scholarly journals Impact of informational and relational continuity for people with palliative care needs: a mixed methods rapid review

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027323 ◽  
Author(s):  
Briony F Hudson ◽  
Sabine Best ◽  
Patrick Stone ◽  
Thomas (Bill) Noble
Keyword(s):  
Palliative Care ◽  
Mixed Methods ◽  
Continuity Of Care ◽  
Hospital Admissions ◽  
Place Of Death ◽  
Rapid Review ◽  
Synthesis Methods ◽  
Relational Continuity ◽  
Meta Analyses ◽  
The Impact

ObjectiveTo identify and synthesise existing literature exploring the impact of relational and informational continuity of care on preferred place of death, hospital admissions and satisfaction for palliative care patients in qualitative, quantitative and mixed methods literature.DesignA mixed methods rapid review.MethodsPUBMED, PsychINFO, CINAHL were searched from June 2008 to June 2018 in order to identify original peer reviewed, primary qualitative, quantitative or mixed methods research exploring the impact of continuity of care for people receiving palliative care. Synthesis methods as outlined by the Cochrane Qualitative and Implementation Methods Group were applied to qualitative studies while meta-analyses for quantitative data were planned.OutcomesThe impact of interventions designed to promote continuity of care for people receiving palliative care on the following outcomes was explored: achieving preferred place of death, satisfaction with care and avoidable hospital admissions.Results18 eligible papers were identified (11 qualitative, 6 quantitative and 1 mixed methods papers). In all, 1951 patients and 190 family caregivers were recruited across included studies. Meta-analyses were not possible due to heterogeneity in outcome measures and tools used. Two studies described positive impact on facilitating preferred place of death. Four described a reduction in avoidable hospital admissions. No negative impacts of interventions designed to promote continuity were reported. Patient satisfaction was not assessed in quantitative studies. Participants described a significant impact on their experiences as a result of the lack of informational and relational continuity.ConclusionsThis rapid review highlights the impact that continuity of care can have on the experiences of patients receiving palliative care. The evidence for the impact of continuity on place of death and hospital admissions is limited. Methods for enhancing, and recording continuity should be considered in the design and development of future healthcare interventions to support people receiving palliative care.

scholarly journals Understanding the Needs of Australian Carers of Adults Receiving Palliative Care in the Home: A Systematic Review of the Literature

2021 ◽  
Vol 7 ◽  
pp. 237796082098568
Author(s):  
Elizabeth M. Miller ◽  
Joanne E. Porter
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Information Needs ◽  
Hospital Admissions ◽  
Positive Outcomes ◽  
Review Of The Literature ◽  
Data Set ◽  
Final Data ◽  
Perceived Impact ◽  
Meta Analyses

Introduction Caring for someone at home requiring palliative care is an ominous task. Unless the current support systems are better utilised and improved to meet the needs of those carers, the demand for acute hospital admissions will increase as the Australian population ages. The aim of this review was to examine the needs of unpaid carers who were caring for adults receiving palliative care in their home in Australia. Methods: A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines between 2008–2020. Results: Only Australian papers were selected due to the intent to understand carers’ needs in the Australian context and 17 papers made up the final data set. Four themes emerged: 1) Perceived factors influencing caregiving; 2) Perceived impact and responses to caregiving; 3) Communication and information needs; and 4) Perceptions of current palliative support services and barriers to uptake. Conclusion: Carers reported satisfaction and positive outcomes and also expressed feeling unprepared, unrecognised, stressed and exhausted.

scholarly journals The impact of the environment on patient experiences of hospital admissions in palliative care

2015 ◽  
Vol 8 (4) ◽  
pp. 485-492 ◽  
Author(s):  
Jackie Robinson ◽  
Merryn Gott ◽  
Clare Gardiner ◽  
Christine Ingleton
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Prognostic Indicators ◽  
Care Needs ◽  
Acute Hospitals ◽  
Almost All ◽  
The Impact ◽  
Palliative Care Needs

