Integration of spiritual care into palliative care service delivery models

2021 ◽  
pp. 1072-1080
Author(s):  
Yvan Beaussant ◽  
Alexandra Nichipor ◽  
Tracy A. Balboni
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Care Delivery ◽  
Palliative Care Team ◽  
Care Team ◽  
Clear Understanding ◽  
Care Provision ◽  
Serious Illness ◽  
Palliative Care Teams ◽  
Religious Dimensions

Addressing spirituality within serious illness is a core dimension of palliative care delivery. However, spiritual care frequently lacks integration within the care of patients and families facing serious illness. This chapter discusses the integration of spiritual care into palliative care delivery. Requisite to this integration is a clear understanding of definitions and palliative care guidelines informing spiritual care provision. Furthermore, integration is informed and motivated by a large body of evidence showing how spiritual and religious factors frequently play salient roles in serious illness and influence palliative care outcomes. The integration of spiritual care into palliative care practice relies on a generalist–specialist model, within which all members of the interdisciplinary palliative care team are responsible for spiritual care provision. Non-spiritual care specialist members of the palliative care team are responsible for generalist spiritual care delivery, including taking spiritual histories and screening for spiritual needs. The care team also includes spiritual care specialists, typically board-certified chaplains, who provide in-depth spiritual care delivery to patients and families and aid the care team in understanding the spiritual and religious dimensions of care. Additionally, data regarding tested spiritual care interventions are discussed as potential tools palliative care teams can employ to improve patient care and outcomes. Finally, the integration of spiritual care into palliative care teams presents both opportunities and challenges that must be considered as efforts needed to foster more seamless spiritual care delivery within palliative care.

Interdisciplinary Palliative Care Teams

2019 ◽  
pp. 89-97
Author(s):  
Polly Mazanec ◽  
Rebekah Reimer ◽  
Jessica Bullington ◽  
Patrick J. Coyne ◽  
Herman Harris ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interdisciplinary Team ◽  
Palliative Care Team ◽  
Care Team ◽  
Patient Centered ◽  
Team Members ◽  
Palliative Care Teams

This chapter defines the composition and roles of interdisciplinary team members on a palliative care team. The team has the responsibility to deliver patient-centered, family-focused care based on the recommendations from the National Consensus Project Guidelines for Quality Palliative Care. Within this chapter, interdisciplinary team members from an academic medical center discuss their respective roles on the team and describe how these roles supported a patient and family case study. The chapter provides an overview of the four most common models of palliative care delivery: inpatient consult teams, with or without a palliative care unit; ambulatory palliative care teams; community-based palliative care teams; and hospice teams. An introduction to essential considerations in the development of a palliative care team and the important components for maintaining a healthy, functional team are described.

An Active In-Home Physician Model of Palliative Care and Its Resulting Performance Indicators Related to Home Deaths, Unplanned Emergency Department Visits and Unplanned Hospital Admissions

2020 ◽  
Vol 36 (1) ◽  
pp. 46-49
Author(s):  
Colleen Webber ◽  
Aurelia Ona Valiulis ◽  
Peter Tanuseputro ◽  
Valerie Schulz ◽  
Tavis Apramian ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Hospital Admissions ◽  
Case Series ◽  
Palliative Care Team ◽  
Emergency Department Visits ◽  
Care Team ◽  
Retrospective Case ◽  
Palliative Care Teams ◽  
Unplanned Hospital Admissions

Background: Limited research has characterized team-based models of home palliative care and the outcomes of patients supported by these care teams. Case presentation: A retrospective case series describing care and outcomes of patients managed by the London Home Palliative Care Team between May 1, 2017 and April 1, 2019. Case management: The London Home Palliative Care (LHPC) Team care model is based upon 3 pillars: 1) physician visit availability 2) active patient-centered care with strong physician in-home presence and 3) optimal administrative organization. Case outcomes: In the 18 month study period, 354 patients received care from the London Home Palliative Care Team. Most significantly, 88.4% ( n = 313) died in the community or at a designated palliative care unit after prearranged direct transfer; no comparable provincial data is available. 21.2% ( n = 75) patients visited an emergency department and 24.6% ( n = 87) were admitted to hospital at least once in their final 30 days of life. 280 (79.1%) died in the community. These values are better than comparable provincial estimates of 62.7%, 61.7%, and 24.0%, respectively. Conclusion: The London Home Palliative Care (LHPC) Team model appears to favorably impact community death rate, ER visits and unplanned hospital admissions, as compared to accepted provincial data. Studies to determine if this model is reproducible could support palliative care teams achieving similar results.

