Palliative care delivery models

2021 ◽  
pp. 111-120
Author(s):  
Irene J. Higginson
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Clinical Care ◽  
Symptom Control ◽  
Palliative Care Service ◽  
Specialist Palliative Care ◽  
Course Of Illness ◽  
Medical Speciality ◽  
Care Services ◽  
Healthcare Settings

Palliative care has grown rapidly across the globe, with a network of services. It is variably a medical speciality or subspeciality, often with academic departments and with different levels of integration. As the population ages and as treatments extend life for children, younger and older people with chronic diseases, and in particular as multimorbidity is growing, so palliative care is more important. Specialist palliative care service are dedicated to palliative care, have staff trained in palliative care, and in addition to providing clinical care, engage in education, research, and the measurement of outcomes. As palliative care extends to support patients with organ failure, dementia, and earlier in the course of illness, new models are emerging. These include short-term palliative care services, working in an integrated way with other services. Principles common to all services include a holistic approach (physical, emotional, social, and spiritual), considering the patient and those important to them as the unit of care, and with impeccable attention to listening, communication, individualized care, and support in decision-making. People with advanced and progressive illness are found in almost all healthcare settings. Therefore, all doctors, nurses, and other health and social care professionals have to offer and know general palliative care and symptom control. Specialist palliative care teams often support those working in general settings with specific tools and/or training.

scholarly journals Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Rasheed Ofosu-Poku ◽  
Michael Owusu-Ansah ◽  
John Antwi
Keyword(s):  
Palliative Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Clinical Care ◽  
Palliative Care Service ◽  
Palliative Care Team ◽  
Care Team ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services

Ghana’s chronic disease burden is on the rise. An essential aspect of clinical care in chronic disease management is to improve the quality of life of both patients and their families and to help them cope with the experience of life-limiting illness. Specialist palliative care services help reach this objective, especially in the context of complex psychosocial challenges and high symptom burden. It is, therefore, necessary that as many patients as possible get access to available specialist palliative care services. This paper explores the factors influencing referral of patients with nonmalignant chronic diseases for specialist palliative care. A qualitative approach was used to explore these factors from eight (8) participants—four (4) physician specialists and four (4) next of kin of patients with advanced nonmalignant chronic illness. Individual face-to-face interviews were conducted using a semistructured interview guide. Interviews were audio-recorded and data coded, themes and subthemes were identified, and thematic analysis was done. Barriers and motivators identified were categorized as either related to physicians, institution, or family. Barriers to referral were perception of the scope of palliative care, medical paternalism, lack of an institutional referral policy, poor human resource capacity of the palliative care team, and lack of awareness about the existence of specialist palliative care service. Poor economic status of the patient and family, poor prognosis, previous interaction with the palliative care team, and an appreciation of patients’ expectations of the healthcare system were identified as motivators for referral. The palliative care team must therefore increase awareness among other health professionals about their services and facilitate the development and availability of a clear policy to guide and improve referrals.

Palliative and Spiritual Care of Persons with HIV and AIDS

2010 ◽  
Author(s):  
Mary Ann Cohen ◽  
Joseph Z. Lux
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Cultural Sensitivity ◽  
Care Delivery ◽  
Clinical Care ◽  
Symptom Control ◽  
Hiv And Aids ◽  
Hiv Care ◽  
Hospice Movement ◽  
Health Organization

Palliative care of persons with HIV and AIDS has changed over the course of the first three decades of the pandemic. The most radical shifts occurred in the second decade with the introduction of combination antiretroviral therapy and other advances in HIV care. In the United States and throughout the world, progress in prevention of HIV transmission has not kept pace with progress in treatment, thus the population of persons living with AIDS continues to grow. Furthermore, economic, psychiatric, social, and political barriers leave many persons without access to adequate HIV care. As a result, persons who lack access to care may need palliative care for late-stage AIDS while persons with access to AIDS treatments are more likely to need palliative care for multimorbid medical illnesses such as cardiovascular disease, cancer, pulmonary disease, and renal disease. Palliative care of persons with HIV and AIDS cannot be confined to the end of life. We present palliative care on a continuum as part of an effort to alleviate suffering and attend to pain, emotional distress, and existential anxiety during the course of the illness. We will provide guidelines for psychiatric and palliative care and pain management to help persons with AIDS cope better with their illnesses and live their lives to the fullest extent, and minimize pain and suffering for them and their loved ones. This chapter reviews basic concepts and definitions of palliative and spiritual care, as well as the distinct challenges facing clinicians involved in HIV palliative care. Finally, issues such as bereavement, cultural sensitivity, communication, and psychiatric contributions to common physical symptom control are reviewed. The terms palliative care and palliative medicine are often used interchangeably. Modern palliative care has evolved from the hospice movement into a more expansive network of clinical care delivery systems with components of home care and hospital-based services (Butler et al., 1996; Stjernsward and Papallona, 1998). Palliative care must meet the needs of the “whole person,” including the physical, psychological, social, and spiritual aspects of suffering (World Health Organization, 1990).

