◽

Nursing Home Residents ◽

Respiratory Illness ◽

Term Care ◽

The People ◽

Care Facilities ◽

Novel Coronavirus

While the whole population is at risk from infection with the coronavirus, older people—often frail and subject to multimorbidity—are at the highest risk for the severe and fatal disease. Despite strict infection control and social distancing measures, frail adults in long-term care facilities may be at particular risk of transmission of respiratory illness. Treatment decisions are often complex attributed to the heterogeneity of this population with regards to different geriatric domains such as functional status, comorbidity, and poly-pharmacy. While measures must be taken to prevent the novel coronavirus from spreading through these facilities, it is also essential that residents with coronavirus disease 2019 (COVID-19) have access to the symptom management and support they want and deserve. What most nursing home residents want during the course of their illness is to be able to stay in their facilities, to be surrounded by the people they love most, and to feel relief from their physical and emotional pain. By addressing the limited access to hospice and palliative care delivery in nursing homes, we can prevent unnecessary suffering and pain from COVID-19 as well as lay the groundwork for improving care for all residents moving forward.

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Palliative care provision in long-term care facilities differs across Europe: Results of a cross-sectional study in six European countries (PACE)

Palliative Medicine ◽

10.1177/0269216319861229 ◽

2019 ◽

Vol 33 (9) ◽

pp. 1176-1188 ◽

Cited By ~ 4

Author(s):

Maud ten Koppel ◽

Bregje D Onwuteaka-Philipsen ◽

Lieve Van den Block ◽

Luc Deliens ◽

Giovanni Gambassi ◽

...

Keyword(s):

Palliative Care ◽

Advance Care Planning ◽

Long Term Care ◽

Care Planning ◽

Care Provision ◽

Cross Sectional ◽

Term Care ◽

Care Facilities ◽

Advance Care

Background: While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed. Aim: To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care. Design: Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses. Setting/participants: Nurses or care assistants who are most involved in care for the resident. Results: We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%–Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%–the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life. Conclusion: The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development.

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CLINICAL AUDIT: QUALITY OF PALLIATIVE CARE IN LONG TERM-CARE FACILITIES IN WESTERN FRANCE, 2015

Innovation in Aging ◽

10.1093/geroni/igx004.1931 ◽

2017 ◽

Vol 1 (suppl_1) ◽

pp. 547-547

Author(s):

J. Prudhomm ◽

V. Morin-Chouarbi ◽

M. Bechac ◽

E. Menand ◽

A. Corvol ◽

...

Keyword(s):

Palliative Care ◽

Audit Quality ◽

Long Term Care ◽

Clinical Audit ◽

Term Care ◽

Care Facilities

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What is the methodological rigour of palliative care research in long-term care facilities in Europe? A systematic review

Palliative Medicine ◽

10.1177/0269216311412232 ◽

2011 ◽

Vol 26 (5) ◽

pp. 722-733 ◽

Cited By ~ 9

Author(s):

Gwenda Albers ◽

Richard Harding ◽

H Roeline W Pasman ◽

Bregje D Onwuteaka-Philipsen ◽

Sue Hall ◽

...

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Long Term Care ◽

Term Care ◽

Care Research ◽

Care Facilities

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Building a Palliative Care Consult Service in Long-Term Care Facilities: Strategy, Business Model, And Outcomes (S704)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2012.10.121 ◽

2013 ◽

Vol 45 (2) ◽

pp. 418 ◽

Cited By ~ 1

Author(s):

Teresa Albanese ◽

Steven Radwany ◽

Erica Hoiles ◽

Christine Hudak ◽

Kelly McGranahan

Keyword(s):

Palliative Care ◽

Business Model ◽

Long Term Care ◽

Consult Service ◽

Term Care ◽

Care Facilities

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Integrating palliative care in long-term care facilities across Europe (PACE): protocol of a cluster randomized controlled trial of the ‘PACE Steps to Success’ intervention in seven countries

BMC Palliative Care ◽

10.1186/s12904-018-0297-1 ◽

2018 ◽

Vol 17 (1) ◽

Cited By ~ 23

Author(s):

Tinne Smets ◽

◽

Bregje B. D. Onwuteaka-Philipsen ◽

Rose Miranda ◽

Lara Pivodic ◽

...

Keyword(s):

Palliative Care ◽

Randomized Controlled Trial ◽

Long Term Care ◽

Controlled Trial ◽

Cluster Randomized Controlled Trial ◽

Term Care ◽

Randomized Controlled ◽

Care Facilities ◽

Cluster Randomized

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Hospice nurse reflections on a palliative care educational intervention in long-term care: An inductive content analysis

10.21203/rs.2.10573/v1 ◽

2019 ◽

Author(s):

Rosemary Ann Frey ◽

Deborah Balmer ◽

Michal Boyd ◽

Jackie Robinson ◽

Merryn Gott

Keyword(s):

Palliative Care ◽

Content Analysis ◽

Educational Intervention ◽

Long Term Care ◽

Knowledge Exchange ◽

Term Care ◽

Hospice Nurses ◽

Staffing Levels ◽

Care Facilities

Abstract Abstract Background: Older people in long-term care facilities are at a greater risk of receiving care at the end of life that does not adequately meet their needs, yet staff in long-term care are often unprepared to provide palliative care. The objective of the study was to explore hospice nurse experiences regarding the barriers and facilitators to the implementation of a palliative care educational intervention, Supportive Hospice Aged Residential Exchange (SHARE) in 20 long-term care facilities. Methods: Reflective logs (465), recorded over the course of the yearlong SHARE intervention by the three hospice nurses, who were the on-site mentors, were qualitatively analyzed by two researchers utilizing inductive content analysis. Results: Categories emerging from the logs include the importance of relationships, knowledge exchange, communication, and the challenges of providing palliative care in a long-term care setting. Conclusion: Evidence from the logs indicated that sustained relationships between hospice nurses and staff as well as reciprocal learning were key factors supporting the implementation of this palliative care educational intervention. Challenges remain however in relation to staffing levels, which further emphasizes the importance of hospice presence as a point of stability.

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