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 Implementation of early will directives: facilities and difficulties experienced by palliative care teams

2020 ◽  
Vol 41 ◽  
Author(s):  
Aline Carniato Dalle Nogario ◽  
Edison Luiz Devos Barlem ◽  
Jamila Geri Tomaschewski-Barlem ◽  
Rosemary Silva da Silveira ◽  
Silvana Bastos Cogo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Implementation Process ◽  
Palliative Care Team ◽  
Legal Issues ◽  
Care Team ◽  
Rio Grande Do Sul ◽  
Palliative Care Teams ◽  
The Family ◽  
The Subject ◽  
Difficult Situations

ABSTRACT Objective: To know the facilities and difficulties the palliative care team professionals experience in the implementation process of advance healthcare directives. Method: Exploratory-descriptive study with a qualitative approach, involving 51 professionals from seven palliative care teams in the state of Rio Grande do Sul, Brazil. The data were collected between December 2018 and April 2019 and discursive textual analysis was applied. Results: The facilities found were: the approach by the palliative care team; listening and respecting patients' wishes; effective communication between professionals, patients, and family members and resolution of difficult situations. The difficulties reported were: legal issues; the lack of knowledge of professionals about the subject; the lack of institutional protocols; the difficulty in talking about death and the family barrier. Conclusion: Despite the perceived facilities and difficulties, palliative care professionals intend to work based on the patients' desires and will, aiming to offer dignity in the dying process.

A National Survey of Palliative Care Team Compositions

2021 ◽  
pp. 082585972110589
Author(s):  
Joseph Chen ◽  
Allison de la Rosa ◽  
Dejian Lai ◽  
Maxine De La Cruz ◽  
Donna Zhukovsky ◽  
...  
Keyword(s):  
Palliative Care ◽  
National Survey ◽  
Primary Outcome ◽  
Primary Objective ◽  
Palliative Care Team ◽  
Care Team ◽  
Team Composition ◽  
Cancer Centers ◽  
Interprofessional Teams ◽  
Palliative Care Teams

Purpose: It is unclear how well palliative care teams are staffed at US cancer centers. Our primary objective was to compare the composition of palliative care teams between National Cancer Institute (NCI)-designated cancer centers and non-NCI-designated cancer centers in 2018. We also assessed changes in team composition between 2009 and 2018. Methods: This national survey examined the team composition in palliative care programs at all 61 NCI-designated cancer centers and in a random sample of 60 of 1252 non-NCI-designated cancer centers in 2018. Responses were compared to those from our 2009 survey. The primary outcome was the presence of an interprofessional team defined as a palliative care physician, nurse, and psychosocial member. Secondary outcomes were the size and number of individual disciplines. Results: In 2018, 52/61 (85%) of NCI-designated and 27/38 (71%) non-NCI-designated cancer centers in the primary outcome comparison responded to the survey. NCI-designated cancer centers were more likely to have interprofessional teams than non-NCI-designated cancer centers (92% vs 67%; P = .009). Non-NCI-designated cancer centers were more likely to have nurse-led teams (14.8% vs 0.0%; P = .01). The median number of disciplines did not differ between groups (NCI, 6.0; non-NCI, 5.0; P = .08). Between 2009 and 2018, NCI-designated and non-NCI-designated cancer centers saw increased proportions of centers with interprofessional teams (NCI, 64.9% vs 92.0%, P < .001; non-NCI, 40.0% vs 66.7%; P = .047). Conclusion: NCI-designated cancer centers were more likely to report having an interprofessional palliative care team than non-NCI-designated cancer centers. Growth has been limited over the past decade, particularly at non-NCI-designated cancer centers.

Confidence and skills for cystic fibrosis end-of-life care

2020 ◽  
pp. bmjspcare-2020-002274
Author(s):  
Eva Harris-Skillman ◽  
Stephen Chapman ◽  
Aoife Lowney ◽  
Mary Miller ◽  
William Flight
Keyword(s):  
Cystic Fibrosis ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Further Education ◽  
Palliative Care Team ◽  
Care Team ◽  
Life Care ◽  
Team Members ◽  
Palliative Care Teams

ObjectivesOptimal cystic fibrosis (CF) end-of-life care (EOLC) is a challenge. There is little formal guidance about who should deliver this and how CF multi-disciplinary teams should interact with specialist palliative care. We assessed the knowledge, experience and preparedness of both CF and palliative care professionals for CF EOLC.MethodsAn electronic questionnaire was distributed to all members of the Oxford adult CF and palliative care teams.Results35 of a possible 63 members responded (19 CF team; 16 palliative care). Levels of preparedness were low in both groups. Only 11% of CF and 19% of palliative care team members felt fully prepared for EOLC in adult CF. 58% of CF members had no (21%) or minimal (37%) general palliative care training. Similarly, 69% of the palliative care team had no CF-specific training. All respondents desired additional education. CF team members preferred further education in general EOLC while palliative care team members emphasised a need for more CF-specific knowledge.ConclusionsFew members of either the CF or palliative care teams felt fully prepared to deliver CF EOLC and many desired additional educations. They expressed complementary knowledge gaps, which suggests both could benefit from increased collaboration and sharing of specialist knowledge.

