scholarly journals 523. COVID-19 Preparedness in Hospice and Palliative Care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S328-S328
Author(s):  
Monika Pogorzelska-Maziarz ◽  
Jeannette Kates ◽  
Jingjing Shang ◽  
Angela M Gerolamo

Abstract Background Due to the emergence of COVID-19 and resulting pandemic, there is an increased demand for palliative care and hospice care services. However, the impact of COVID-19 on the hospice and palliative agencies is unknown. Methods An electronic survey was disseminated via the Hospice & Palliative Nurses Association newsletter, posted to the Sigma Theta Tau Hospice and Palliative Care Community Group discussion board and advertised through social media from May 7–28, 2020. Summary statistics were computed. Results We collected 36 surveys representing all U.S. regions. Most respondents (78%) reported that their agency has cared for confirmed COVID-19 patients. Only half of agencies had access to laboratory facilities for surveillance and detection of the presence of outbreaks in both patients and staff (58%) and the ability to test patients and providers for COVID-19 (55%). Due to COVID-19, participants stated that the agency added new protocols regarding aerosol-generating procedures policies (58%), use of surface barriers (61%) and PPE usage (e.g. donning and doffing) in patient homes (56%). The majority (76%) reported that their agency required field clinicians to call ahead to ascertain COVID-19 exposure/symptoms before a home visit. More than half (58%) reported that their agency lacked supplies, including N95 respirators (45%), cleaning/disinfectant product (23%), alcohol based sanitizer (18%), eye protection (18%), gowns (18%), and surgical masks (14%). Overall, participants shared that field clinicians had to reuse (76%), extend (73%) or ration (30%) PPE supplies. Respondents reported that their agency accessed supplemental PPE through state/local resources (67%), private/community donations (67%), and do-it-yourself efforts (55%). One third (31%) reported that their agency was experiencing staffing shortages due to COVID-19; of these, 60% reported that shortages were due to staff infected with/quarantined due to COVID-19. Conclusion Our findings suggest that COVID-19 has presented significant challenges for palliative care and hospice agencies as they provide care to patients and families at an unprecedented rate. Disclosures All Authors: No reported disclosures

Author(s):  
Ros Scott

This chapter explores the experience of volunteers in hospice and palliative care their own words. Frequently we hear about the work of volunteers from paid staff, from research, but not always from the volunteers themselves in their own words. In this chapter we have tried to explore what happens in the unique place that volunteers have within hospice and palliative care services; somewhere between staff, patients, and families. The stories in this chapter have all come directly from volunteers from Italy, Australia, Romania, India, United States of America (USA), and the United Kingdom (UK) in their own words. Translation, where required, has tried to remain true to the original story and all volunteers have agreed the translation to ensure that it has not changed the essence of the story. Volunteers have described their roles, what volunteering means to them, and the impact that it has on their lives.


2008 ◽  
Vol 6 (2) ◽  
pp. 159-164 ◽  
Author(s):  
Scott A. Irwin ◽  
Sanjai Rao ◽  
Kimberly A. Bower ◽  
Joanna Palica ◽  
Sanjay S. Rao ◽  
...  

ABSTRACTObjectives:Delirium is prevalent, difficult to assess, under-recognized, and undertreated in hospice and palliative care settings. Furthermore, it is associated with significant morbidity and mortality. Under-recognition of delirium results in under-treatment and increased suffering. The intent of this study was to retrospectively evaluate the recognition of delirium in a large cohort of hospice patients by interdisciplinary hospice care teams.Methods:A retrospective chart review of 2,716 patients receiving hospice care was conducted in order to determine the baseline rate of recognition of delirium in patients with advanced, life-threatening illnesses by front-line hospice clinicians. Documentation of “delirium” as either a diagnosis or problem was used as an estimate of how often these disorders were considered significant issues by the treating interdisciplinary team.Results:Of the patients receiving home/long-term care, 17.8% (386/2168) had delirium documented as a diagnosis or significant problem. The presence of recognized delirium in this setting was associated with significant differences in marital status, ethnicity, hospice diagnosis, and age. Total length of hospice care was also significantly longer. Of patients receiving inpatient care, 28.3% (614/548) had delirium documented as a diagnosis or significant problem. Recognized delirium in this setting was associated with significant differences in gender, ethnicity, hospice diagnosis, and length of inpatient stay.Significance of results:If documentation is representative of the care that the interdisciplinary teams provide, delirium of any kind appears to be under-recognized in this population. In fact, it is on the low end of prevalence estimates in the literature. Improved delirium assessment is needed in order to minimize the impact of delirium on patients living with advanced, life-threatening illnesses and their caregivers.


