Potential Perils to the Promise of Specialty Palliative Care

2016 ◽  
Author(s):  
Robert M. Arnold
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care System ◽  
Specialist Palliative Care ◽  
The Past ◽  
Seriously Ill Patients ◽  
Seriously Ill ◽  
Generalist Palliative Care ◽  
Care System

Despite the growth of specialty palliative care over the past twenty years, the experience of most seriously ill patients in America has not changed. Although some have argued that the solution to this problem is to increase specialist palliative care (SPC), the author argues that this is a mistake. The growth of SPC may distract attention from solutions that are more likely to improve care for most seriously ill patients. SPC may decrease the quality and quantity of palliative care provided by nonspecialists by allowing the health care system to continue to deny death and “ghetto-izing” and deskilling generalist palliative care. This chapter presents these two arguments and tries to determine what changes are required to ensure that all seriously ill patients receive good palliative care, regardless of who provides the care.

Assisting People With Their Living, Not Their Dying: Health Professionals’ Perspectives of Palliative Care and Opioids in ILD

2021 ◽  
pp. 104990912110186
Author(s):  
Lauren Russo ◽  
Karen Willis ◽  
Natasha Smallwood
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Palliative Care ◽  
Health Care System ◽  
Therapeutic Relationships ◽  
Specialist Palliative Care ◽  
Cross Sectional ◽  
Symptom Palliation ◽  
Care System

Objectives: Interstitial lung disease (ILD) is a debilitating and life-limiting condition, requiring multi-disciplinary care. While guidelines recommend early specialist palliative care referral to improve symptoms and quality of life, few patients access such care towards the end-of-life. This study aimed to explore clinicians’ perspectives regarding specialist palliative care and opioids to understand barriers to optimal care and guide clinical practice improvement initiatives. Methods: A cross-sectional, exploratory, qualitative study was undertaken with Australian respiratory clinicians caring for people with ILD (n = 17). In-depth, semi-structured interviews were audio-recorded, transcribed verbatim and coded. Thematic analysis was undertaken to extrapolate recurring ideas from the data. Results: Four themes were identified: 1) understanding how to improve patient care and support, 2) the need to dispel stigmatized beliefs and misconceptions, 3) the importance of trusted relationships and good communication and 4) the challenges of navigating the health-care system. Participants discussed the need to implement early specialist palliative care and symptom palliation to alleviate symptoms, provide emotional support and augment quality of life. Participants described challenges accessing palliative care and opioids due to stigmatized beliefs amongst patients and clinicians and difficulties navigating the health-care system. Trusted therapeutic relationships with patients and strong inter-disciplinary partnerships with collaborative education and communication were perceived to improve patients’ access to symptom palliation. Conclusion: Specialist palliative care and opioids were believed to improve patients’ quality of life, however, many barriers can make accessing such care challenging. To address these issues, multi-disciplinary collaboration, high-quality communication and trusted therapeutic relationships are crucial throughout the ILD illness journey.

scholarly journals Palliative and End-of-Life Care in the Home in Regional/Rural Victoria, Australia: The Role and Lived Experience of Primary Carers

2021 ◽  
Vol 7 ◽  
pp. 237796082110362
Author(s):  
Elizabeth M. Miller ◽  
Joanne E. Porter ◽  
Rebecca Peel
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Lived Experience ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Primary Health Care System ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Care System

Introduction Palliative support services (generalist or specialist) can provide much-needed assistance to carers who are providing palliative and end-of-life care in their homes, but access to such services in regional and rural areas of Australia is poorly understood. Objectives This study aimed to explore the role and lived experience of primary carers who are providing palliative and end-of-life care in the home in regional/rural Victoria, Australia. Methods Nine female participants, of whom six were bereaved between 7 and 20 months were interviewed using a semistructured interview technique. Each interview was audio-recorded, transcribed verbatim, and analyzed thematically. Results Two themes emerged: “ Negotiating healthcare systems” which described the needs for multidisciplinary supports and “ The caring experience” which discussed daily tasks, relationships, mental and physical exhaustion, respite, isolation, medication management, and grief and loss. Findings show that regional/rural carers have an added burden of travel stress as well as feeling overwhelmed, isolated, and physically and emotionally exhausted. Carers would benefit from greater flexibility for short-term respite care. The engagement of specialist palliative care services assisted the participants to navigate the health care system. Some participants did not understand the value of palliative care, highlighting the need for general practitioners to conduct early conversations about this with their patients. Education is needed to build capacity within the primary palliative care workforce, confirming the importance of timely referrals to a specialist palliative care practitioner if pain or symptom control is not effectively managed. Conclusion Providing palliative and end-of-life care in the home is an exhausting and emotionally draining role for unpaid, primary carers. Multiple supports are needed to sustain primary carers, as they play an essential role in the primary health care system.