scholarly journals Palliative medicine in the intensive care unit: needs, delivery, quality

2021 ◽  
pp. bmjspcare-2020-002795
Author(s):  
Stephanie A Hill ◽  
Abdul Dawood ◽  
Elaine Boland ◽  
Hannah E Leahy ◽  
Fliss EM Murtagh
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Care Delivery ◽  
Multiorgan Failure ◽  
Symptom Control ◽  
Palliative Care Team ◽  
Care Team ◽  
Specialist Palliative Care ◽  
Treatment Limitation

Background15%–20% of critical care patients die during their hospital admission. This service evaluation assesses quality of palliative care in intensive care units (ICUs) compared with national standards.MethodsRetrospective review of records for all patients who died in four ICUs (irrespective of treatment limitation) between 1 June and 31 July 2019. Descriptive statistics reported for patient characteristics, length of stay, admission route, identification triggers and palliative care delivery.ResultsForty-five patients died, two records were untraced, thus N=43. The dying process was recognised in 88% (n=38). Among those where dying was recognised (N=35), 97% (34) had documented family discussion before death, 9% (3) were offered religious/spiritual support, 11% (4) had review of hydration/nutrition and 6% (2) had documented preferred place of death. Prescription of symptom control medications was complete in 71% (25) opioids, 34% (12) haloperidol, 54% (19) midazolam and 43% (15) hyoscine. Combining five triggers—length of stay >10 days prior to ICU admission 7% (3), multiorgan failure ≥3 systems 33% (14), stage IV malignancy 5% (2), post-cardiac arrest 23% (10) and intracerebral haemorrhage requiring mechanical ventilation 12% (5)—identified 60% (26) of patients. Referral to the palliative care team was seen in 14% (5), and 8% (3) had specialist palliative care team review.ConclusionsRecognition of dying was high but occurred close to death. Family discussions were frequent, but religious/spiritual needs, hydration/nutrition and anticipatory medications were less often considered. The ICUs delivered their own palliative care in conjunction with specialist palliative care input. Combining five triggers could increase identification of palliative care needs, but a larger study is needed.

scholarly journals The Griffith Area Palliative Care Service: A Pilot Project

2003 ◽  
Vol 26 (2) ◽  
pp. 11 ◽  
Author(s):  
Ian Hatton ◽  
Keith Mcdonald ◽  
Lynette Nancarrow ◽  
Keith Fletcher
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Care Service ◽  
Palliative Care Service ◽  
Pilot Project ◽  
Service Development ◽  
Care Services ◽  
Rural And Remote Areas

In September 2000 the Commonwealth released, as part of its National Palliative Care Strategy under the AustralianHealth Care Agreements, a National Framework for Palliative Care Service Development. The new NationalFramework stressed an important set of values to guide models of palliative care delivery. It notes that the challenge isto secure the place of palliative care as an integral part of health care across Australia, routinely available within localcommunities to those people who need it. Care and support for people who are dying and their families need to bebuilt not only into health care services, but also into the fabric of communities and their support networks. While fewwould disagree with this, little is known about how best to achieve it in rural Australia. The Griffith Area PalliativeCare Service (GAPS) is a two-year pilot project delivering a palliative care service through a truly integrated approachto care for patients, their carers and families within the Griffith Local Government Area and Carrathool Shire areas.This paper describes how GAPS is successfully meeting the challenges of service provision to rural and remote areas.

Palliative care delivery models

2015 ◽  
Author(s):  
Irene J. Higginson
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Clinical Care ◽  
Holistic Approach ◽  
Outpatient Services ◽  
Specialist Service ◽  
Medical Speciality ◽  
Complex Needs ◽  
Individualized Care ◽  
Palliative Care Services

Palliative care is not integrated into health care in many countries, with a network of services, a medical speciality or sub-speciality, and academic departments. A common distinction exists between generalist and specialist palliative care. Specialist service are dedicated to palliative care, have staff trained in it, and in addition to providing clinical care, engage in education, research, and the measurement of outcomes. Moreover, the patients they care for have more complex needs. Models of service delivery include inpatient palliative care units and hospices, consultation teams (at home, in the community, and in hospitals), day care units, and outpatient services. New models include short-term palliative care services, working in an integrated way with other services. Principles common to all services include a holistic approach (physical, emotional, social, and spiritual), considering the patient and family as the unit of care, and with impeccable attention to listening, communication, and individualized care.