2013 ◽  
Vol 3 (3) ◽  
pp. 267-270
Author(s):  
Zuzana Karabová ◽  
Lubica Ilievová

This article describes the medical, psychological, and social challenges encountered during home-based, family-centred palliative care of a 3-year-old female with secondary histiocytic sarcoma diagnosed during treatment for T-cell acute lymphoblastic leukaemia. Histiocytic sarcoma is an exceedingly rare cancer in adults, but even less frequent and highly aggressive when presenting as a secondary cancer in children. Comprehensive, multidisciplinary paediatric hospice care services are not widely available across Slovakia,thus limiting the number of patients and families offered such highly specialized end-of-life care. This case study illustrates the primary benefits for the child and family of such a program as well as the impact on the medical and nursing professionals working in the fi eld of paediatric haematology-oncology.


Author(s):  
Ros Scott

This chapter explores the history of volunteers in the founding and development of United Kingdom (UK) hospice services. It considers the changing role and influences of volunteering on services at different stages of development. Evidence suggests that voluntary sector hospice and palliative care services are dependent on volunteers for the range and quality of services delivered. Within such services, volunteer trustees carry significant responsibility for the strategic direction of the organiszation. Others are engaged in diverse roles ranging from the direct support of patient and families to public education and fundraising. The scope of these different roles is explored before considering the range of management models and approaches to training. This chapter also considers the direct and indirect impact on volunteering of changing palliative care, societal, political, and legislative contexts. It concludes by exploring how and why the sector is changing in the UK and considering the growing autonomy of volunteers within the sector.


2018 ◽  
Vol 21 (2) ◽  
pp. 62-71
Author(s):  
Henry O’Lawrence ◽  
Rohan Chowlkar

Purpose The purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the hypotheses of this study. Home health care and hospice care services have the potential to avert hospital admissions in patients requiring palliative care, which significantly affects medicare spending. With the aging population, it has become evident that demand of palliative care will increase four-fold. It was determined that current spending on end-of-life care is radically emptying medicare funds and fiscally weakening numerous families who have patients under palliative care during life-threatening illnesses. The study found that a majority of people registering for palliative and hospice care settings are above the age group of 55 years old. Design/methodology/approach Different variables like length of stay, mode of payment and disease diagnosis were used to filter the available data set. Secondary data were utilized to test the hypothesis of this study. There are very few studies on hospice and palliative care services and no study focuses on the cost associated with this care. Since a very large number of the USA, population is turning 65 and over, it is very important to analyze the cost of care for palliative and hospice care. For the purpose of this analysis, data were utilized from the National Home and Hospice Care Survey (NHHCS), which has been conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Descriptive statistics, χ2 tests and t-tests were used to test for statistical significance at the p<0.05 level. Findings The Statistical Package for Social Sciences (SPSS) was utilized for this result. H1 predicted that patients in the age group of 65 years and up have the highest utilization of home and hospice care. This study examined various demographic variables in hospice and home health care which may help to evaluate the cost of care and the modes of payments. This section of the result presents the descriptive analysis of dependent, independent and covariate variables that provide the overall national estimates on differences in use of home and hospice care in various age groups and sex. Research limitations/implications The data set used was from the 2007 NHHCS survey, no data have been collected thereafter, and therefore, gap in data analysis may give inaccurate findings. To compensate for this gap in the data set, recent studies were reviewed which analyzed cost in palliative care in the USA. There has been a lack of evidence to prove the cost savings and improved quality of life in palliative/hospice care. There is a need for new research on the various cost factors affecting palliative care services as well as considering the quality of life. Although, it is evident that palliative care treatment is less expensive as compared to the regular care, since it eliminates the direct hospitalization cost, but there is inadequate research to prove that it improves the quality of life. A detailed research is required considering the additional cost incurred in palliative/hospice care services and a cost-benefit analysis of the same. Practical implications While various studies reporting information applicable to the expenses and effect of family caregiving toward the end-of-life were distinguished, none of the previous research discussed this issue as their central focus. Most studies addressed more extensive financial effect of palliative and end-of-life care, including expenses borne by the patients themselves, the medicinal services framework and safety net providers or beneficent/willful suppliers. This shows a significant hole in the current writing. Social implications With the aging population, it has become evident that demand of palliative/hospice care will increase four-fold. The NHHCS have stopped keeping track of the palliative care requirements after 2007, which has a negative impact on the growing needs. Cost analysis can only be performed by analyzing existing data. This review has recognized a huge niche in the evidence base with respect to the cost cares of giving care and supporting a relative inside a palliative/hospice care setting. Originality/value The study exhibited that cost diminishments in aggressive medications can take care of the expenses of palliative/hospice care services. The issue of evaluating result in such a physically measurable way is complicated by the impalpable nature of large portions of the individual components of outcome. Although physical and mental well-being can be evaluated to a certain degree, it is significantly more difficult to gauge in a quantifiable way, the social and profound measurements of care that help fundamentally to general quality of care.


