A Scoping Review of End-of-Life Communication in International Palliative Care Guidelines for Acute Care Settings

2020 ◽  
Author(s):  
Maja Magdalena Olsson ◽  
Carol Windsor ◽  
Shirley Chambers ◽  
Theresa L. Green
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Acute Care ◽  
Scoping Review ◽  
Care Guidelines ◽  
Acute Care Settings ◽  
End Of Life Communication

Development of a Content Valid Tool for Assessing End-of-Life Communication in Acute Care Settings

2012 ◽  
Vol 15 (4) ◽  
pp. 381-387 ◽  
Author(s):  
Rosemarie Fernandez ◽  
Ashley L. Deutsch ◽  
Maria-Pamela Janairo ◽  
Scott A. Compton
Keyword(s):  
End Of Life ◽  
Acute Care ◽  
Acute Care Settings ◽  
End Of Life Communication

scholarly journals Early initiation of palliative care is associated with reduced late-life acute-hospital use: A population-based retrospective cohort study

2018 ◽  
Vol 33 (2) ◽  
pp. 150-159 ◽  
Author(s):  
Danial Qureshi ◽  
Peter Tanuseputro ◽  
Richard Perez ◽  
Greg R Pond ◽  
Hsien-Yeang Seow
Keyword(s):  
Palliative Care ◽  
Confidence Interval ◽  
Organ Failure ◽  
End Of Life ◽  
Acute Care ◽  
Odds Ratio ◽  
Population Based ◽  
Community Based ◽  
Early Palliative Care ◽  
Acute Care Settings

Background: Early palliative care can reduce end-of-life acute-care use, but findings are mainly limited to cancer populations receiving hospital interventions. Few studies describe how early versus late palliative care affects end-of-life service utilization. Aim: To investigate the association between early versus late palliative care (hospital/community-based) and acute-care use and other publicly funded services in the 2 weeks before death. Design: Retrospective population-based cohort study using linked administrative healthcare data. Setting/participants: Decedents (cancer, frailty, and organ failure) between 1 April 2010 and 31 December 2012 in Ontario, Canada. Initiation time before death (days): early (⩾60) and late (⩾15 and <60). ‘Acute-care settings’ included acute-hospital admissions with (‘palliative-acute-care’) and without palliative involvement (‘non-palliative-acute-care’). Results: We identified 230,921 decedents. Of them, 27% were early palliative care recipients and 13% were late; 45% of early recipients had a community-based initiation and 74% of late recipients had a hospital-based initiation. Compared to late recipients, fewer early recipients used palliative-acute care (42% vs 65%) with less days (mean days: 9.6 vs 12.0). Late recipients were more likely to use acute-care settings; this was further modified by disease: comparing late to early recipients, cancer decedents were nearly two times more likely to spend >1 week in acute-care settings (odds ratio = 1.84, 95% confidence interval: 1.83–1.85), frailty decedents were three times more likely (odds ratio = 3.04, 95% confidence interval: 3.01–3.07), and organ failure decedents were four times more likely (odds ratio = 4.04, 95% confidence interval: 4.02–4.06). Conclusion: Early palliative care was associated with improved end-of-life outcomes. Late initiations were associated with greater acute-care use, with the largest influence on organ failure and frailty decedents, suggesting potential opportunities for improvement.

Methods used to attribute costs avoided from pharmacist interventions in acute care: A scoping review

2021 ◽  
Author(s):  
Sujita W Narayan ◽  
Ivo Abraham ◽  
Brian L Erstad ◽  
Curtis E Haas ◽  
Arthur Sanders ◽  
...  
Keyword(s):  
Acute Care ◽  
Scoping Review ◽  
Pharmacy Practice ◽  
Economic Implications ◽  
Medline Search ◽  
Cost Avoidance ◽  
Harmful Consequence ◽  
Pharmacist Interventions ◽  
Acute Care Settings ◽  
Human Participants

Abstract Purpose Cost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists’ interventions in acute care settings. Methods An Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice. Results The database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the specific harm that would occur in the absence of intervention. No clear methods of estimating cost avoidance could be identified for 7 studies. Among all 39 included articles, only 1 attributed both a probability to the potential harm and identified the cost specific to that harm. Conclusion Cost-avoidance studies of pharmacists’ interventions in acute care settings over the last decade have common flaws and provide estimates that are likely to be inflated. There is a need for guidance on consistent methodology for such investigations for reporting of results and to confirm the validity of their economic implications.

scholarly journals Association between high cost user status and end-of-life care in hospitalized patients: A national cohort study of patients who die in hospital

