scholarly journals Palliative care at home: Carers and medication management

2008 ◽  
Vol 6 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Barbara A. Anderson ◽  
Debbie Kralik
Keyword(s):  
Palliative Care ◽  
Medication Management ◽  
Symptom Relief ◽  
Symptom Control ◽  
Subcutaneous Administration ◽  
Care Practice ◽  
Home Based ◽  
Palliative Care Setting ◽  
Care At Home ◽  
At Home

ABSTRACTObjective:The decision to receive palliative care at home brings with it the complexity of managing a medication regime. Effective symptom control is often directly linked to medication management and relies on access to medications at all times. In home-based palliative care practice, polypropylene syringes of medications may be drawn up and left in clients' domestic refrigerators for subcutaneous administration by carers to provide immediate relief for symptoms such as pain and nausea. However, although there has been some discussion in the literature about the need for ready access to medications for symptom control of clients receiving care in the community, the feasibility of this practice has received scant attention. The aim of this article is to present the carers' experiences of administering medications in this manner.Methods:Semistructured interviews with 14 carers, who were administering medication in a home-based palliative care setting, were analyzed using qualitative methods to develop meaning units and themes.Results:Interviews revealed that this practice was highly valued. The carers willingly assumed the responsibility of medication administration, as it allowed the clients to remain at home where they desired to be. They could provide immediate symptom relief, which was of utmost importance to both the client and carer. The carers were empowered in their caring role, being able to participate in the care provided, rather than standing on the sidelines as helpless observers. Carers acknowledged the security and ethical issues associated with the presence of certain medications in the home and valued the 24-h telephone support that was available to them. After clients had died, the carers reflected on their involvement in care and felt a sense of pride and achievement from administering medications in this way because they had been able to care for their loved ones at home and fulfill their wish to die there.Significance of results:These interviews confirm the feasibility of this practice, which is a component of quality end-of-life care.

Subcutaneous administration at home for symptom management in palliative care.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 49-49
Author(s):  
Luisa Fernanda Rodriguez ◽  
Cesar Antonio Consuegra Pareja ◽  
Alirio Bastidas ◽  
Marta Ximena Leon ◽  
Alejandra Umbacia ◽  
...  
Keyword(s):  
Palliative Care ◽  
Karnofsky Performance Status ◽  
Symptom Control ◽  
Subcutaneous Administration ◽  
Oral Intake ◽  
Care Program ◽  
Palliative Care Program ◽  
Home Based ◽  
The Mean ◽  
At Home

49 Background: Patients who require home-based palliative care have advanced complex illnesses with functional limitations and decline. Subcutaneous administration of drugs and hydration is a possible alternative when oral intake is hampered. This observational study characterized the use of subcutaneous catheters at a home based palliative care program in Bogotá, Colombia. Methods: Consecutive medical records from September 1, 2017 to February 28, 2018 were reviewed for 272 patients at a home based palliative care program who received subcutaneous administration of drugs and/ or hydration. Statistical analysis was performed to describe the characteristics of the population and its relation to the use of subcutaneous catheters using SPSS tool. Results: The mean age was 72 years (SD: 18), 163 (60%) were females, with a mean in Barthel Index 20 (SD:22), Karnofsky Performance Status Scale 36 (SD: 9.6), PPS of 36 (SD: 11), and PPI 6 (SD: 3.4). The mean time for subcutaneous use was of 34 days (SD: 52). The main indication for the subcutaneous route was poor symptom control in 162 (60%), and because of reduced oral intake in 107 (39%). The administration of drugs was done by a family member in 207 (76%), all trained by a nurse (spouse 14%, offspring 52%, others 34%). The mean number of drugs used per catheter was 3,7 (SD: 1,7). The most common opioid was hydromorphone (57%) followed by morphine (35%). Other medications used were haloperidol (59%) and midazolam (23%). The most common site of application was the upper right extremity. The change of the catheter due to dysfunction was made in 98 (36%) subjects, due to infection in 9 (3.3%) of the 272 patients and 1.5% of 594 catheter insertions. An association with catheter dysfunction was found after multivariate analysis of the time of catheter use and the number of medications. 240 patients (88.2%) died with the catheter in place. Conclusions: Subcutaneous administration of hydration and drugs when used with proper education, training, and followed up by home care programs is a useful strategy for delivering care at home for optimal symptom control for patients receiving palliative care.