scholarly journals Palliative Care as Response to Suffering at End of Life

2014 ◽  
Vol 6 (2) ◽  
pp. 227-245
Author(s):  
Daniela Moşoiu
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Health Care System ◽  
Spiritual Distress ◽  
History Of Development ◽  
History Of ◽  
Hospice And Palliative Care ◽  
Care System

Abstract Persons suffering from chronic and life limiting illnesses often have unrelieved symptoms such as pain, depression, fatigue, and psychosocial and spiritual distress. In Romania they are frequently left in the care of their families with little support from the health care system. It seems a paradox that those who are the sickest persons in a country find little place in the health care system. This article presents palliative care as a solution to the suffering for these patients and their families by describing the concept, models of services, its beneficiaries and benefits and presenting the history of development of hospice and palliative care worldwide and in Romania.

scholarly journals Challenges Facing the Chinese Health Care System

2020 ◽  
pp. 101053952096846
Author(s):  
Kaixuan Hu
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Disease Surveillance ◽  
World Health ◽  
Outbreak Response ◽  
The Past ◽  
Disease Surveillance System ◽  
Rural And Urban ◽  
Health Organization ◽  
Care System

The purposes of this article are to explore the challenges the Chinese health care system will be facing in the next decade. The recent outbreak of coronavirus disease (COVID-19) having infected more than 90 000 persons in China (Source: World Health Organization, WHO Coronavirus Disease Dashboard) again reveals the weaknesses of the fragmental health care system. Over the past 3 decades, increasing out-of-pocket spending on health care, increasing mortality rate of chronic disease, growing disparities between rural and urban populations, the defectiveness of disease surveillance system, and disease outbreak response system have been pressing Chinese authorities for action. As this country has experienced an unprecedented economic growth along with an unparalleled development of health care system in the past 3 decades, the challenges ahead are unavoidably numerous and complex.

scholarly journals Social and Health System Complexities Impacting on Decision-Making for Utilization of Oncology and Palliative Care in an African Context: A Qualitative Study

2019 ◽  
Vol 35 (3) ◽  
pp. 185-191 ◽  
Author(s):  
David A. Agom ◽  
Stuart Allen ◽  
Sarah Neill ◽  
Judith Sixsmith ◽  
Helen Poole ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Palliative Care ◽  
Qualitative Study ◽  
Health Care System ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Semistructured Interview ◽  
Design Data ◽  
Care System

Background: There is a dearth of research focusing on identifying the social complexities impacting on oncology and palliative care (PC), and no study has explored how the health-care system in Nigeria or other African contexts may be influencing utilization of these services. Aim: This study explored how social complexities and the organization of health-care influenced the decision-making process for the utilization of oncology and PC in a Nigerian hospital. Methods: This qualitative study used an interpretive descriptive design. Data were collected using semistructured interview guides with 40 participants, comprising health-care professionals, patients, and their families. Thematic analysis was conducted to generate and analyze patterns within the data. Findings: Three themes were identified: dysfunctional structural organization of the health-care delivery system, service-users’ economic status, and the influence of social networks. The interrelationship between the themes result in patients and their family members decisions either to present late to the hospital, miss their clinical appointments, or not to seek oncological health care and PC. Conclusion: This article offers insights into the role of the health-care system, as organized currently in Nigeria, as “autoinhibitory” and not adequately prepared to address the increasing burden of cancer. We therefore argue that there is a need to restructure the Nigerian health-care system to better meet the needs of patients with cancer and their families as failure to do so will strengthen the existing inequalities, discourage usage, and increase mortality.

Changes in Cuban Health Care: An Argument against Technological Pessimism

1977 ◽  
Vol 7 (3) ◽  
pp. 383-400 ◽  
Author(s):  
Sally Guttmacher ◽  
Ross Danielson
Keyword(s):  
Health Care ◽  
Social Services ◽  
Health Care System ◽  
Health Workers ◽  
Care Delivery ◽  
Social Changes ◽  
The Past ◽  
Political Economic ◽  
Care System

Since the popular revolution in 1959, alterations in the organization and delivery of health care in Cuba have paralleled the country's broader political, economic, and social changes. This paper discusses the evolution of the Cuban health care system during the past seventeen years within the wider context of societal development. The authors compare three “snapshots” of Cuba, the first in 1959, the second in 1970, and the last in 1976, and touch upon such issues as the organization of health care delivery, the recruitment and socialization of health workers, and aspects of the process of receiving health care. They point out that the Cuban experience should be of particular interest to the developing world. For though it is true that a larger portion of Cuban national resources has been directed to the health and social services than in other developing countries, nonetheless, it was largely through the reorganization and equalization of the prerevolutionary health care system that improvement in the health status of the population was achieved. It appears that Cuba could well serve as an example for those who are skeptical about the possibility of combining technical development with improvement in the humane quality of care.

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