scholarly journals Institutional Effects on Early Palliative Care among Mexican-Heritage Elders

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 895-895
Author(s):  
Susan Miller ◽  
Ester Carolina Apesoa-Varano
Keyword(s):  
Palliative Care ◽  
Older People ◽  
Qualitative Interviews ◽  
Social Institutions ◽  
Structural Constraints ◽  
Early Palliative Care ◽  
Institutional Effects ◽  
Social Structural ◽  
Mexican Heritage ◽  
To Receive

Abstract This paper addresses Mexican-heritage older people’s experiences with early palliative care (EPC). EPC is the early provision of medical, social and spiritual reports to relieve suffering. Empirically, Mexican-heritage older people are known to have less access to EPC and, when they access it, to receive care of lower quality. However, little work has explored how Mexican-heritage older people think about and access such care. The paper addresses this gap. Methods are longitudinal: 36 Mexican-heritage people ranging in age from 55 to 90 years completed longitudinal semi-structured qualitative interviews, for a total of 69 interviews. Results explore how respondents’ participation in social institutions may mediate the effects of larger social structural constraints on their health and access to care.

scholarly journals The views of patients with brain cancer about palliative care: a qualitative study

2017 ◽  
Vol 24 (6) ◽  
pp. 374 ◽  
Author(s):  
M. Vierhout ◽  
M. Daniels ◽  
P. Mazzotta ◽  
J. Vlahos ◽  
W.P. Mason ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Brain Cancer ◽  
Chronic Conditions ◽  
Structured Interviews ◽  
Optimal Care ◽  
Early Palliative Care ◽  
Care Services ◽  
Palliative Care Services ◽  
To Receive

Background Palliative care, a specialty aimed at providing optimal care to patients with life-limiting and chronic conditions, has several benefits. Although palliative care is appropriate for neurosurgical conditions, including brain cancer, few studies have examined the views of brain cancer patients about palliative care. We aimed to explore the thoughts of brain cancer patients about palliative care, their opinions about early palliative care, and their preferred care setting.Methods Semi-structured interviews and the qualitative research methodologies of grounded theory were used to explore perceptions of palliative care on the part of 39 brain cancer outpatients.Results Seven overarching actions emerged:Patients would prefer to receive palliative care in the home.Increased time with caregivers and family are the main appeals of home care.Patients express dissatisfaction with brief and superficial interactions with health care providers.Patients believe that palliative care can contribute to their emotional well-being.Patients are open to palliative care if they believe that it will not diminish optimism.There is a preconceived idea that palliative care is directly linked to active dying, and that supposed link generates fear in some patients.Patients prefer to be educated about palliative care as an option early in their illness, even if they are fearful of it.Conclusions Overall, when educated about the true meaning of palliative care, most patients express interest in accessing palliative care services. Although the level of fear concerning palliative care varies in patients, most recognize the associated benefits.

Longitudinal Perceptions of Prognosis and Goals of Therapy in Patients With Metastatic Non–Small-Cell Lung Cancer: Results of a Randomized Study of Early Palliative Care

2011 ◽  
Vol 29 (17) ◽  
pp. 2319-2326 ◽  
Author(s):  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Sonal Admane ◽  
Emily R. Gallagher ◽  
Vicki A. Jackson ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Early Palliative Care ◽  
Metastatic Nsclc ◽  
Oncology Care ◽  
To Receive ◽  
Over Time

Purpose Understanding of prognosis among terminally ill patients impacts medical decision making. The aims of this study were to explore perceptions of prognosis and goals of therapy in patients with metastatic non–small-cell lung cancer (NSCLC) and to examine the effect of early palliative care on these views over time. Patients and Methods Patients with newly diagnosed metastatic NSCLC were randomly assigned to receive either early palliative care integrated with standard oncology care or standard oncology care alone. Participants completed baseline and longitudinal assessments of their perceptions of prognosis and the goals of cancer therapy over a 6-month period. Results We enrolled 151 participants on the study. Despite having terminal cancer, one third of patients (46 of 145 patients) reported that their cancer was curable at baseline, and a majority (86 of 124 patients) endorsed getting rid of all of the cancer as a goal of therapy. Baseline perceptions of prognosis (ie, curability) and goals of therapy did not differ significantly between study arms. A greater percentage of patients assigned to early palliative care retained or developed an accurate assessment of their prognosis over time (82.5% v 59.6%; P = .02) compared with those receiving standard care. Patients receiving early palliative care who reported an accurate perception of their prognosis were less likely to receive intravenous chemotherapy near the end of life (9.4% v 50%; P = .02). Conclusion Many patients with newly diagnosed metastatic NSCLC hold inaccurate perceptions of their prognoses. Early palliative care significantly improves patient understanding of prognosis over time, which may impact decision making about care near the end of life.

