scholarly journals Qualitative situational analysis of palliative care for adolescents with cancer and HIV in South Africa: healthcare worker perceptions

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023225
Author(s):  
Nothando Ngwenya ◽  
Julia Ambler ◽  
Moherndran Archary
Keyword(s):  
South Africa ◽  
Palliative Care ◽  
Service Provision ◽  
Public Awareness ◽  
Situational Analysis ◽  
Care Pathways ◽  
Main Task ◽  
Process Mapping ◽  
Care Needs ◽  
Health And Social Care

ObjectivesThe unmet palliative care need is intensified in resource-limited countries where there is inequitable access to healthcare and adolescents and young adults (AYA) fall between the cracks of paediatric and adult services. We aimed to examine palliative care for AYA with cancer and/or HIV in South Africa.DesignIndividual and small group interviews using process mapping.SettingData were collected between November 2016 and March 2017 with staff from government hospitals, hospices and clinics from three provinces of South Africa.ParticipantsHealth and social care professionals (n=30) (eg, physicians, nurses, social workers, psychologists) from KwaZulu-Natal, Western Cape and Gauteng provinces.MethodsIn this qualitative situational analysis study, participants were recruited to interviews and process mapping used to try and identify palliative care pathways of AYA with palliative care needs. We developed a thematic framework using a deductive approach to analyse the interview data.ResultsPalliative care pathways were not easily identifiable, ambiguous and varied and participants reported on their experiences and perceptions of service provision. Participants expressed that resource challenges limited the service provision. A need for nurse prescribing of pain relief at community level was mentioned as AYA are reluctant to use hospitals and clinics. Lack of (1) palliative care education among professionals, (2) public awareness and (3) adolescent-specific care posed a challenge to service provision.ConclusionsThe changing burden of HIV and increase in cancer prevalence calls for integration of palliative care in mainstream health services. Despite good policies, the pragmatic aspect of training professionals will influence a change in practice. The main task will be to absorb palliative care philosophy and practice at all levels of care to avoid overburdening the care system and to integrate it in community care programmes.

First steps: Health and social care professionals beginning to address the palliative and end of life care needs of people with diverse gender identities and sexual orientations in Lebanon

Sexualities ◽  
2020 ◽  
pp. 136346072093238
Author(s):  
Claude Chidiac
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Social Stigma ◽  
Life Care ◽  
Care Needs ◽  
Mena Region ◽  
Healthcare Needs ◽  
Health And Social Care ◽  
The Impact

The available evidence demonstrates that lesbian, gay, bisexual, and transgender (LGBT) people face challenges when accessing palliative care services, and receive suboptimal care at the end of life. This is mainly attributed to assumed heterosexuality, lack of knowledge and understanding of LGBT issues and specific healthcare needs, discrimination, homophobia, and transphobia. In Lebanon, legal and institutional support for LGBT individuals is minimal, and palliative care provision remains scarce and fragmented. This compounds the impact of social stigma and marginalisation, and results in unrecognised palliative and end of life care needs for the LGBT individual. This short commentary discusses the development of an LGBT palliative care workshop in Lebanon, which was the first initiative of its kind in the Middle East and North Africa (MENA) region. It also explores how this initiative has led to further developments, and how these efforts can be replicated in other countries in the MENA region.

scholarly journals Supports for migrant farmworkers: tensions in (in)access and (in)action

2020 ◽  
Vol 16 (4) ◽  
pp. 557-571
Author(s):  
Susana Caxaj ◽  
Amy Cohen ◽  
Sarah Marsden
Keyword(s):  
Service Provision ◽  
Service Providers ◽  
Situational Analysis ◽  
Migrant Farmworkers ◽  
Content Type ◽  
Clinical Encounters ◽  
Analysis Methodology ◽  
Health And Social Care ◽  
Research Findings

Purpose This study aims to examine the role of support actors in promoting or hindering access to public services/spaces for migrant agricultural workers (MAWs) and to determine the factors that influence adequate support for this population. Design/methodology/approach Using a situational analysis methodology, the authors carried out focus groups and interviews with 40 support actors complimented by a community scan (n = 28) with public-facing support persons and a community consultation with migrant farmworkers (MFWs) (n = 235). Findings Two major themes were revealed: (In)access and (In)action and Blurred Lines in Service Provision. The first illustrated how support actors could both reinforce or challenge barriers for this population through tensions of “Coping or Pushing Back on Constraints” and “Need to find them first!” Justification or Preparation? Blurred lines in Service Provision encompassed organizational/staff’s behaviors and contradictions that could hinder meaningful support for MFWs revealing two key tensions: “Protection or performance?” and “Contradicting or reconciling priorities? Our findings revealed a support system for MAWs still in its infancy, contending with difficult political and economic conditions. Social implications Service providers can use research findings to improve supports for MAWs. For example, addressing conflicts of interests in clinical encounters and identification of farms to inform adequate outreach strategies can contribute to more effective support for MAWs. Originality/value This research is novel in its examination of multiple sectors as well as its inclusion of both formal and informal actors involved in supporting MAWs. Our findings have the potential to inform more comprehensive readings of the health and social care resources available to MAWs.

