Improving specialist palliative care in residential care for older people: a checklist to guide practice

2017 ◽  
Vol 8 (3) ◽  
pp. 347-353 ◽  
Author(s):  
Liz Forbat ◽  
Michael Chapman ◽  
Clare Lovell ◽  
Wai-Man Liu ◽  
Nikki Johnston
Keyword(s):  
Palliative Care ◽  
Older People ◽  
Residential Care ◽  
Participant Observation ◽  
Qualitative Interviews ◽  
Symptom Burden ◽  
Ethnographic Study ◽  
Specialist Palliative Care ◽  
Care Needs ◽  
Palliative Care Needs

ObjectivesPalliative care needs rounds are triage meetings that have been introduced in residential care for older adults to help identify and prioritise care for people most at risk for unplanned dying with inadequately controlled symptoms. This study sought to generate an evidence-based checklist in order to support specialist palliative care clinicians integrate care in residential nursing homes for older people.MethodsA grounded theory ethnographic study, involving non-participant observation and qualitative interviews. The study was conducted at four residential facilities for older people in one city. Observations and recordings of 15 meetings were made, and complimented by 13 interviews with staff attending the needs rounds.ResultsThe palliative care needs round checklist is presented, alongside rich description of how needs rounds are conducted. Extracts from interviews with needs rounds participants illustrate the choice of items within the checklist and their importance in supporting the evolution towards efficient and effective high-quality specialist palliative care input to the care of older people living in residential care.ConclusionsThe checklist can be used to support the integration of specialist palliative care into residential care to drive up quality care, provide staff with focused case-based education, maximise planning and reduce symptom burden for people at end of life.

scholarly journals What makes palliative care needs “complex”? A multisite sequential explanatory mixed methods study of patients referred for specialist palliative care

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anne M. Finucane ◽  
Connie Swenson ◽  
John I. MacArtney ◽  
Rachel Perry ◽  
Hazel Lamberton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Healthcare Professionals ◽  
Psychological Needs ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Care Needs ◽  
Complex Needs ◽  
Sequential Explanatory ◽  
Palliative Care Needs

Abstract Background Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service. Methods Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly. Conclusions Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.

scholarly journals Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes

2020 ◽  
Vol 34 (5) ◽  
pp. 571-579 ◽  
Author(s):  
Liz Forbat ◽  
Wai-Man Liu ◽  
Jane Koerner ◽  
Lawrence Lam ◽  
Juliane Samara ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Care Home ◽  
Care Homes ◽  
Randomised Control Trial ◽  
Specialist Palliative Care ◽  
Stepped Wedge ◽  
Model Of Care ◽  
Care Needs ◽  
Palliative Care Needs

Background: Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. Aim: To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. Design: Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. Setting/participants: 1700 residents in 12 Australian care homes for older people. Results: Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: −0.44, −0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). Conclusion: The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.

scholarly journals Symptom Burden and Palliative Care Needs Among High-Risk Veterans With Multimorbidity

2019 ◽  
Vol 57 (5) ◽  
pp. 880-889 ◽  
Author(s):  
Lynn F. Reinke ◽  
Elizabeth K. Vig ◽  
Erica V. Tartaglione ◽  
Peter Rise ◽  
David H. Au
Keyword(s):  
Palliative Care ◽  
High Risk ◽  
Symptom Burden ◽  
Care Needs ◽  
Palliative Care Needs

scholarly journals The Role of Palliative Care in Oncology

2017 ◽  
Vol 34 (04) ◽  
pp. 307-312 ◽  
Author(s):  
Rajiv Agarwal ◽  
Andrew Epstein
Keyword(s):  
Palliative Care ◽  
Symptom Burden ◽  
Well Being ◽  
Care Needs ◽  
Patients With Cancer ◽  
Living With Cancer ◽  
Palliative Care Needs ◽  
Shed Light

AbstractPalliative care is a powerful adjunct to oncology that adds distinct value to the physical, mental, and psychosocial well-being of patients living with cancer. Its expanding role and integration with standard oncologic care has proven clinical benefit, as the practice of palliative care can help alleviate symptom burden, enhance illness and prognostic understanding, and improve both the quality of life and overall survival for patients. The primary aim of this review article is to highlight the significant interplay between palliative care and oncology and, in doing so, shed light on the areas for improvement and modern challenges that exist to meet the complex palliative care needs of patients with cancer.

Palliative care in the nursing home

2015 ◽  
Author(s):  
Jane L. Phillips ◽  
Annmarie Hosie ◽  
Patricia M. Davidson
Keyword(s):  
Palliative Care ◽  
Nursing Homes ◽  
Older People ◽  
Care Needs ◽  
Allied Health Professionals ◽  
Family Structures ◽  
Technological Advances ◽  
Challenges And Opportunities ◽  
Care Outcomes ◽  
Palliative Care Needs

Internationally, ageing, technological advances, evolving patterns of disease and disability, and changes in family structures have resulted in nursing homes becoming the final residence for many frailer older people. Much of the on-site assistance with activities of daily living in nursing homes is predominately provided by an unregulated or minimally trained carer workforce with registered nurse supervision, while professional nursing and medical care is provided either by on-site or visiting doctors, nurses, and allied health professionals from external services. This chapter details the palliative care needs of older people living in nursing homes and the challenges and opportunities to deliver better end-of-life care to this population, and proposes utilizing the Chronic Care Model as a framework for delivering the elements of a palliative approach to improve care outcomes for residents and their families.