Impact of early palliative care consultation on inpatient length of stay and discharge disposition among oncology patients.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 53-53
Author(s):  
Ajay Dhakal ◽  
Suvash Shrestha ◽  
Peter Homel ◽  
Beth Popp
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Health Agency ◽  
Living Condition ◽  
Advanced Illness ◽  
Early Palliative Care ◽  
Discharge Disposition ◽  
Palliative Care Consultation ◽  
To Receive

53 Background: As palliative care develops as a medical subspecialty, studies are needed to assess its impact on patient care. Studies examining the effect of inpatient palliative care consult (PCC) on the admission length of stay (LOS) for non-ICU patients have failed to demonstrate consistent results. Also, there is a paucity of data on the effect of PCC on discharge disposition. The objective of this study is to examine the effect of early PCC on the length of stay and discharge disposition among cancer patients discharged alive. Methods: A retrospective review of oncology inpatients (pts) from January 2011 to Jan 2014 of whom 307 had PCC (PC group) and 305 pts did not have PCC (NC group). Visits less than 4 days, those ending with in-hospital deaths and those with PCC called more than 3 days into the admission were excluded. Groups were randomly matched based on All Patient Refined Diagnosis Related Group (APR DRG) Severity of Illness scores. Median LOS was compared with the Mann Whitney test. Pts coming from home without services (certified home health agency, advanced illness management, hospice, skilled nursing facility, or rehabilitation center) and discharged with services were considered favorable dispositions; any discharge without services was considered unfavorable disposition; all other dispositions considered neutral. Chi Square test was used to analyze discharge disposition. Results: The demographic profiles of 2 groups were similar in age, race, religion, marital status, insurance and living condition; females were more likely to get PCC (60 % vs 44 %, p<0.001). Median (minimum, maximum) LOS for PC group was longer by 1 day: 8 (4, 76) days vs 7 (4, 251) days for NC group (p=0.003). PC group was more likely to receive a favorable discharge disposition (45 % vs 36 %); less likely to receive unfavorable discharge (13 % vs 28 %, overall p < 0.001). Neutral dispositions were similar (41% vs 35 %). Conclusions: Oncology pts with PCC have 1 day longer LOS compared to those without it but are more likely to get a favorable discharge disposition. This may favorably impact readmission rates, which we hope to study in the future.

Improving specialist palliative care in residential care for older people: a checklist to guide practice

2017 ◽  
Vol 8 (3) ◽  
pp. 347-353 ◽  
Author(s):  
Liz Forbat ◽  
Michael Chapman ◽  
Clare Lovell ◽  
Wai-Man Liu ◽  
Nikki Johnston
Keyword(s):  
Palliative Care ◽  
Older People ◽  
Residential Care ◽  
Participant Observation ◽  
Qualitative Interviews ◽  
Symptom Burden ◽  
Ethnographic Study ◽  
Specialist Palliative Care ◽  
Care Needs ◽  
Palliative Care Needs

ObjectivesPalliative care needs rounds are triage meetings that have been introduced in residential care for older adults to help identify and prioritise care for people most at risk for unplanned dying with inadequately controlled symptoms. This study sought to generate an evidence-based checklist in order to support specialist palliative care clinicians integrate care in residential nursing homes for older people.MethodsA grounded theory ethnographic study, involving non-participant observation and qualitative interviews. The study was conducted at four residential facilities for older people in one city. Observations and recordings of 15 meetings were made, and complimented by 13 interviews with staff attending the needs rounds.ResultsThe palliative care needs round checklist is presented, alongside rich description of how needs rounds are conducted. Extracts from interviews with needs rounds participants illustrate the choice of items within the checklist and their importance in supporting the evolution towards efficient and effective high-quality specialist palliative care input to the care of older people living in residential care.ConclusionsThe checklist can be used to support the integration of specialist palliative care into residential care to drive up quality care, provide staff with focused case-based education, maximise planning and reduce symptom burden for people at end of life.

Experiences of patients and caregivers with early palliative care: A qualitative study

2016 ◽  
Vol 31 (1) ◽  
pp. 72-81 ◽  
Author(s):  
Breffni Hannon ◽  
Nadia Swami ◽  
Gary Rodin ◽  
Ashley Pope ◽  
Camilla Zimmermann
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Qualitative Study ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Cluster Randomised Controlled Trial ◽  
Early Palliative Care ◽  
Individual Interviews ◽  
Randomised Controlled

Background: Early palliative care improves quality of life and satisfaction with care and is increasingly endorsed for patients with advanced cancer. However, little is known about the experience of receiving early palliative care from a patient and caregiver perspective. Aim: The aim of this qualitative study was to determine, from a participant perspective, the experience of receiving early palliative care and elements of that care. Design: Qualitative grounded theory study using individual interviews. Setting/participants: The study took place at a comprehensive cancer centre. Patients ( n = 26) and caregivers ( n = 14) from the intervention arm of a cluster-randomised controlled trial of early palliative care versus standard oncology care participated in qualitative interviews. Participants were asked to comment on their quality of life, the quality of care provided over the intervention period and their experiences with the palliative care team. Results: Participants described feeling supported and guided in their illness experience and in their navigation of the healthcare system. Specific elements of early palliative care included prompt, personalised symptom management; holistic support for patients and caregivers; guidance in decision-making; and preparation for the future. Patients with symptoms particularly valued prompt attention to their physical concerns, while those without symptoms valued other elements of care. Although three patients were ambivalent about their current need for palliative care, no distress was reported as a consequence of the intervention. Conclusion: The elements of care described by participants may be used to develop, support and refine models of early palliative care for patients with cancer.