Factors that Promote Success in Home Palliative Care: A Study of a Large Suburban Palliative Care Practice

2002 ◽  
Vol 18 (4) ◽  
pp. 282-286 ◽  
Author(s):  
Vincent Maida
Keyword(s):  
Palliative Care ◽  
Home Ownership ◽  
Care Service ◽  
Palliative Care Service ◽  
Care Physician ◽  
Care Practice ◽  
Evaluation Tool ◽  
Home Death ◽  
Home Based ◽  
At Home

It has been repeatedly shown that most people would prefer to die in their own homes. However, many factors affect the feasibility of this choice. This study retrospectively examined the medical and nursing charts of 402 cancer patients who wished to die at home and had been referred to a palliative care service. Of those reviewed, 223 (55%) died at home, while 179 died in hospitals. The presence of more than one caregiver, an increased length of time between diagnosis and referral to a palliative care physician, an increased length of time under that physician's care, older age at referral, home ownership, and race were all significantly associated with home death, as were certain cancer diagnoses. The most compelling of these predictive factors have formed the basis for an evaluation tool, soon to be validated, to help palliative health professionals assess the viability of home-based palliative care culminating in a home death.

scholarly journals What does it take to deliver brilliant home-based palliative care? Using positive organisational scholarship and video reflexive ethnography to explore the complexities of palliative care at home

2018 ◽  
Vol 33 (1) ◽  
pp. 91-101 ◽  
Author(s):  
Aileen Collier ◽  
Michael Hodgins ◽  
Gregory Crawford ◽  
Alice Every ◽  
Kerrie Womsley ◽  
...  
Keyword(s):  
Palliative Care ◽  
Service Management ◽  
Video Recording ◽  
Care Services ◽  
Home Based ◽  
Palliative Care Services ◽  
Care At Home ◽  
Or Team ◽  
Different Levels ◽  
At Home

Background: Despite the increasing number of people requiring palliative care at home, there is limited evidence on how home-based palliative care is best practised. Aim: The aim of this participatory qualitative study is to determine the characteristics that contribute to brilliant home-based palliative care. Design: This study was inspired by the brilliance project – an initiative to explore how positive organisational scholarship in healthcare can be used to study brilliant health service management from the viewpoint of patients, families, and clinicians. The methodology of positive organisational scholarship in healthcare was combined with video-reflexive ethnography. Setting/participants: Home-based specialist palliative care services across two Australian states participated in the study. Clinicians were able to take part in the study at different levels. Pending their preference, this could involve video-recording of palliative care, facilitating and/or participating in reflexive sessions to analyse and critique the recordings, identifying the characteristics that contribute to brilliant home-based palliative care, and/or sharing the findings with others. Results: Brilliance in home-based palliative care is contingent on context and is conceptualised as a variety of actions, people, and processes. Care is more likely to be framed as brilliant when it is epitomised: anticipatory aptitude and action; a weave of commitment; flexible adaptability; and/or team capacity-building. Conclusion: This study is important because it verifies the characteristics of brilliant home-based palliative care. Furthermore, these characteristics can be adapted for use within other services.

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.

Paramedics providing palliative care at home: A mixed-methods exploration of patient and family satisfaction and paramedic comfort and confidence

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 513-522 ◽  
Author(s):  
Alix J. E. Carter ◽  
Marianne Arab ◽  
Michelle Harrison ◽  
Judah Goldstein ◽  
Barbara Stewart ◽  
...  
Keyword(s):  
Palliative Care ◽  
Thematic Analysis ◽  
Symptom Relief ◽  
Family Satisfaction ◽  
Likert Scale ◽  
Free Text ◽  
Peace Of Mind ◽  
Telephone Interviews ◽  
Care At Home ◽  
At Home