2021 ◽  
pp. 026921632110020
Author(s):  
Kieran L Quinn ◽  
Amy T Hsu ◽  
Christopher Meaney ◽  
Danial Qureshi ◽  
Peter Tanuseputro ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Acute Care ◽  
End Of Life Care ◽  
Major Surgery ◽  
Life Care ◽  
Healthcare Use ◽  
National Cohort ◽  
Acute Healthcare ◽  
Invasive Intervention

Background: Studies comparing end-of-life care between patients who are high cost users of the healthcare system compared to those who are not are lacking. Aim: The objective of this study was to describe and measure the association between high cost user status and several health services outcomes for all adults in Canada who died in acute care, compared to non-high cost users and those without prior healthcare use. Settings and participants: We used administrative data for all adults who died in hospital in Canada between 2011 and 2015 to measure the odds of admission to the intensive care unit (ICU), receipt of invasive interventions, major surgery, and receipt of palliative care during the hospitalization in which the patient died. High cost users were defined as those in the top 10% of acute healthcare costs in the year prior to a person’s hospitalization in which they died. Results: Among 252,648 people who died in hospital, 25,264 were high cost users (10%), 112,506 were non-high cost users (44.5%) and 114,878 had no prior acute care use (45.5%). After adjustment for age and sex, high cost user status was associated with a 14% increased odds of receiving an invasive intervention, a 15% increased odds of having major surgery, and an 8% lower odds of receiving palliative care compared to non-high cost users, but opposite when compared to patients without prior healthcare use. Conclusions: Many patients receive aggressive elements of end-of-life care during the hospitalization in which they die and a substantial number do not receive palliative care. Understanding how this care differs between those who were previously high- and non-high cost users may provide an opportunity to improve end of life care for whom better care planning and provision ought to be an equal priority.

scholarly journals Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e039647
Author(s):  
Mairead Moloney ◽  
Therese Hennessy ◽  
Owen Doody
Keyword(s):  
Intellectual Disability ◽  
Acute Care ◽  
Scoping Review ◽  
Service Provision ◽  
Care Setting ◽  
Acute Care Setting ◽  
Inclusion Criteria ◽  
Health Service Provision ◽  
Acute Care Settings ◽  
Fair Access

ObjectivesPeople with intellectual disability are vulnerable in terms of health service provision due to increased comorbidity, higher dependency and cognitive impairment. This review explored the literature to ascertain what reasonable adjustments are evident in acute care to support people with intellectual disability, ensuring they have fair access and utilisation of health services.DesignScoping review.SettingAcute care settings.MethodsFive databases were systematically searched to identify studies that reported on the implementation of reasonable adjustments. Authors worked in pairs to screen studies for inclusion, data were extracted and charted and findings were synthesised according to content and themes.ResultsOf the 7770 records identified, six studies were included in the review. The volume of evidence was influenced by specific inclusion criteria, and only papers that reported on the actual implementation of a reasonable adjustment within an acute care setting were included. Many papers reported on the concept of reasonable adjustment; however, few identified its applications in practice.ConclusionsThe scoping review highlights a lack of research on the practice and implementation of reasonable adjustments within acute care settings. There is a need for increased support, education and the provision of intellectual disability specialists across acute care settings.

scholarly journals P330 Current Practices at the End of Life in General Medicine Acute Care Settings in Canada

2016 ◽  
Vol 52 (6) ◽  
pp. e150
Author(s):  
Philippe Toupin ◽  
Natalia Novosedlik ◽  
Lisa Le ◽  
Camilla Zimmermann ◽  
Kirsten Wentlandt ◽  
...  
Keyword(s):  
End Of Life ◽  
Acute Care ◽  
General Medicine ◽  
Acute Care Settings ◽  
Current Practices

On the Margins of Death: A Scoping Review on Palliative Care and Schizophrenia

2018 ◽  
Vol 34 (1) ◽  
pp. 62-69 ◽  
Author(s):  
Erin Relyea ◽  
Brooke MacDonald ◽  
Christina Cattaruzza ◽  
Denise Marshall
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Access To Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Scoping Review ◽  
End Of Life Care ◽  
Psychosocial Interventions ◽  
Life Care ◽  
Care Providers

