scholarly journals ‘It’s not what they were expecting’: A systematic review and narrative synthesis of the role and experience of the hospital palliative care volunteer

2020 ◽  
Vol 34 (5) ◽  
pp. 589-604 ◽  
Author(s):  
Melissa J Bloomer ◽  
Catherine Walshe
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Health Professionals ◽  
Psychosocial Support ◽  
Narrative Synthesis ◽  
Dying Patients ◽  
Hands On ◽  
High Acuity ◽  
Positive Work Relationships ◽  
And Training

Background: Volunteers make a major contribution to palliative care but little is known specifically about hospital palliative care volunteers. Aim: The aim of this study was to understand the role and experience of hospital palliative care volunteers. Design: Systematic review and narrative synthesis. Data sources: CINAHL, Embase, Medline, PsycINFO, PubMed and three dissertation databases were searched from inception to June 2019. A forward and backward search of included papers in key journals was also undertaken. Records were independently assessed against inclusion criteria by authors. Included papers were assessed for quality, but none were excluded. Results: In total, 14 papers were included. Hospital palliative care volunteers were mostly female, aged above 40 years, and training varied considerably. Volunteers faced unique challenges in supporting dying patients due to the nature of hospital care, rapid patient turnover and the once-off nature of support. Volunteer roles were diverse, with some providing hands-on care, but most focused on ‘being with’ the dying patient. Volunteers were appreciated for providing psychosocial support, seen as complementary to, rather than replacing the work of health professionals. Given volunteers were often required to work across multiple wards, establishing positive work relationships with health professionals was challenging. Divergent views about whether the volunteer was part of or external to the team impacted volunteers’ experience and perceptions of the value of their contribution. Conclusion: Hospital palliative care volunteers face unique challenges in supporting terminally ill patients. Volunteer support in hospital settings is possible and appropriate, if sufficient support is available to mitigate the challenges associated with complex, high-acuity care.

48 Junior doctors and end of life care: a systematic review and narrative synthesis

2018 ◽  
Vol 8 (3) ◽  
pp. 378.1-378
Author(s):  
Aamena Bharmal ◽  
Tessa Morgan ◽  
Stephen Barclay
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Empirical Literature ◽  
Junior Doctors ◽  
List Type ◽  
Narrative Synthesis ◽  
Life Care ◽  
Dying Patients

BackgroundNearly 50% of all deaths in the UK occur in hospitals.1 The majority of these patients die in a generalist setting2 where their medical care is predominately provided by junior doctors. There is a growing recognition of a need to embed palliative care into doctors’ training.3Little evidence exists, however, concerning junior doctors’ current experiences of palliative care.AimsTo review the empirical literature between 2000 and 2018 concerning junior doctors experience of and preparation for palliative and end of life care.MethodsSystematic review and narrative synthesis of qualitative and quantitative studies within six databases to find empirical studies on junior doctors experience of adult palliative care in inpatient hospital or hospice settings.ResultsFrom the initial 6308 titles identified, 32 studies met the inclusion criteria with a further five identified from reference searching.Three key themes were identified:‘Significance of death and dying’‘Thrown into the deep end’‘Addressing the gaps’. All the studies provided evidence that junior doctors care for many dying patients very early in their career. Junior doctors do not feel adequately prepared to care for dying patients and feel unsupported when doing so. Junior doctors report emotional distress when caring for their first few dying patients, memories of which continue to affect them throughout their careers. Their attitudes towards end–of–life care varied: some reported it as a privilege while others associated it with a culture of disengagement that stigmatised dying patients.ConclusionsJunior doctors need further support, education and preparation for their exposure to palliative care. Experiential learning, reflective practice and role modelling are described as the most effective ways to learn palliative care and this also teaches them other transferrable skills such as communication, teamwork and professionalism that are vital for their future careers.References. Office for National Statistics Deaths Registered in England and Wales2016.. Gomes B, Higginson I. Where people die (1974–2030): Past trends, future projections and implications for care. Palliative Med2008;22:33–41.. General Medical Council. Tomorrow’s doctors: Recommendations on undergraduate medical education 2002 (2nd ed.). London: GMC.

Occupational Stress, Burnout, and Professional Support in Nurses Working with Dying Patients

1996 ◽  
Vol 32 (2) ◽  
pp. 93-109 ◽  
Author(s):  
Anne Plante ◽  
Louise Bouchard
Keyword(s):  
Palliative Care ◽  
Occupational Stress ◽  
Medical Oncology ◽  
Professional Support ◽  
Stress Factors ◽  
Metropolitan Region ◽  
Staff Burnout ◽  
Dying Patients ◽  
The Relationship ◽  
And Training

