The impact of providing end-of-life care during a pandemic on the mental health and wellbeing of health and social care staff: Systematic review and meta-synthesis

Background: There is a growing need for palliative care for patients near the end of life and their caregivers. Palliative and end-of-life care (EoLC) education are recommended for all health care (e.g., physicians, nurses, and allied health practitioners) and social care professionals (e.g., social workers) to ensure the quality of services. However, less attention has been afforded to generic, in contrast to specialized, EoLC education. This study evaluated the effectiveness of a series of short-term generic EoLC educational programs for health and social care professionals. Method: A pre-post survey design was adopted, focusing on different EoLC core competences. Results: Significant improvement was observed in all perceived competences after the educational programs, regardless of participants’ occupation or EoLC experience. Perceived competence in self-care was rated significantly higher than all other competences prior to the programs. Healthcare professionals rated significantly higher on competence in symptom management than social workers. Scores on communication skill and self-care competences were significantly higher following longer (i.e., 16-24 hours) than shorter (i.e., 4-8 hours) programs. Conclusion: Generalist palliative/EoLC educational programs may enable health and social care professionals to refresh and extend their knowledge and skills and enhance their perceived competence in providing EoLC. Further research on generalist palliative/EoLC education is needed to examine the impact of continuing training on professionals’ actual practice in EoLC and palliative care.

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Information sharing challenges in end-of-life care: a qualitative study of patient, family and professional perspectives on the potential of an Electronic Palliative Care Co-ordination System

BMJ Open ◽

10.1136/bmjopen-2020-037483 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037483

Author(s):

Holly Standing ◽

Rebecca Patterson ◽

Mark Lee ◽

Sonia Michelle Dalkin ◽

Monique Lhussier ◽

...

Keyword(s):

Palliative Care ◽

Qualitative Study ◽

Information Sharing ◽

End Of Life ◽

End Of Life Care ◽

Social Care ◽

Hospital Admissions ◽

Sufficient Information ◽

Life Care ◽

Health And Social Care

ObjectivesTo explore current challenges in interdisciplinary management of end-of-life care in the community and the potential of an Electronic Palliative Care Co-ordination System (EPaCCS) to facilitate the delivery of care that meets patient preferences.DesignQualitative study using interviews and focus groups.SettingHealth and Social Care Services in the North of England.Participants71 participants, 62 health and social care professionals, 9 patients and family members.ResultsFour key themes were identified: information sharing challenges; information sharing systems; perceived benefits of an EPaCCS and barriers to use and requirements for an EPaCCS. Challenges in sharing information were a source of frustration for health and social care professionals as well as patients, and were suggested to result in inappropriate hospital admissions. Current systems were perceived by participants to not work well—paper advance care planning (ACP) documentation was often unavailable or inaccessible, meaning it could not be used to inform decision-making at the point of care. Participants acknowledged the benefits of an EPaCCS to facilitate information sharing; however, they also raised concerns about confidentiality, and availability of the increased time and resources required to access and maintain such a system.ConclusionsEPaCCS offer a potential solution to information sharing challenges in end-of-life care. However, our findings suggest that there are issues in the initiation and documentation of end-of-life discussions that must be addressed through investment in training in order to ensure that there is sufficient information regarding ACP to populate the system. There is a need for further qualitative research evaluating use of an EPaCCS, which explores benefits and challenges, uptake and reasons for disparities in use to better understand the potential utility and implications of such systems.

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First steps: Health and social care professionals beginning to address the palliative and end of life care needs of people with diverse gender identities and sexual orientations in Lebanon

Sexualities ◽

10.1177/1363460720932380 ◽

2020 ◽

pp. 136346072093238

Author(s):

Claude Chidiac

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Social Stigma ◽

Life Care ◽

Care Needs ◽

Mena Region ◽

Healthcare Needs ◽

Health And Social Care ◽

The Impact

The available evidence demonstrates that lesbian, gay, bisexual, and transgender (LGBT) people face challenges when accessing palliative care services, and receive suboptimal care at the end of life. This is mainly attributed to assumed heterosexuality, lack of knowledge and understanding of LGBT issues and specific healthcare needs, discrimination, homophobia, and transphobia. In Lebanon, legal and institutional support for LGBT individuals is minimal, and palliative care provision remains scarce and fragmented. This compounds the impact of social stigma and marginalisation, and results in unrecognised palliative and end of life care needs for the LGBT individual. This short commentary discusses the development of an LGBT palliative care workshop in Lebanon, which was the first initiative of its kind in the Middle East and North Africa (MENA) region. It also explores how this initiative has led to further developments, and how these efforts can be replicated in other countries in the MENA region.