Schizophrenia is a serious chronic mental illness that results in marginalization and stigma for sufferers. It is the seventh leading cause for disability worldwide. The symptoms of the illness, including hallucinations, delusions, and extremely disordered thinking and behavior, may also introduce barriers to accessing treatment, education, housing, and employment. Little is known about end-of-life care for individuals with schizophrenia. To address this gap, a scoping review was conducted to enhance understanding of hospice and palliative care for patients with schizophrenia. From this scoping review, 342 unique titles and abstracts were identified through a search of 20 databases, including 11 social science databases, 6 medical databases, and 3 gray literature databases. A total of 32 articles met the inclusion criteria and the following 4 themes were identified: Stigma affecting quality of care and access to care; Issues related to consent and capacity for the patient’s end-of-life care decisions and to appoint substitute decision makers; Best practices for psychosocial interventions, pharmacology, family and health-care collaborations, goals of care, setting, and smoking; and Barriers to care, including setting, communication, provider education, and access to care. The review suggests the importance of mandatory interdisciplinary training practices and policy standards outlining cooperative communication across health-care providers. It highlights gaps in evidence-based research on psychosocial interventions and collaborative frameworks to enable the provision of quality end-of-life care for individuals with schizophrenia.

End of life in hospitalised prisoners: a group comparison of palliative medicine and hospital use

2021 ◽  
pp. bmjspcare-2020-002703
Author(s):  
Stacey Panozzo ◽  
Tamsin Bryan ◽  
David Marco ◽  
Anna Collins ◽  
Carrie Lethborg ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Acute Care ◽  
End Of Life Care ◽  
Public Hospital ◽  
Prison Population ◽  
Care Hospital ◽  
Life Care ◽  
Comparator Group ◽  
Population Demographic

BackgroundProviding optimal palliative and end-of-life care for people in prison with advanced progressive disease is a growing challenge. This study aimed to examine hospital and palliative care utilisation for people in prison who are hospitalised during the final 3 months of life and to compare with a disease-matched non-incarcerated patient cohort.MethodsA retrospective cohort study of people in prison who died between 2009 and 2019 in an Australian public hospital that provides tertiary-level healthcare for 18% of Australia’s prison population. Demographic, clinical and service use data were extracted from medical records of eligible patients experiencing incarceration (prison group) and a disease-matched, non-incarcerated patient comparator group (comparator group).ResultsAt the time of death, patients in the prison group were aged a median of 20 years younger than the comparator group (median age 58 vs 78 years, p<0.01). The prison group experienced more than double the mean length of acute care hospital stay at the end of life. A higher proportion of patients in the prison group experienced an intensive care unit episode (22% vs 12%). More than two-thirds (71%) of the prison group patients were seen by palliative care prior to death, similar to the comparator group (p=0.44). Those transferred to the palliative care unit had a shorter length of stay and were admitted later, just prior to death (median 5 vs 8 days).ConclusionsPeople in prison have prolonged acute care public hospital stays and are more likely to experience escalation of care at the end of life. Future opportunity may exist for increased access to formal subacute care settings for people in prison with life-limiting illness to receive optimal palliative and end-of-life care.

Teaching end-of-life communication: priorities, challenges, scope—systematic review

2021 ◽  
pp. bmjspcare-2020-002725
Author(s):  
Jack K H Pun ◽  
Ka Man Cheung ◽  
Chung Hang James Chow
Keyword(s):  
End Of Life ◽  
Scoping Review ◽  
Search Strategy ◽  
Medical Providers ◽  
Comprehensive Overview ◽  
Qualitative And Quantitative ◽  
Quantitative Studies ◽  
End Of Life Communication ◽  
Future Practice

BackgroundWithout a well-rounded syllabus to teach end-of-life (EOL) communication, medical providers find it challenging to enhance their patients’ quality of life at the final stage of life.AimThe aim of this scoping review was to explore studies about the teaching of EOL communication and to detail how educators can approach the teaching of EOL communication.MethodsA scoping review of both qualitative and quantitative studies was conducted according to the methodological framework of scoping review. The PsycINFO, PubMed, ERIC, CINAHL and EMBASE databases were searched for studies using the keywords ‘teach’, ‘educat*’, ‘end of life’, ‘terminal care’, ‘communication’ and ‘palliative care’. Sixteen studies were appraised, and none was rejected on the grounds of quality.ResultsThe search strategy yielded 22 278 entries and 16 studies were included. Two themes were identified from the priorities in teaching EOL communication: (1) challenges to teaching EOL communication and (2) methods of teaching EOL communication. To present a comprehensive overview of EOL communication teaching, we provide directions for priorities of topics and approaches when teaching EOL communication.ConclusionsThe review detailed the complexity of teaching EOL communication, which indicates the need for a well-rounded syllabus that includes skills such as non-verbal social cues, communication strategies and understanding EOL communication in various cultural contexts to facilitate a well-rounded EOL communication experience for students’ future practice.

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