Nurses working with dying people are exposed to numerous stress factors. Their occupational stress may be so important as to lead to burnout. The aim of the present study is to examine the relationship among occupational stress, burnout, and professional support in nurses working with patients dying from cancer. The study has taken place in four palliative care and three medical oncology units of the Montreal metropolitan region. In all, seventy-six nurses of the N nurses fitting the entrance criteria of the study were selected. Participants completed a French version of the following instruments: the Occupational Stress of Nurses Working with Dying Patients, the Jones Staff Burnout Scale for Health Professionals and the Professional Support Scale. Results indicate that there is a significant relationship between occupational stress and burnout ( r = 0.462, p < 0.001) and between professional support and burnout ( r = −0.449, p < 0.001). Further, the results showed that the level of occupational stress and burnout was significantly lower for the palliative care nurses who received significantly more professional support than their colleagues working in medical oncology units. Professional support and training for nurses working with patients dying from cancer should be implemented in order to minimize the development of burnout.

scholarly journals Medical student confidence in care of the dying and their family: a systematic review

2020 ◽  
pp. bmjspcare-2019-001977
Author(s):  
Geoffrey Wells ◽  
Elaney Youssef ◽  
Rebecca Winter ◽  
Juliet Wright ◽  
Carrie Llewellyn
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Medical Student ◽  
Cochrane Review ◽  
Assessment Tools ◽  
Junior Doctors ◽  
Medical Council ◽  
Dying Patients ◽  
Medical Undergraduate ◽  
Student Confidence

BackgroundThe General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying.AimThis systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients.DesignA systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools and details of applied educational interventions. Pre/postintervention confidence comparisons were made. Factors influencing confidence levels were explored.Data sourcesMEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsycINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms ‘medical student’, ‘confidence’ and ‘dying’, alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsFifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased postinterventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence.ConclusionThis review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning.PROSPERO registration numberCRD42019119057.

scholarly journals Specialist palliative care services for older people in primary care: A systematic review using narrative synthesis

2019 ◽  
Vol 34 (1) ◽  
pp. 32-48 ◽  
Author(s):  
Kim de Nooijer ◽  
Yolanda WH Penders ◽  
Lara Pivodic ◽  
Nele J Van Den Noortgate ◽  
Peter Pype ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Palliative Care ◽  
Older People ◽  
Narrative Synthesis ◽  
Specialist Palliative Care ◽  
Family Carers ◽  
Care Services ◽  
Specialist Services ◽  
Palliative Care Services

Background: There is recognition that older people with incurable conditions should have access to specialist palliative care services. However, it remains unclear which activities and outcomes these services entail for older people in primary care and to which patients they are provided. Aim: The aim of this review was to identify the criteria for referral to specialist services; who provides specialist palliative care; through which activities and with which frequency; which outcomes are reported; and which suggestions are made to improve services. Design: Systematic review of the literature and narrative synthesis. Quality appraisal and selection of studies were performed independently by two researchers. Participant characteristics, intervention features, outcome data and suggestions for improvement were retrieved. Data sources: Embase, Medline, Web of Science, Cochrane, Google Scholar, PsycINFO and CINAHL EBSCO databases (until June 2019). Results: Ten eligible articles, three qualitative, three quantitative, three mixed-method and one narrative review, were identified. Referral criteria were mainly based on patient characteristics such as diagnosis. The specialist services involved a variety of activities and outcomes and descriptions were often lacking. Services could be improved regarding the information flow between healthcare professionals, greater in-depth palliative care knowledge for case managers and social workers, identification of a key worker and support for family carers. Conclusion: The limited evidence available shows areas for improvement of the quality of and access to specialist services for older people, such as support for family carers. In addition, this review underscores the need for comprehensive reporting of interventions and the use of consensus-based outcome measures.

Consumer and carer leadership in palliative care academia and practice: A systematic review with narrative synthesis

2019 ◽  
Vol 33 (8) ◽  
pp. 959-968 ◽  
Author(s):  
Brett Scholz ◽  
Alan Bevan ◽  
Ekavi Georgousopoulou ◽  
Aileen Collier ◽  
Imogen Mitchell
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Palliative Care ◽  
Service Planning ◽  
Data Sources ◽  
Health Policies ◽  
Narrative Synthesis ◽  
Inclusion Criteria ◽  
Systemic Decision Making ◽  
Synthesis Approach

Background: Contemporary health policies call for consumers to be part of all aspects of service planning, implementation, delivery and evaluation. The extent to which consumers are part of the systemic decision-making levels of palliative care appears to vary between and within services and organisations. Aim: The aim of this systematic review is to develop understandings about consumer and carer leadership in palliative care. Design: A systematic, narrative synthesis approach was adopted due to the heterogeneity of included studies. The review was registered on PROSPERO prospectively (PROSPERO 2018 CRD42018111625). Data sources: PubMed, Scopus and PsycINFO were searched for all studies published in English specifically focusing on consumers’ leadership in palliative care organisations and systems. Articles were appraised for quality using a modified JBI-QARI tool. Results: Eleven studies met the inclusion criteria and quality assessment. Consumers are currently involved in leadership of palliative care teaching, research and services. Findings highlight the benefits of consumer leadership in palliative care including more relevant, higher-quality services, teaching and research. Across the included studies, it was not clear the extent to which consumer leaders had influence in relation to setting agendas across the palliative care sector. Conclusion: The findings suggest that more could be done to support consumer leadership within palliative care. Academics and clinicians might improve the relevance of their work if they are able to more meaningfully partner with consumers in systemic roles in palliative care.