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Development and evaluation of an LGBT+ education programme for palliative care interdisciplinary teams

Palliative Care and Social Practice ◽

10.1177/26323524211051388 ◽

2021 ◽

Vol 15 ◽

pp. 263235242110513

Author(s):

Claude Chidiac ◽

Kate Grayson ◽

Kathryn Almack

Keyword(s):

Mental Health ◽

Palliative Care ◽

End Of Life ◽

Cultural Change ◽

End Of Life Care ◽

Healthcare Access ◽

Interdisciplinary Teams ◽

Life Care ◽

Educational Work ◽

Health And Social Care

Background: Despite national policy recommendations to enhance healthcare access for LGBT+ (lesbian, gay, bisexual, transgender, and those who do not identify as cisgender heterosexual) people, education on LGBT+ issues and needs is still lacking in health and social care curricula. Most of the available resources are focused on primary care, mental health, and sexual health, with little consideration to broader LGBT+ health issues and needs. The limited available educational programmes pertaining to LGBT+ individuals outside the context of sexual or mental health have mainly focused on cancer care or older adults. Aim: To support palliative care interdisciplinary teams to provide LGBT+ affirmative care for people receiving and needing palliative and end-of-life care. Methods: A 1½-h workshop was developed and evaluated using Kotter’s eight-step process for leading change. Across four hospices, 145 health and social professionals participated in the training. A quasi-experimental non-equivalent groups pre–post-test design was used to measure self-reported levels of knowledge, confidence, and comfort with issues, and needs and terminology related to LGBT+ and palliative care. Results: There was a significant increase in the reported levels of knowledge, confidence, and comfort with issues, needs, and terminology related to LGBT+ and palliative care after attending the training. Most participants reported that they would be interested in further training, that the training is useful for their practice, and that they would recommend it to colleagues. Conclusion: The project illustrates the importance of such programmes and recommends that such educational work is situated alongside wider cultural change to embed LGBT+-inclusive approaches within palliative and end-of-life care services.

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Impact of Home Healthcare on End-of-life Outcomes for People With Dementia: a Systematic Review

10.21203/rs.3.rs-810894/v1 ◽

2021 ◽

Author(s):

Ping-Jen Chen ◽

Lisanne Smits ◽

Rose Miranda ◽

Jung-Yu Liao ◽

Irene Petersen ◽

...

Keyword(s):

Systematic Review ◽

Palliative Care ◽

End Of Life ◽

Healthcare Utilization ◽

Social Care ◽

Home Healthcare ◽

Life Outcomes ◽

Health And Social Care ◽

Acute Healthcare ◽

The Impact

Abstract Background: Home healthcare (HHC) may reduce acute hospital utilization, but its effect on homebound people living with dementia (PLWD) at end-of-life remains unclear. We aim to describe the impact of HHC on acute healthcare utilization and end-of-life outcomes in PLWD.Methods: Design: A systematic review of quantitative and qualitative studies regarding the association between HHC (exposure) and targeted outcomes. Interventions: HHC provided by health care professionals, including physicians or nurses. Participants: At least 80% of study participants had dementia and lived at home. Measurements: Primary outcome was acute healthcare utilization in the last year of life. Secondary outcomes included palliative care use, advance care planning (ACP), continuity of care in the last year of life, and place of death. We identified contextual information about policy changes in HHC for these outcomes.Results: We included five studies from USA, Japan, and Italy, none of which received a high-quality rating. At micro-level, HHC may be associated with a lower risk of acute healthcare utilization in the early period (e.g., last 90 days before death) and a higher risk in the late period (e.g. last 15 days) of the disease trajectory toward end-of-life in PLWD. ACP with written decisions may be an important mediator of this. HHC increases referrals to palliative care. At meso-level, HHC providers’ difficulty in making treatment decisions for PLWD at the end-of-life may require further training and external support. Coordination between HHC and social care is mentioned but not well examined in the existing literature.Conclusions: The review highlights the dearth of dementia-specific research regarding the impact of HHC on end-of-life outcomes. In PLWD, the core components of HHC for achieving better quality end-of-life, the integration between health and social care, and coordination between primary HHC and palliative care should be further investigated in future studies.