ObjectiveTo explore the impact of environment on experiences of hospitalisation from the perspective of patient's with palliative care needs.MethodsA qualitative study design using longitudinal semistructured, face-to-face interviews were used to elicit the views of patients with palliative care needs admitted to hospital in 1 large urban acute hospital in New Zealand. The sample comprised of 14 patients admitted to hospital between July 2013 and March 2014 who met one of the Gold Standard Framework Prognostic Indicators for palliative care need.ResultsAlmost all participants described a range of factors associated with the environment which impacted negatively on their experiences of hospitalisation. This included challenges with the physical surroundings, the impact on social relationships with other patients, families and health professionals and the influence of the cultural milieu of the hospital setting.ConclusionsEmulating the ‘ideal’ environment for palliative care such as that provided in a hospice setting is an unrealistic goal for acute hospitals. Paying attention to the things that can be changed, such as enabling family to stay and improving the flexibility of the physical environment while improving the social interplay between patients and health professionals, may be a more realistic approach than replicating the hospice environment in order to reduce the burden of hospitalisations for patients with palliative care needs.

Proactive, multidisciplinary approach to supportive medicine: Improving health outcomes and care utilization.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6537-6537
Author(s):  
Brooke Worster ◽  
Valerie P Csik ◽  
Jared Minetola ◽  
Gregory D. Garber ◽  
Alison Petok ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Care Plan ◽  
Cancer Center ◽  
Care Plans ◽  
Oncology Care ◽  
The Impact

6537 Background: Evidence suggests that cancer patients who receive palliative care early in their disease have improved quality of life, decreased emergency department (ED) visits, and less aggressive end-of-life care. In 2017, the Sidney Kimmel Cancer Center at Jefferson established the Neu Center for Supportive Medicine and Cancer Survivorship (NCSMCS) as a model for integrated care in the outpatient setting for all cancer patients. A multidisciplinary team consisting of palliative care physicians, social work, psychology, and navigation conducts biopsychosocial screening and initiates a personalized care plan for each patient to clarify treatment goals and offer assistance. Objectives: To use biopsychosocial screening at specified time points to identify needs and evaluate the impact of supportive care as part of standardized oncology care regardless of stage. Methods: This assessment utilized Oncology Care Model (OCM) data for Jefferson Medicare patients between 7/1/16 to 7/31/18. Incidence of ED admits ED/Observation and admissions were evaluated as well as ICU utilization and advanced care planning. Poisson regression was used to generate incidence rate ratios (IRR) and 95% confidence intervals (CI) to facilitate the comparison of post- vs. pre- incidence rates of hospitalization. Results: The post-intervention hospital admissions decreased by 31% in NCSMCS (IRR 0.69; 95% CI 0.48-0.98) and by 10% in Non-NCSMCS (IRR 0.90; 0.84-0.96) and advanced care plans were more likely to be on file for NCSMCS (9.0% vs. 4.9%). The intensive care unit (ICU) admissions were decreased by 17% among Non-NCSMCS (IRR 0.83; 95% CI 0.74-0.93). The utilization rates for ED admissions were not statistically different among both the groups. Conclusions: The preliminary data is promising and impact will be monitored as the intervention is expanded. Reducing admissions has benefits from both a cost savings as well as quality of life perspective. Future analyses will consider the impact of the intervention on a patient’s quality of life.

Palliative Care Unit at Home: Impact on Quality of Life in Cancer Patients at the End of Life in a Rural Environment

2021 ◽  
pp. 104990912110383
Author(s):  
Maria Elena Iriarte Moncho ◽  
Vicente Palomar-Abril ◽  
Teresa Soria-Comes
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Medical Department ◽  
The Impact ◽  
At Home