ABSTRACTObjectiveParamedics Providing Palliative Care at Home was launched in two provinces, including a new clinical practice guideline, database, and paramedic training. The aim of this study was to evaluate patient/family satisfaction and paramedic comfort and confidence.MethodsIn Part A, we gathered perspectives of patients/families via surveys mailed at enrolment and telephone interviews after an encounter. Responses were reported descriptively and by thematic analysis. In Part B, we surveyed paramedics online pre- and 18 months post-launch. Comfort and confidence were scored on a 4-point Likert scale, and attitudes on a 7-point Likert scale, reported as the median (interquartile range [IQR]); analysis with Wilcoxon ranked sum/thematic analysis of free text.ResultsIn Part A, 67/255 (30%) enrolment surveys were returned. Three themes emerged: fulfilling wishes, peace of mind, and feeling prepared for emergencies. In 18 post-encounter interviews, four themes emerged: 24/7 availability, paramedic professionalism and compassion, symptom relief, and a plea for program continuation. Thematic saturation was reached with little divergence. In Part B, 235/1255 (18.9%) pre- and 267 (21.3%) post-surveys were completed. Comfort with providing palliative care without transport improved post launch (p = < 0.001) as did confidence in palliative care without transport (p = < 0.001). Respondents strongly agreed that all paramedics should be able to provide basic palliative care.ConclusionsAfter implementation of the multifaceted Paramedics Providing Palliative Care at Home Program, paramedics describe palliative care as important and rewarding. The program resulted in high patient/family satisfaction; simply registering provides peace of mind. After an encounter, families particularly noted the compassion and professionalism of the paramedics.

scholarly journals Palliative care is effective: but hospital symptom outcomes superior

2018 ◽  
Vol 10 (2) ◽  
pp. 186-190 ◽  
Author(s):  
Kathy Eagar ◽  
Sabina Petranella Clapham ◽  
Samuel Frederic Allingham
Keyword(s):  
Palliative Care ◽  
Regression Models ◽  
Severe Symptom ◽  
Palliative Care Team ◽  
Logistic Regression Models ◽  
Home Based ◽  
Hospital Patients ◽  
Care At Home ◽  
The Difference ◽  
At Home

ObjectivesTo explore differences in severe symptom outcomes for palliative care patients receiving hospital care compared with those receiving care at home.MethodsChange in symptom distress from the start of an episode of palliative care to just prior to death was measured for 25 679 patients who died under the care of a hospital or home-based palliative care team between January 2015 and December 2016. Logistic regression models controlled for differences between hospital and home and enabled a comparison of the number of severe symptoms just prior to death.ResultsAll symptoms improved and over 85% of all patients had no severe symptoms prior to death. Pain control illustrates this with 7.4% of patients reporting severe pain distress at episode start and 2.5% just prior to death. When comparing all symptom outcomes by place of death, hospital patients are 3.7 times more likely than home patients to have no severe symptoms.Conclusion Symptom outcomes are better for hospital patients. Patients at home have less improvement overall and some symptoms get worse. Reasons for the difference in outcomes by hospital and home are multifactorial and must be considered in relation to the patient’s right to choose their place of care.

Palliative Sedation at Home

2009 ◽  
Vol 25 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Ora S. Rosengarten ◽  
Yonat Lamed ◽  
Timna Zisling ◽  
Ayelet Feigin ◽  
Jeremy M. Jacobs
Keyword(s):  
Palliative Care ◽  
Median Time ◽  
Treatment Option ◽  
Symptom Control ◽  
Palliative Sedation ◽  
Intractable Pain ◽  
Existential Suffering ◽  
Dying Patients ◽  
Care At Home ◽  
At Home

A large number of dying patients receive palliative care at home, and although palliative sedation (PS) may be indicated, literature describing PS at home is scarce. This study is a retrospective description of PS delivered to terminal patients at home from December 2000 to March 2006. A total of 36 patients (with a median age of 65) received home PS. Cancer was the diagnosis for 35 patients, and most patients suffered more than one symptom — most commonly, intractable pain, followed by agitation and existential suffering. Drugs used included midazolam, morphine, haloperidol, fentanyl TTS, and promethazine. Median duration of sedation was three days; median time to symptom control was 24 hours. Good symptom control was achieved in 28 out of 36 patients, and 34 of the patients died at home. In conclusion, PS was a feasible and successful treatment option, improving the care of terminal patients whose preference is to die at home.