scholarly journals Interstitial lung disease and specialist palliative care access: a healthcare professionals survey

2020 ◽  
pp. bmjspcare-2019-002148
Author(s):  
Jee Whang Kim ◽  
Sandra Olive ◽  
Steve Jones ◽  
Muhunthan Thillai ◽  
Anne-Marie Russell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Healthcare Professionals ◽  
Symptom Control ◽  
Survey Study ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Teams ◽  
Palliative Care Services

BackgroundFibrotic interstitial lung disease is an incurable disease with poor prognosis. We aimed to understand factors affecting decisions regarding referrals to specialist palliative care services and to address barriers and facilitators to referrals from healthcare professionals’ perspectives.MethodsA survey study of healthcare professionals, including respiratory physicians, interstitial lung disease nurse specialists, respiratory nurse specialists and palliative care physicians, was conducted using a questionnaire, entailing 17 questions.ResultsThirty-six respondents, including 15 interstitial lung disease nurse specialists completed the questionnaire. Symptom control, psychological/spiritual support, general deterioration and end-of-life care were the most common reasons for referrals to specialist palliative care services. Most respondents felt confident in addressing palliative care needs and discussing palliative care with patients. A few participants emphasised that experienced respiratory nurse specialists are well placed to provide symptom management and to ensure continuity of patient care. Participants reported that access to palliative care could be improved by increasing collaborative work between respiratory and palliative care teams.ConclusionsMost respondents felt that enhancing access to specialist palliative care services would benefit patients. However, palliative care and respiratory care should not be considered as mutually exclusive and multidisciplinary approach is recommended.

Non-specialist palliative care: A principle-based concept analysis

2019 ◽  
Vol 33 (6) ◽  
pp. 634-649 ◽  
Author(s):  
Mary Nevin ◽  
Valerie Smith ◽  
Geralyn Hynes
Keyword(s):  
Palliative Care ◽  
Clinical Care ◽  
Grey Literature ◽  
Concept Analysis ◽  
Cochrane Library ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services ◽  
The Cochrane Library ◽  
Care Capacity

Background: Building palliative care capacity among all healthcare practitioners caring for patients with chronic illnesses, who do not work in specialist palliative care services (non-specialist palliative care), is fundamental in providing more responsive and sustainable palliative care. Varying terminology such as ‘generalist’, ‘basic’ and ‘a palliative approach’ are used to describe this care but do not necessarily mean the same thing. Internationally, there are also variations between levels of palliative care which means that non-specialist palliative care may be applied inconsistently in practice because of this. Thus, a systematic exploration of the concept of non-specialist palliative care is warranted. Aim: To advance conceptual, theoretical and operational understandings of and clarity around the concept of non-specialist palliative care. Design: The principle-based method of concept analysis, from the perspective of four overarching principles, such as epistemological, pragmatic, logical and linguistic, were used to analyse non-specialist palliative care. Data sources: The databases of CINAHL, PubMed, PsycINFO, The Cochrane Library and Embase were searched. Additional searches of grey literature databases, key text books, national palliative care policies and websites of chronic illness and palliative care organisations were also undertaken. Conclusion: Essential attributes of non-specialist palliative care were identified but were generally poorly measured and understood in practice. This concept is strongly associated with quality of life, holism and patient-centred care, and there was blurring of roles and boundaries particularly with specialist palliative care. Non-specialist palliative care is conceptually immature, presenting a challenge for healthcare practitioners on how this clinical care may be planned, delivered and measured.

Pathways, partners and payers: The trifecta of palliative care integration.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 129-129
Author(s):  
Diane G. Portman ◽  
Sarah Thirlwell
Keyword(s):  
Palliative Care ◽  
Strategic Alliance ◽  
Care Delivery ◽  
Clinical Pathways ◽  
Clinical Care ◽  
Symptom Control ◽  
Hematologic Malignancies ◽  
Cancer Center ◽  
Care Pathways ◽  
Disease States

129 Background: Moffitt Cancer Center has developed proprietary oncology clinical pathways. Multiple external partnership agreements which require adoption of these pathways have been completed. Our Center has enacted new cancer care delivery and payment arrangements with payers to foster cost and quality balance via use of the pathways and earlier involvement of palliative care (PC). Methods: Executive and PC leadership collaborated with the clinical pathways and strategic alliance teams to identify high priority disease states for integration of PC. Working with oncologist pathway developers, critical junctures in the pathways for inclusion of PC consultation were proposed and refined. EHR mechanisms to promote pathway adherence by clinicians were initiated. The value of pathway utilization and care coordination to involve PC was promoted to prospective oncology partners and payers. Results: PC has been mandated in oncology clinical care pathways, with a focus on thoracic, breast, gastrointestinal, prostate, gynecologic and hematologic malignancies, as directed by specific payer arrangements. Partnerships have expanded, resulting in greater utilization of PC by other centers as well. Increased referral volumes to PC, broader symptom control, and enhanced advance care planning have resulted. Conclusions: Incorporation of PC in oncologic clinical care pathways, with dissemination to internal providers, external partners and as part of novel payment models, optimizes PC integration. [Table: see text]

scholarly journals Clinical networks influencing policy and practice: the establishment of advanced practice pharmacist roles for specialist palliative care services in South Australia