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Does post-registration palliative care education for nurses improve practice? A systematic review

International Journal of Palliative Nursing ◽

10.12968/ijpn.2019.25.11.552 ◽

2019 ◽

Vol 25 (11) ◽

pp. 552-564 ◽

Cited By ~ 2

Author(s):

Angela Thavaraj ◽

Karen Gillett

Keyword(s):

Systematic Review ◽

Palliative Care ◽

End Of Life ◽

Outcome Measures ◽

End Of Life Care ◽

Quantitative Data ◽

Life Care ◽

Care Education ◽

Palliative Care Education ◽

The Impact

Aims: We aimed to answer the question: what is the evidence that post-registration palliative care education for nurses improves practice? Background: The 2008 End of Life Care Strategy emphasised the need for a workforce equipped to provide high-quality end-of-life care for patients and their families. As registered nurses are the healthcare professionals spending most time with patients and families at the end of life, associated policy documents stress the importance of educating nurses to equip them with the necessary knowledge and skills to provide effective care. Despite education being a consistent recommendation, the ability of education to influence nursing practice is uncertain. Methods: We undertook a systematic review of literature using Joanna Briggs Institute Methodology for Mixed Methods by searching the Medline, Embase and CINAHL databases between January 2006 and December 2018. Findings: Ten studies met the inclusion criteria, seven contained quantitative data. Six demonstrated improvements in outcome measures, but not all results were statistically significant. Most quantitative data related to self-reported measures of confidence. Six studies contained qualitative findings that were categorised into themes: confidence, practice change, skills and proactivity. Conclusion: Little research exists exploring the impact of post-registration palliative care education for nurses. Existing outcome measures do not clearly demonstrate changes to end-of-life practice. Research is suggested to establish links between self-reported confidence and improvements to practice. Evaluation of the impact on practice should be an integral component of end-of-life education initiatives.

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Development and psychometric validation of a comprehensive end-of-life care competence scale: A study based on three-year surveys of health and social care professionals in Hong Kong

Palliative & Supportive Care ◽

10.1017/s1478951520000723 ◽

2020 ◽

pp. 1-10

Author(s):

Daiming Xiu ◽

Amy Y.M. Chow ◽

Iris K.N. Chan

Keyword(s):

Hong Kong ◽

End Of Life ◽

Health Care Professionals ◽

End Of Life Care ◽

Social Care ◽

Life Care ◽

Internal Reliability ◽

Health And Social Care ◽

Competence Scale ◽

Bereavement Care

Abstract Objective This study aimed to develop an assessment tool measuring comprehensive interdisciplinary competence in end-of-life care (EoLC) and investigate its content, construct validity, reliability, and their correlates. Method Items of the Comprehensive End-of-Life Care Competence Scale (CECCS) were developed according to a comprehensive core competence framework in EoLC and refined by a multi-disciplinary panel of experts. The psychometric properties were further tested through region-wide surveys of self-administered questionnaires completed by health and social care professionals in Hong Kong. Results Participants comprised social workers, nurses, physicians, and allied health care professionals (445 participants in 2016, 410 in 2017, and 523 in 2018). Factor analysis validated the construct of the questionnaire which encompassed 26 items describing EoLC core competences in seven domains with satisfactory internal reliability (confirmatory factor analysis: χ2/df = 3.12, GFI = 0.85, TLI = 0.93, CFI = 0.94, RMSEA = 0.07; Cronbach's alphas ranged from 0.89 to 0.97): overarching value & knowledge, communication skills, symptom management, psychosocial and community care, end-of-life decision-making, bereavement care, and self-care. Higher perceived levels in these competences were correlated with a higher level of job meaningfulness and satisfaction (r ranged from 0.17 to 0.39, p < 0.01) and correlated with lower perceived stress (r ranged from –0.11 to –0.28, p < 0.05). Regression analysis found that age and work involvement in EoLC were positively associated with the perceived competences in all domains; professionals working in hospices reported higher levels of competence than workers in other settings; social workers showed lower perceived competences in symptom management, but higher levels in bereavement care than other health care professionals. Significance of results The validity and internal reliability of CECCS were demonstrated. The levels of perceived competences working in EoLC were significantly associated with professionals’ job-related well-being. Practically, there is still room for improvement in comprehensive competences among health and social care workers in Hong Kong.

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