2010 ◽  
Vol 16 (6) ◽  
pp. 274-284 ◽  
Author(s):  
Tanya Connell ◽  
Ritin S Fernandez ◽  
Rhonda Griffiths ◽  
Duong Tran ◽  
Meera Agar ◽  
...  

2021 ◽  
Author(s):  
Felicity Hasson ◽  
Paul Slater ◽  
Anne Fee ◽  
Tracey McConnell ◽  
Sheila Payne ◽  
...  

Abstract BackgroundGlobally COVID-19 has had a profound impact on the provision of healthcare, including palliative care. However, there is little evidence about the impact of COVID-19 on delivery of out-of-hours specialist palliative care services in the United Kingdom. The aim of the study is to investigate the impact of the COVID-19 pandemic on the delivery of out-of-hours community-based palliative care services.Methods A national online census survey of managers of adult hospices in the United Kingdom was undertaken. Survey were emailed to managers of adult hospices (n=150) who provided out-of-hours community palliative care services. Fifteen questions related specifically to the impact of COVID-19 and data were analysed thematically.ResultsEighty-one responses to the survey were returned (54% response rate); 59 were complete of which 47 contained COVID-19 data. Findings indicated that COVID-19 impacted on out-of-hours community-based palliative care. To meet increased patient need, hospices reconfigured services; redeployed staff; and introduced new policies and procedures to minimize virus transmission. Lack of integration between charitably and state funded palliative care providers was reported. The interconnected issues of the use and availability of Personal Protective Equipment (n=21) and infection control screening (n=12) resulted in changes in nursing practices due to fear of contagion for patients, carers and staff. Conclusions Survey findings suggest that due to increased demand for community palliative care services, hospices had to rapidly adapt and reconfigure services. Even though this response to the pandemic led to some service improvements, in the main, out-of-hours service reconfiguration resulted in challenges for hospices, including workforce issues, and availability of resources such as Personal Protective Equipment. These challenges were exacerbated by lack of integration with wider healthcare services. More research is required to fully understand the implications of such changes on the quality of care provided.


2016 ◽  
Vol 12 (2) ◽  
pp. 149-150 ◽  
Author(s):  
Angelique Wong ◽  
Akhila Reddy ◽  
Janet L. Williams ◽  
Jimin Wu ◽  
Diane Liu ◽  
...  

QUESTION ASKED: What are graduate medical education trainees’ attitudes and beliefs regarding palliative care, what is their awareness of the availability and role of palliative care services, and does previous exposure to a palliative care rotation facilitate a better awareness of palliative care? SUMMARY ANSWER: A vast majority of oncology trainees perceived palliative care services to be beneficial for patient care (92%) and were supportive of mandatory palliative care training (74%). Surgical oncology trainees and trainees with no previous palliative care exposure were significantly less likely to consult palliative care and had significantly less awareness of palliative care. METHODS: We conducted an institutional review board–approved online survey to determine awareness of palliative care among graduate medical trainees at MD Anderson. One hundred seventy oncology trainees who completed at least 9 months of training in medical, surgical, gynecologic, and radiation oncology fellowship and residency program during the 2013 academic year completed an online questionnaire. Descriptive, univariate, and multivariate analyses were performed. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Although there was a substantial response rate (78%), the results may not be generalizable as the survey was conducted at a single institution. Also, the frequency of palliative care referrals is self-reported. REAL-LIFE IMPLICATIONS: Our findings suggest that exposure to palliative care training may lead to increased awareness of palliative care among oncologists, and thus, increased overall and early referrals to palliative care. Surgical oncology trainees may benefit from increased exposure to palliative care rotations. More research is needed to characterize the impact of training on referral patterns to palliative care. In the meantime, efforts should be made to include formal palliative care rotations in oncology training. [Table: see text]


2013 ◽  
Vol 67 (1-2) ◽  
pp. 193-200 ◽  
Author(s):  
Sonia Quinones-Gonzalez

The Hispanic and Latino populations have increased nationwide. Hispanics are now the largest minority group in the United States. This increase in population will have an impact on all service areas, including hospice and palliative care. The goal as service providers is to remove barriers to care in order to increase opportunities for all the people residing in the communities. This project addresses the impact of the Hispanic and Latino populations in Pasco County, Florida, and the need to develop Latino outreach programs that will inform, educate, and provide culturally sensitive services which will decrease the barriers of communication and accessibility for Hispanics and Latinos who are in need of hospice and palliative care. The new outreach program, named Nuestro, which means “ours” in Spanish, is designed with this purpose in mind. The project's goal was to increase service by 200%; the outcome after 2 years was an increase of services by 900%.


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