Barriers to end-of-life discussions among hematologists: A qualitative study

2018 ◽  
Vol 32 (5) ◽  
pp. 1021-1029 ◽  
Author(s):  
Chloé Prod’homme ◽  
Dominique Jacquemin ◽  
Licia Touzet ◽  
Regis Aubry ◽  
Serge Daneault ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Great Difficulty ◽  
Care Plan ◽  
Early Palliative Care ◽  
Individual Interviews ◽  
To Receive ◽  
Early Discussion ◽  
Opening Up

Background: Integrated palliative care is correlated with earlier end-of-life discussion and improved quality of life. Patients with haematological malignancies are far less likely to receive care from specialist palliative or hospice services compared to other cancers. Aim: The main goal of this study was to determine hematologists’ barriers to end-of-life discussions when potentially fatal hematological malignancies recur. Design: Qualitative grounded theory study using individual interviews. Setting/participants: Hematologists ( n = 10) from four hematology units were asked about their relationships with their patients and their attitudes toward prognosis and end-of-life discussions at the time of recurrence. Results: As long as there are potential treatments, hematologists fear that end-of-life discussions may undermine their relationship and the patient’s trust. Because of their own representations, hematologists have great difficulty opening up to their patients’ end-of-life wishes. When prognosis is uncertain, negative outcome, that is, death, is not fully anticipated. Persistent hope silences the threat of death. Conclusion: This study reveals some of the barriers clinicians face in initiating early discussion about palliative care or patients’ end-of-life care plan. These difficulties may explain why early palliative care is little integrated into the hematology care model.

scholarly journals Discouragement Towards Seeking Health Care of Older People in Rural China: The Influence of Culture and Structural Constraints

2020 ◽  
pp. 273-278
Author(s):  
Xiang Zou
Keyword(s):  
Health Care ◽  
Older People ◽  
Cultural Values ◽  
Rural China ◽  
Field Work ◽  
Cultural Value ◽  
Structural Constraints ◽  
Health Seeking ◽  
Social Structural ◽  
Socioeconomic Burden

AbstractThis chapter portrays a discouraged, dispiriting attitude towards health-seeking of rural older people in China. Based on the case of health-seeking of Aunt Chens’s family collected from a 6-month’s field work in a rural Chinese hospital, this chapter depicts how discouragement and discrimination operate in older members’ health-seeking experiences, throughout which older people’s health care was devalued as worthless socioeconomic burden. Underpinning discouragement and devaluation is the cultural value that encourages older people to be enduring with suffering and restricted with health-seeking. Simultaneously, this chapter traces various sources of institutional and social structural impediments, as they intersect with unfavourable cultural values that normalise discouragement and decimation.

scholarly journals BreathEase: rationale, design and recruitment of a randomised trial and embedded mixed methods study of a multi-professional breathlessness service in early palliative care

2021 ◽  
pp. 00228-2020
Author(s):  
Michaela Schunk ◽  
Ursula Berger ◽  
Lien Le ◽  
Eva Rehfuess ◽  
Larissa Schwarzkopf ◽  
...  
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Randomised Trial ◽  
Underlying Disease ◽  
Postal Survey ◽  
Willingness To Participate ◽  
Early Palliative Care ◽  
Sample Characteristics ◽  
Randomised Controlled

BackgroundThe Munich Breathlessness Service (MBS) has adapted novel support services to the German context, to reduce burden in patients and carers from breathlessness in advanced disease. It has been evaluated in a pragmatic fast track randomised controlled trial (RCT) (BreathEase, NCT02622412) with embedded qualitative interviews and postal survey. The aim of this paper is to describe the intervention model and study design, analyse recruitment to the trial and compare sample characteristics with other studies in the field.MethodsAnalysis of recruitment pathways and enrolment, sociodemographic and clinical characteristics of participants and carers.ResultsOf 439 people screened, 253 (58%) were offered enrolment and 183 (42%) participated. n=97 (70%) carers participated. 186 people (42%) did not qualify for inclusion, mostly because breathlessness could not be attributed to an underlying disease. All participants were self-referring, 60% through media sources. Eligibility and willingness to participate were associated to social networks and illness-related activities as recruitment routes. Mean age of participants was 71 years (51% women), with COPD (63%), chronic heart failure (8%), interstitial lung disease (9%), pulmonary hypertension (6%) and cancer (7%) as underlying conditions. Postal survey response rate was 89%. Qualitative interviews were conducted with 16 patients and 9 carers.ConclusionThe BreathEase study has a larger and more heterogeneous sample compared to other trials. The self-referral-based and prolonged recruitment drawing on media sources approximates real-world conditions of early palliative care. Integrating qualitative and quantitative components will allow a better understanding and interpretation of the results of the main effectiveness study.

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