scholarly journals Dementia and mild cognitive impairment in prisoners aged over 50 years in England and Wales: a mixed-methods study

2020 ◽  
Vol 8 (27) ◽  
pp. 1-116
Author(s):  
Katrina Forsyth ◽  
Leanne Heathcote ◽  
Jane Senior ◽  
Baber Malik ◽  
Rachel Meacock ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Service Provision ◽  
Prevalence Rate ◽  
Social Care ◽  
Care Pathway ◽  
Prison Population ◽  
Care Needs ◽  
England And Wales ◽  
Health And Social Care

Background People aged ≥ 50 years constitute the fastest-growing group in the prison population of England and Wales. This population has complex health and social care needs. There is currently no national strategy to guide the development of the many-faceted services required for this vulnerable population; therefore, prisons are responding to the issue with a range of local initiatives that are untested and often susceptible to failure if they are not fully embedded in and securely funded as part of commissioned services. Objectives The objectives were to establish the prevalence of dementia and mild cognitive impairment in prisoners in England and Wales and their health and social care needs; validate the six-item cognitive impairment test for routine use in prisons to aid early and consistent identification of older prisoners with possible dementia or mild cognitive impairment; identify gaps in current service provision; understand the first-hand experiences of prisoners living with dementia and mild cognitive impairment; develop a care pathway for prisoners with dementia and mild cognitive impairment; develop dementia and mild cognitive impairment training packages for staff and prisoners; and produce health economic costings for the care pathway and training packages. Design This was a mixed-methods study. Setting The study setting was prisons in England and Wales. Participants Prisoners aged ≥ 50 years and multiagency staff working in prison discipline and health and social care services took part. Results Quantitative research estimated that the prevalence rate of suspected dementia and mild cognitive impairment in the prison population of England and Wales is 8%. This equates to 1090 individuals. Only two people (3%) in our sample had a relevant diagnosis in their health-care notes, suggesting current under-recognition of these conditions. The prevalence rate in prisons was approximately two times higher among individuals aged 60–69 years and four times higher among those aged ≥ 70 years than among those in the same age groups living in the community. The Montreal Cognitive Assessment screening test was found to be more effective than the six-item cognitive impairment test assessment in the older prisoner population. Qualitative research determined that staff and prisoners lacked training in knowledge and awareness of dementia and mild cognitive impairment, and this leads to problematic behaviour being viewed as a disciplinary issue rather than a health issue. Local initiatives to improve the lives of prisoners with dementia and mild cognitive impairment are often disadvantaged by not being part of commissioned services, making them difficult to sustain. Multidisciplinary working is hampered by agencies continuing to work in silos, with inadequate communication across professional boundaries. A step-by-step care pathway for prisoners with dementia and mild cognitive impairment was developed, and two tiers of training materials were produced for staff and prisoners. Limitations Our prevalence rate was based on the results of a standardised assessment tool, rather than on clinical diagnosis by a mental health professional, and therefore it may represent an overestimation. Furthermore, we were unable to distinguish subcategories of dementia. We were also unable to distinguish between a likely diagnosis of dementia and other conditions presenting with mild cognitive impairment, including learning disability, severe depression and hearing impairment. Questionnaires regarding current service provision were collected over an extended period of time, so they do not reflect a ‘snapshot’ of service provision at a particular point. Conclusions We hypothesise that implementing the step-by-step care pathway and the training resources developed in this study will improve the care of older prisoners with dementia and mild cognitive impairment. Future work The care pathway and training materials should be evaluated in situ. Alternatives to prison for those with dementia or mild cognitive impairment should be developed and evaluated. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 27. See the NIHR Journals Library website for further project information.