Introduction: Advanced cancer is accompanied by a substantial burden of symptoms, and palliative care (PC) plays an essential role, especially at the end of life (EOL). In fact, a comprehensive PC through Home Palliative Care Units (HPCU) has been associated with reducing potentially aggressive care at the EOL. We aim to study the impact of HPCU on the quality of assistance of cancer patients at Alcoy Health Department. Methods: A retrospective study was conducted including patients diagnosed with terminal cancer at the Medical Department of Hospital Virgen de los Lirios who died between January 2017 and December 2018. The Multivariate Cox regression model was used to assess the impact of HPCU assistance on the quality of life indicators. Results: 388 patients were included. The median age was 71 years; 65% patients were male, and 68% presented with a 0-2 score on the ECOG scale. On the multivariate analysis, a lack of assistance by HPCU was associated with a higher risk of consulting in the emergency department (OR = 1.29, 95% CI: 1.02-1.67), of hospital admissions (OR = 4.72, 95% CI: 2.45-9.09), a higher probability of continuing active treatment (OR = 2.59, 95% CI: 1.44-4.67), and a greater probability of dying in hospital (OR = 6.52, 95% CI: 3.78-11.27). Conclusions: Patients receiving HPCU assistance have a lower number of emergency room visits and hospital admissions, and are more likely to die at home. Taken together, these results support the relevance of HPCU providing a high quality attention of cancer patients.

scholarly journals A multistage mixed methods study protocol to evaluate the implementation and impact of a reconfiguration of acute medicine in Ireland’s hospitals

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
E. Hurley ◽  
S. McHugh ◽  
J. Browne ◽  
L. Vaughan ◽  
C. Normand
Keyword(s):  
Mixed Methods ◽  
Hospital Stay ◽  
Patient Care ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Length Of Hospital Stay ◽  
Comparative Case Study ◽  
Medical Patients ◽  
Acute Medicine ◽  
The Impact

Abstract Background To address deficits in the delivery of acute services in Ireland, the National Acute Medicine Programme (NAMP) was established in 2010 to optimise the management of acutely ill medical patients in the hospital setting, and to ensure their supported discharge to primary and community-based care. NAMP aims to reduce inappropriate hospital admissions, reduce length of hospital stay and ensure patients receive timely treatment in the most appropriate setting. It does so primarily via the development of Acute Medical Assessment Units (AMAUs) for the rapid assessment and management of medical patients presenting to hospitals, as well as streamlining the care of those admitted for further care. This study will examine the impact of this programme on patient care and identify the factors influencing its implementation and operation. Methods We will use a multistage mixed methods evaluation with an explanatory sequential design. Firstly, we will develop a logic model to describe the programme’s outcomes, its components and the mechanisms of change by which it expects to achieve these outcomes. Then we will assess implementation by measuring utilisation of the Units and comparing the organisational functions implemented to that recommended by the NAMP model of care. Using comparative case study research, we will identify the factors which have influenced the programme’s implementation and its operation using the Consolidated Framework for Implementation Research to guide data collection and analysis. This will be followed by an estimation of the impact of the programme on reducing overnight emergency admissions for potentially avoidable medical conditions, and reducing length of hospital stay of acute medical patients. Lastly, data from each stage will be integrated to examine how the programme’s outcomes can be explained by the level of implementation. Discussion This formative evaluation will enable us to examine whether the NAMP is improving patient care and importantly draw conclusions on how it is doing so. It will identify the factors that contribute to how well the programme is being implemented in the real-world. Lessons learnt will be instrumental in sustaining this programme as well as planning, implementing, and assessing other transformative programmes, especially in the acute care setting.

scholarly journals O-22 The impact of a new children’s palliative care service on place of death: giving families choices

2021 ◽  
Author(s):  
Joanna Elverson ◽  
Helen Aspey ◽  
Owen Lever ◽  
Ellie Bond ◽  
Christine Mackerness ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Place Of Death ◽  
The Impact

scholarly journals Care Integration Decreases Hospitalization Costs: Retrospective Cohort Study of Palliative Care Consult Service for Hospital Patients With Metastatic Cancer