2014 ◽  
Vol 38 (2) ◽  
pp. 238 ◽  
Author(s):  
Kate Swetenham ◽  
Debra Rowett ◽  
David Stephenson
Keyword(s):  
Palliative Care ◽  
South Australia ◽  
Palliative Care Service ◽  
Advanced Practice ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Clinical Network ◽  
Care Services ◽  
Palliative Care Services ◽  
Pharmacist Roles

Objectives To operationalise the concept of ‘advanced practice roles’ in pharmacy within the new integrated regionalised palliative care service model outlined in the Palliative Care Services Plan 2009–2016, SA Health. Methods A working group was established under the auspices of the Palliative Care Clinical Network to progress the development of advanced practice pharmacist roles for regionalised palliative care services. A pharmacy stakeholder forum was conducted in December 2010 to provide further guidance on the advanced practice pharmacist roles in the following domains: education; network links and partnerships; quality and safety; and research. Results Advanced practice pharmacist positions were created for each of the three regionalised palliative care services in South Australia (SA). Funding was obtained for a Statewide Palliative Care Pharmacy Network project, to build a sustainable community-based palliative care pharmacy network. Advanced practice pharmacists commenced in the regionalised palliative care services of SA on 4 October 2011. Conclusions The Statewide Palliative Care Clinical Network and the SA Palliative Care Plan provided a policy framework that supported involvement and advocacy in the planning of the advanced practice pharmacist roles. Collaboration between leaders in workforce reform, service planners, specialist palliative care providers and the pharmacy sector was a key enabler for developing the advanced practice pharmacist positions for regionalised palliative care services. What is known about the topic? The advanced practice palliative care pharmacist role reflects a new direction for the discipline of pharmacy and has been embraced at a time when a nationally endorsed Advanced Pharmacy Practice Framework has been published, while recognising that registration for pharmacists in Australia currently does not have specific endorsement for advanced practice. What does this paper add? This paper outlines the value of collaboration across settings and sectors. There is an opportunity for these roles to align with the new nationally endorsed framework for advanced practice in pharmacy. What are the implications for practitioners? These new positions strengthen the links between the hospital and community pharmacy sectors to enhance a quality use of medicines approach with improved access to end-of-life medicines for home-based palliative care clients, which actively facilitates a home death for those who choose it.

Referrals to a perinatal specialist palliative care consult service in Ireland, 2012–2015

2017 ◽  
Vol 103 (6) ◽  
pp. F573-F576 ◽  
Author(s):  
Des L McMahon ◽  
Marie Twomey ◽  
Maeve O’Reilly ◽  
Mary Devins
Keyword(s):  
Palliative Care ◽  
Chromosomal Abnormalities ◽  
Care Service ◽  
Symptom Control ◽  
Palliative Care Service ◽  
University Hospital ◽  
Dose Titration ◽  
Inpatient Setting ◽  
Specialist Palliative Care ◽  
Symptom Profile

ObjectiveTo analyse the referral patterns of perinatal patients referred to a specialist palliative care service (SPCS), their demographics, diagnoses, duration of illness, place of death and symptom profile.DesignA retrospective chart review of all perinatal referrals over a 4-year period to the end of 2015.SettingA consultant-led paediatric SPCS at Our Lady’s Children’s Hospital, Crumlin, Dublin, and the Coombe Women & Infants University Hospital, Dublin.Results83 perinatal referrals were received in a 4-year period. Chromosomal abnormalities accounted for 35% of diagnoses, congenital heart disease 25%, complex neurological abnormalities 11% and renal agenesis 4%. 22 referrals (26.5%) were made antenatally, with 61 (73.5%) postnatally. Of the postnatal referrals, 27 (44%) were asymptomatic on referral. An opioid medication was recommended (regularly or as required) in 46 cases. Symptom control was achieved without dose titration in 43 of these cases (93%). Of 47 deaths in this group referred postnatally, 22 of these (47%) died at home with support from community teams. Discharge home for best supportive care required complex interagency communication and cooperation.ConclusionsPerinatal palliative care requires effective multidisciplinary work, whether delivered in the inpatient setting or in the community. With appropriate support, end-of-life care can be delivered in the community.

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