HSR19-080: Situational Analysis and Needs Assessment Regarding the Availability and Extent of Pediatric Palliative Care Services in the Philippines

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-080
Author(s):  
Loyda Amor N. Cajucom ◽  
Rita C. Ramos ◽  
Raymund Kernell B. Mañago ◽  
Raya Kathreen T. Fuentes ◽  
Primo G. Garcia ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pediatric Oncology ◽  
Healthcare Providers ◽  
The Philippines ◽  
Situational Analysis ◽  
Care Needs ◽  
Care Services ◽  
Palliative Care Services ◽  
The Common ◽  
Palliative Care Needs

Background: Around 200,000 pediatric clients are diagnosed with cancer each year globally. Majority (84%) of cancer cases are found in developing countries with 20% average survival rate (Ferlay et al, 2012). Two-thirds of pediatric oncology clients in the Philippines are diagnosed at advanced stages (Lecciones, 2015). Abandonment of treatment is high at 80%. Only about 10%–20% of clients attain long-term survival despite availability of multidisciplinary management. These outcomes reflect the gap in service delivery for pediatric oncology clients (Ferlay et al, 2012). Therefore, to improve accessibility to healthcare, it is necessary to determine the perceived palliative care needs of clients, their caregivers, and healthcare providers. Objective: To identify the availability of palliative care services in the country, identify barriers in service delivery, and determine the palliative care needs of pediatric oncology clients, their caregivers, and healthcare providers. Methods: The descriptive, cross-sectional study design involved a situational analysis by mapping 2 Philippine palliative centers. Focus group discussions (FGD) and interviews with healthcare professionals were conducted to determine the extent of services, geographical coverage, and perceived palliative care needs. The needs assessment tool by WHO (2004) was adopted to identify the palliative care needs of pediatric oncology clients as perceived by caregivers. Results: From a total of 181 primary caregivers, the identified main problems in caring was the economical (95.6%) aspect. Financial support (92%) was the most pressing need. Caregivers would like to learn more about general cancer care (39%) and nutrition counseling (24%). The most common palliative care needs as perceived by caregivers included accessibility to cancer facility (27%), free cancer medications (12.7%), and financial assistance (14.9%). The common barriers in rendering care were financial constraints (66%), behavioral changes (12.7%), and travel limitations (6%). The common themes found during the FGDs and interviews were: (1) inadequate human and structural health resources; (2) need to focus on psychosocial care; (3) addressing economic constraints; and (4) need to increase cancer awareness among caregivers. Conclusion: The findings of the study documented the need for the development of structured programs for pediatric palliative care in the Philippines.

scholarly journals The Development of an Enhanced Palliative Care Pharmacy Service during the Initial COVID-19 Surge

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 196
Author(s):  
Jaquie Hanley ◽  
Maureen Spargo ◽  
Joanne Brown ◽  
Julie Magee
Keyword(s):  
Palliative Care ◽  
Northern Ireland ◽  
Service Provision ◽  
Healthcare Professionals ◽  
Social Care ◽  
Access To Medicines ◽  
Pharmacy Service ◽  
Large Hospital ◽  
Health And Social Care

The Northern Health and Social Care Trust developed an enhanced palliative care pharmacy service for acute inpatients within a large hospital in Northern Ireland during the initial COVID-19 surge. By training additional staff, there was an opportunity to increase service provision, utilising palliative care pharmacy skills to undertake activities such as the symptom management of patients, appropriate management of medicines, improved access to medicines, advice for other healthcare professionals, and supporting discharge from the hospital. The data collected showed a mean of 6.8 interventions per patient, and that, irrespective of the demand resulting from the COVID-19 pandemic, the palliative care pharmacy team had a role in improving the quality of care for palliative and end-of-life patients. Subsequent data analysis also demonstrated associated cost saving and the potential for the palliative care pharmacy team to reduce the length of stay at the hospital.

An Admiral Nursing and hospice partnership in end-of-life care: Innovative practice

Dementia ◽  
2018 ◽  
Vol 19 (7) ◽  
pp. 2484-2493
Author(s):  
Karen Harrison Dening ◽  
Jaqueline Crowther ◽  
Sadaf Adnan
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Stage ◽  
Life Care ◽  
Care Providers ◽  
Care Needs ◽  
People With Dementia ◽  
Health And Social Care ◽  
Palliative Care Needs

Addressing palliative care needs of people with dementia appropriately, identifying the end-of-life stage, meeting the needs of family carers as well as supporting the preferences and wishes of the person with the diagnosis can all present challenges to generalist health and social care providers. In partnership with Dementia UK and Kirkwood Hospice in West Yorkshire embarked upon a two-year pilot to introduce the first end-of-life care Admiral Nurse to their Specialist Community Palliative Care Team to identify and support people with dementia who required palliative and end-of-life care. This paper describes and discusses this innovative partnership and outcomes from year one evaluation and sets out future plans.

scholarly journals How many people will need palliative care in Scotland by 2040? A mixed-method study of projected palliative care need and recommendations for service delivery