2020 ◽  
Author(s):  
Antal Tamás Zemplenyi ◽  
Ágnes Csikós ◽  
Petra Fadgyas-Freyler ◽  
Marcell Csanádi ◽  
Zoltán Kaló ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Hospital Admissions ◽  
Metastatic Cancer ◽  
Cost Of Care ◽  
Index Number ◽  
Consult Service ◽  
Complex Needs ◽  
Hospitalization Costs ◽  
The Impact

Abstract Background: Palliative Care Consult Service (PCCS) programme was established in Hungary to provide palliative care to hospitalized patients with complex needs and to manage the patients’ pathway when discharged from the hospital. The aim of this study was to measure the impact of PCCS on healthcare costs from the perspective of the payer.Methods: Study population consisted of patients with metastatic cancer (identified by TNM status or ICD-10 code), who were admitted to the Clinical Center of the University of Pécs between 1 January 2014 and 31 December 2016. Patients who did not die within 180-days from enrolment were excluded. Patients receiving services from PCCS team (intervention patients) were compared to patients receiving usual care (controls). The two populations were matched using propensity scores based on age, gender, number of tumor affected organs, Charlson comorbidity index, number of hospital admissions in the year prior to enrollment, outpatient visits in 90 days prior to hospitalization, and number of days to death. Data was obtained from electronic health records linked to claims data. Results: 197 matched pairs were identified with comparable characteristics. Mean number of hospital admissions was 2.1 and 2.5 (p =0.020); ratio of hospital deaths was 75% and 86% (p = 0.003); cost of inpatient care was 1,053 EUR and 1,300 EUR (p = 0.013); cost of home hospice care was 58 EUR and 21 EUR (p = 0.003); and total cost of care was 1,719 EUR and 1,982 EUR (p = 0.099) in the intervention and control groups, respectively. Conclusion: This study demonstrated that palliative care consult service for end-stage cancer patients with a very limited prognosis can add value to healthcare by reducing costs associated with hospital stays and unnecessary examinations and treatments. The data suggest that early initiation of palliative care could have even greater implications.

Impact of COVID-19 on Mental Health of Palliative Care Professionals and Services: A Mixed-Methods Survey Study

2021 ◽  
pp. 104990912110570
Author(s):  
Wallace Chi Ho Chan ◽  
Raymond Kam Wing Woo ◽  
Denis Ka-Shaw Kwok ◽  
Clare Tsz Kiu Yu ◽  
Lawrence Man-Hon Chiu
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Palliative Care ◽  
Mixed Methods ◽  
Professional Quality Of Life ◽  
Care Services ◽  
Professional Quality ◽  
Palliative Care Services ◽  
The Impact

Introduction This study aimed to examine the mental health of palliative care professionals in Hong Kong during the COVID-19 pandemic, the relationship of mental health with socio-demographic factors, and the impact of the pandemic on palliative care services. Methods A total of 142 palliative care professionals in Hong Kong participated in an online survey. The questionnaire includes measurements on depression, anxiety, perceived stress, post-traumatic stress, professional quality of life, items that measure the effect of COVID-19 on palliative care services, and one open-ended question for describing how the services were affected. Descriptive and multivariate regression analyses were conducted. Quantitative and qualitative data about the impact of COVID-19 on palliative care services were analyzed and triangulated using a mixed-methods approach. Results Up to 82%, 43%, and 42% of the participants felt moderately to highly stressed, anxious, and depressed, respectively, during the pandemic. Younger participants tended to have poorer mental health and professional quality of life. Around 82% felt stressed when communicating with patients and family members under the no-visiting policy during the pandemic. More than three-quarters of participants showed lack of confidence in the anti-epidemic policy of the government. Qualitative findings identified 3 themes affecting the provision of palliative care: 1. the tightening of restrictions on visitors; 2. the limited provision of services; and 3. staff deployment. Conclusions Appropriate responses are required to give extra support to palliative care professionals during the pandemic and facilitate their coping with the impact of COVID-19 on the provision of palliative care.

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