Seeking Excellence in End of Life Care (SEE Care): A Multi-Centered Acute Hospitals Service Evaluation

2021 ◽  
pp. 104990912110278
Author(s):  
Simon Tavabie ◽  
Anja Berglund ◽  
David Barclay ◽  
Steve Bass ◽  
Naomi Collins ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life Care ◽  
Service Evaluation ◽  
Hospital Inpatient ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Care Needs ◽  
Care Plans ◽  
Inpatient Population ◽  
Palliative Care Needs

Context: A proportion of UK hospital inpatients have palliative care needs but do not access specialist services. Objectives: To contemporaneously evaluate the significance of unmet specialist palliative care needs within the hospital inpatient population. Methods: Prospective multi-centered service evaluation was conducted through 4 snapshots across 4 acute NHS hospital trusts. All patients identified as dying in each hospital were included. Data extraction included symptom burden, medications and completion of care plans. Results: End-of-life care plans were completed for 73%, symptom-focused prescribing present in 96%. Symptoms were not well managed for 22%, with 4% suffering moderate to severely. Specific intervention was triggered in 56% of patients, consisting of prescribing advice and holistic support. Conclusion: There are significant unmet specialist palliative care needs within the hospital inpatient population. Contemporaneous data collection coupled with an outreach approach helps palliative care services better understand the experiences of dying people, alongside where improvement is needed.

scholarly journals What Makes Palliative Care Needs “Complex”?: A Multisite Sequential Explanatory Mixed Methods Study of Patients Referred to Specialist Palliative Care

2020 ◽  
Author(s):  
Anne Finucane ◽  
Connie Swenson ◽  
John I MacArtney ◽  
Rachel Perry ◽  
Hazel Lamberton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Healthcare Professionals ◽  
Psychological Needs ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Care Needs ◽  
Complex Needs ◽  
Sequential Explanatory ◽  
Palliative Care Needs

Abstract Background: Specialist palliative care (SPC) providers tend to use the term ‘complex need’ to refer to the needs of patients who require SPC. However, little is known about “complex needs” on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on first referral to a hospice service. Methods: Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results: Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived as influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly.Conclusions: Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed specialist palliative care knowledge or support to meet their needs. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of specialist palliative care input.

scholarly journals Development of an Early Warning System to Prevent Crises in the Palliative Home Care Setting of Patients and Their Informal Caregivers: Protocol for a Mixed Method Study

10.2196/13933 ◽  
2019 ◽  
Vol 8 (11) ◽  
pp. e13933 ◽  
Author(s):  
André Fringer ◽  
Eleonore Arrer ◽  
Edith Maier ◽  
Wilfried Schnepp ◽  
Tom Ulmer
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Early Warning ◽  
Early Warning System ◽  
Care Setting ◽  
Symptom Burden ◽  
Warning System ◽  
Care Needs ◽  
Palliative Care Needs ◽  
At Home

Background Most people wish to die at home, but most people in Switzerland die in hospitals or nursing homes. Family caregivers often offer support so patients with palliative care needs can stay at home for as long as possible. However, crises and unplanned hospital admissions often occur in this setting because of family caregiver strain and symptom severity in patients. The so-called smart devices such as wearables or smartphones offer the opportunity to continuously monitor certain parameters and recording symptom deteriorations. By providing professionals with this information in a timely manner, crises in the home could be avoided. Objective The aim of this interdisciplinary study is to explore the symptom burden of people with palliative care needs who are cared for at home and to understand the development of crises in the home care setting. On the basis of the findings from this study, we will develop an early warning system to stabilize the home care situation and to prevent critical events from happening, thereby reducing avoidable hospitalizations. Methods A mixed method study is being conducted consisting of 4 main consecutive phases: (1) developing the monitoring system; (2) pretesting the system and adapting it to user needs; (3) conducting the study in the palliative home care setting with approximately 40 patients; and (4) distinguishing symptom patterns from the collected data specific to crisis emergence, followed by the development of an early warning system to prevent such crises. In study phase 3, each patient will receive an upper arm sensor and a symptom diary to assess symptom burden related to patients and family caregivers. A within-case analysis will be conducted for each patient’s situation followed by a cross-case comparison to identify certain symptom patterns that may predict symptom deterioration (study phase 4). Results The collaboration with the local mobile palliative care team for participant recruitment and data collection has been established. Recruitment is forthcoming. Conclusions We expect the findings of this study to provide holistic insight into symptom burden and the well-being of patients with palliative care needs and of their family caregivers. This information will be used to develop an early warning system to avoid the occurrence of potential crises, thereby improving palliative care provision at home. International Registered Report Identifier (IRRID)  PRR1-10.2196/13933

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