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041317
Author(s):  
Anne M Finucane ◽  
Anna E Bone ◽  
Simon Etkind ◽  
David Carr ◽  
Richard Meade ◽  
...  
Keyword(s):  
Palliative Care ◽  
Service Delivery ◽  
Causes Of Death ◽  
Social Care ◽  
Care Needs ◽  
Health And Social Care ◽  
Mortality Forecasts ◽  
Delivery Models ◽  
Palliative Care Needs ◽  
Roll Out

ObjectiveTo estimate future palliative care need and complexity of need in Scotland, and to identify priorities for future service delivery.DesignWe estimated the prevalence of palliative care need by analysing the proportion of deaths from defined chronic progressive illnesses. We described linear projections up to 2040 using national death registry data and official mortality forecasts. An expert consultation and subsequent online consensus survey generated recommendations on meeting future palliative care need.SettingScotland, population of 5.4 million.ParticipantsAll decedents in Scotland over 11 years (2007 to 2017). The consultation had 34 participants; 24 completed the consensus survey.Primary and secondary outcomesEstimates of past and future palliative care need in Scotland from 2007 up to 2040. Multimorbidity was operationalised as two or more registered causes of death from different disease groups (cancer, organ failure, dementia, other). Consultation and survey data were analysed descriptively.ResultsWe project that by 2040, the number of people requiring palliative care will increase by at least 14%; and by 20% if we factor in multimorbidity. The number of people dying from multiple diseases associated with different disease groups is projected to increase from 27% of all deaths in 2017 to 43% by 2040. To address increased need and complexity, experts prioritised sustained investment in a national digital platform, roll-out of integrated electronic health and social care records; and approaches that remain person-centred.ConclusionsBy 2040 more people in Scotland are projected to die with palliative care needs, and the complexity of need will increase markedly. Service delivery models must adapt to serve growing demand and complexity associated with dying from multiple diseases from different disease groups. We need sustained investment in secure, accessible, integrated and person-centred health and social care digital systems, to improve care coordination and optimise palliative care for people across care settings.

scholarly journals Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications

2020 ◽  
Vol 34 (9) ◽  
pp. 1193-1201 ◽  
Author(s):  
Anna E Bone ◽  
Anne M Finucane ◽  
Javiera Leniz ◽  
Irene J Higginson ◽  
Katherine E Sleeman
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Descriptive Analysis ◽  
Palliative Care Service ◽  
Routine Data ◽  
Population Based ◽  
Service Planning ◽  
Care Homes ◽  
Care Needs ◽  
Health And Social Care

Background: COVID-19 has directly and indirectly caused high mortality worldwide. Aim: To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research. Design: Descriptive analysis and population-based modelling of routine data. Participants and setting: All deaths registered in England and Wales between 7 March and 15 May 2020. We described the following mortality categories by age, gender and place of death: (1) baseline deaths (deaths that would typically occur in a given period); (2) COVID-19 deaths and (3) additional deaths not directly attributed to COVID-19. We estimated the proportion of people who died from COVID-19 who might have been in their last year of life in the absence of the pandemic using simple modelling with explicit assumptions. Results: During the first 10 weeks of the pandemic, there were 101,614 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220%, while home and hospital deaths increased by 77% and 90%, respectively. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged ⩾ 75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 22% (13%–31%) of COVID-19 deaths occurred among people who might have been in their last year of life in the absence of the pandemic. Conclusion: The COVID-19 pandemic has led to a surge in palliative care needs. Health and social care systems must ensure availability of palliative care to support people with severe COVID-19, particularly in care homes.

scholarly journals FACILITATORS OF DEPENDENCY IN THE VERY OLD: RESULTS FROM THE NEWCASTLE 85+ STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S242-S242
Author(s):  
A Kingston ◽  
Louise A Robinson ◽  
Rachel Duncan ◽  
Carol Jagger
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Older People ◽  
Service Provision ◽  
Daily Living ◽  
Social Care ◽  
Care Needs ◽  
Daily Care ◽  
Increased Risk ◽  
Health And Social Care

Abstract In order for governments to plan health and social care strategies to help people maintain independence, evidence is required to show how risk factors are associated with progression in dependency. We use a transparent measure of dependency, based on help needed with activities of daily living, incontinence and cognitive impairment, categorised as: high (24-hour care); medium (daily care); low (less than daily) and independent, then characterise changes over ten years (age 85-95) using the Newcastle 85+ Study while exploring how eight disease groups, multimorbidity and impairments interact to increase care needs. Stroke and diabetes confer an increased risk of low-level dependency. Complex multimorbidity, or three or more falls engendered the greatest risk of transitions to substantial dependency. There should be a focus on prevention of, and appropriate and efficient service provision for those with complex multimorbidity with emphasis on stroke, diabetes and falls, to maintain the independence of older people

Sign in / Sign up

Export Citation Format

Share Document