Palliative care for community patients diagnosed with dementia: a systematic review

2019 ◽  
Vol 24 (12) ◽  
pp. 570-575
Author(s):  
Cathryn Smith ◽  
Gina Newbury
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Good Practice ◽  
Community Setting ◽  
Life Care ◽  
Staff Support ◽  
The Uk

Despite many efforts made by health organisations to deliver effective end-of-life care to patients with dementia, research indicates that palliative care is predominantly aimed at patients with terminal cancer, and that patients with dementia face challenges in accessing end-of-life care. This article explores the views of health professionals on providing palliative care to those patients diagnosed with dementia within the community setting. A systematic review of seven qualitative studies was performed to identify the best available evidence. The findings show that effective palliative care for patients with dementia continues being affected by many barriers and challenges. Good practice seems to be inconsistent and fragmented throughout the UK and European countries, and many health professionals are faced with difficulties associated with services and financial implications, training and education, staff support, communication, family support and dementia care.

ASCO Guideline report: Palliative Care in the Global Setting—ASCO Resource-Stratified Practice Guideline.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 85-85
Author(s):  
James F. Cleary ◽  
Hibah Osman ◽  
Nahla Gafer ◽  
Sudip Shrestha ◽  
Zipporah Ali ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Practice Guideline ◽  
Expert Panel ◽  
Psychosocial Support ◽  
Guideline Development ◽  
Indirect Evidence ◽  
Opioid Analgesics ◽  
Models Of Care ◽  
Resource Constrained

85 Background: The purpose of the new ASCO resource-stratified guideline on global palliative care (Osman H, Shrestha S, Temin S, et al, Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline, JGO, 2018) is to provide expert guidance to clinicians and policymakers on implementing palliative care in resource-constrained settings and was intended to complement the 2016 “Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update”. Methods: ASCO convened a multidisciplinary, multinational panel of experts. Guideline development involved a systematic review, a modified ADAPTE process of existing high-quality guidelines and a formal consensus-based process with the expert panel and additional experts (consensus ratings group), as well as open comment. Results: The systematic review included 48 full-text publications regarding palliative care in resource-constrained settings, along with cost-effectiveness analyses; the evidence for many clinical questions was limited. These provided indirect evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% (by consensus ratings group including expert panel). Conclusions: The recommendations help define: the models of care, staffing requirements, and roles and training needs of team members in a variety of resource settings for palliative care. Recommendations also outline the standards for provision of psychosocial support, spiritual care, and opioid analgesics, which can be particularly challenging and often overlooked in resource-constrained settings.

scholarly journals Supportive and palliative care in people with cirrhosis: International systematic review of the perspective of patients, family members and health professionals

2018 ◽  
Vol 69 (6) ◽  
pp. 1260-1273 ◽  
Author(s):  
Joseph T.S. Low ◽  
Gudrun Rohde ◽  
Katherine Pittordou ◽  
Bridget Candy ◽  
Sarah Davis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Health Professionals ◽  
Family Members

scholarly journals Experience of and access to maternity care in the UK by immigrant women: a narrative synthesis systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e029478 ◽  
Author(s):  
Gina Marie Awoko Higginbottom ◽  
Catrin Evans ◽  
Myfanwy Morgan ◽  
Kuldip Kaur Bharj ◽  
Jeanette Eldridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Professionals ◽  
Maternity Care ◽  
Immigrant Women ◽  
Grey Literature ◽  
Further Education ◽  
Social Needs ◽  
Narrative Synthesis ◽  
Foreign Born ◽  
The Uk

One in four births in the UK is to foreign-born women. In 2016, the figure was 28.2%, the highest figure on record, with maternal and perinatal mortality also disproportionately higher for some immigrant women. Our objective was to examine issues of access and experience of maternity care by immigrant women based on a systematic review and narrative synthesis of empirical research.Review methodsA research librarian designed the search strategies (retrieving literature published from 1990 to end June 2017). We retrieved 45 954 citations and used a screening tool to identify relevance. We searched for grey literature reported in databases/websites. We contacted stakeholders with expertise to identify additional research.ResultsWe identified 40 studies for inclusion: 22 qualitative, 8 quantitative and 10 mixed methods. Immigrant women, particularly asylum-seekers, often booked and accessed antenatal care later than the recommended first 10 weeks. Primary factors included limited English language proficiency, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Maternity care experiences were both positive and negative. Women with positive perceptions described healthcare professionals as caring, confidential and openly communicative in meeting their medical, emotional, psychological and social needs. Those with negative views perceived health professionals as rude, discriminatory and insensitive to their cultural and social needs. These women therefore avoided continuously utilising maternity care.We found few interventions focused on improving maternity care, and the effectiveness of existing interventions have not been scientifically evaluated.ConclusionsThe experiences of immigrant women in accessing and using maternity care services were both positive and negative. Further education and training of health professionals in meeting the challenges of a super-diverse population may enhance quality of care, and the perceptions and experiences of maternity care by immigrant women.

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