Attending to the Suffering Other: A Case Study of Teleconsultation in Palliative Care at Home

2018 ◽  
pp. 1-17
Author(s):  
Jelle van Gurp ◽  
Jeroen Hasselaar ◽  
Evert van Leeuwen ◽  
Martine van Selm ◽  
Kris Vissers
Keyword(s):  
Palliative Care ◽  
Care At Home ◽  
At Home

scholarly journals Seeing the collective: family arrangements for care at home for older people with dementia

2018 ◽  
Vol 39 (06) ◽  
pp. 1200-1218 ◽  
Author(s):  
CHRISTINE CECI ◽  
HOLLY SYMONDS BROWN ◽  
MARY ELLEN PURKIS
Keyword(s):  
Family Care ◽  
High Volume ◽  
Ethnographic Study ◽  
Family Carers ◽  
Care Giving ◽  
People With Dementia ◽  
Home Based ◽  
Health And Social Care ◽  
Care At Home ◽  
At Home

ABSTRACTWith the predicted growth in the number of people with dementia living at home across the globe, the need for home-based care is expected to increase. As such, it will be primarily family carers who will provide this crucial support to family members. Designing appropriate support for family carers is thus essential to minimise risks to their health, to prevent premature institutionalisation or poor care for persons with dementia, as well as to sustain the effective functioning of health and social care systems. To date, the high volume of research related to care at home and acknowledged low impact of interventions suggests that a re-examination of the nature of care at home, and how we come to know about it, is necessary if we are to advance strategies that will contribute to better outcomes for families. This paper describes findings from an ethnographic study that was designed to support an analysis of the complexity and materiality of family care arrangements – that is, the significance of the actual physical, technological and institutional elements shaping care-giving situations. In this paper, we describe the arrangements made by one family to show the necessary collectivity of these arrangements, and the consequences of the formal care system's failure to respond to these.

scholarly journals Advantages and challenges in using telehealth for home-based palliative care: A systematic mixed studies review protocol (Preprint)

2020 ◽  
Author(s):  
Simen A Steindal ◽  
Andréa Aparecida Goncalves Nes ◽  
Tove E. Godskesen ◽  
Susanne Lind ◽  
Alfhild Dhle ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Patient Centered ◽  
Care Services ◽  
Home Based ◽  
Mixed Studies Review ◽  
Palliative Care Services ◽  
Meta Analyses ◽  
Systematic Mixed Studies Review ◽  
At Home

BACKGROUND Due to the increasing number of people in need of palliative care services and the current health care professional workforce strain, providing equitable, quality palliative care has become a challenge. Telehealth could be an innovative approach to palliative care delivery, enabling patients to spend more time or even remain at home, if they wish, throughout the illness trajectory. However, no previous systematic mixed studies reviews have synthesized evidence on patients’ experiences of the advantages and challenges of telehealth for home-based palliative care. OBJECTIVE The aim of this systematic mixed studies review is to critically appraise and synthesize findings from studies that investigated patients’ use of telehealth in home-based palliative care with a focus on the advantages and challenges experienced by the patients. METHODS This article describes the protocol for a systematic mixed studies review with a convergent design. The reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. A systematic search was performed in eight databases for studies published from January 2010 to June 2020. The search will be updated in 2021. Pairs of authors will independently assess eligibility, extract data and assess methodological quality. The data will then be analyzed using thematic synthesis. RESULTS We described the rationale and design of a systematic mixed studies review. The database searches were performed on June 25, 2020. Assessment of eligibility and further steps have not yet been performed. Results are anticipated by August 2021. CONCLUSIONS Following the ethos of patient-centered palliative care, this systematic mixed studies review could contribute recommendations for practice and policy enabling the development of telehealth applications and services that align with patients’ preferences and needs when using telehealth applications and services at home.

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