scholarly journals Evaluating the use of video communication technology in a hospital specialist palliative care team during the COVID-19 pandemic

2021 ◽  
Vol 3 ◽  
pp. 5
Author(s):  
Benjamin Crosby ◽  
Sarika Hanchanale ◽  
Sarah Stanley ◽  
Amara Callistus Nwosu
Keyword(s):  
Palliative Care ◽  
Communication Technology ◽  
Healthcare Professionals ◽  
Palliative Care Team ◽  
Video Communication ◽  
Care Team ◽  
Published Data ◽  
Specialist Palliative Care ◽  
Hospital Specialist ◽  
Palliative Care Teams

Background: Healthcare professionals’ use of video communication technology has increased during the novel coronavirus disease (COVID-19) pandemic, due to infection control restrictions. Currently there is little published data about the experiences of specialist palliative care teams who are using technology to communicate during the COVID-19 pandemic. The aim of this evaluation was to describe the experience of a UK based hospital specialist palliative care team, who were using video communication technology to support care during the COVID-19 pandemic. Methods: An online survey was distributed to the specialist palliative care team at a University teaching hospital in the North West of the UK. We asked participants to provide their views on the scope of use, barriers and future opportunities to use technology for communication in hospital palliative care. Results: The survey was completed by 14 healthcare professionals. Participants indicated that the most common reasons for using the technology was to receive team updates (n= 14, 100%), participate in multidisciplinary team meetings (n=14, 100%), for education (n=12, 86%) and to facilitate cross-site working (n=9, 64%). We identified barriers to using the technology, which were summarised as: (1) user-based difficulties; (2) inadequate technological infrastructure; (3) data security, privacy and ethical concerns; and (4) concerns regarding staff wellbeing. Participants stated that technology can potentially improve care by improving communication with hospital and community teams and increasing access to education. We have used these findings to develop recommendations to help palliative care teams to implement this technology better in clinical practice. Conclusion: Video communication technology has the potential to improve specialist palliative care delivery; however, it is essential that healthcare organisations address the existing barriers to using this technology, to ensure that these systems work meaningfully to improve palliative care for those who are most vulnerable beyond the COVID-19 pandemic.

What Do Chaplains Do: The Views of Palliative Care Physicians, Nurses, and Social Workers

2018 ◽  
Vol 36 (5) ◽  
pp. 396-401 ◽  
Author(s):  
Annelieke Damen ◽  
Dirk Labuschagne ◽  
Laura Fosler ◽  
Sean O’Mahony ◽  
Stacie Levine ◽  
...  
Keyword(s):  
Palliative Care ◽  
Social Workers ◽  
Spiritual Care ◽  
Treatment Decision ◽  
Palliative Care Team ◽  
Clear Understanding ◽  
Community Based ◽  
Treatment Decision Making ◽  
Written Comments ◽  
Broad Understanding

It is well accepted that attention to spiritual concerns is a core dimension of palliative care. It is similarly well accepted that chaplains are the spiritual care specialists who should address such concerns. However, what chaplains do when they provide care for patients and families is often poorly understood by their palliative care colleagues. Having a clear understanding of what chaplains do is important because it contributes to improved utilization of the spiritual care and other resources of the palliative care team and thereby to better care for patients and families. The aim of this study was to describe what palliative care physicians, nurses, and social workers understand about what chaplains do. Brief surveys were distributed to participants at 2 workshops for palliative care professionals in 2016. The survey was completed by 110 participants. The majority reported that they understood what chaplains do moderately well or very well. Thirty-three percent of the written comments about what chaplains do were very general; 25% were more specific. Only a small proportion of the participants were aware that chaplains provide care for the team, are involved in facilitating treatment decision-making, perform spiritual assessments, and bridge communication between the patient/family/team/community. Based on our survey, palliative care colleagues appear to have a broad understanding of what chaplains do but many may be unfamiliar with important contributions of chaplains to care for patients, families, and teams. These findings point to the need for ongoing education of palliative teams about what chaplains do in palliative care.

Assessment of a Statewide Palliative Care Team Training Course: COMFORT Communication for Palliative Care Teams

2016 ◽  
Vol 19 (7) ◽  
pp. 746-752 ◽  
Author(s):  
Elaine Wittenberg ◽  
Betty Ferrell ◽  
Joy Goldsmith ◽  
Sandra L. Ragan ◽  
Judith Paice
Keyword(s):  
Palliative Care ◽  
Team Training ◽  
Palliative Care Team ◽  
Care Team ◽  
Training Course ◽  
Palliative Care Teams
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