Palliative care transitions from acute care to community-based care: A qualitative systematic review of the experiences and perspectives of health care providers

2020 ◽  
Vol 34 (10) ◽  
pp. 1316-1331 ◽  
Author(s):  
Tieghan Killackey ◽  
Emily Lovrics ◽  
Stephanie Saunders ◽  
Sarina R. Isenberg
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Acute Care ◽  
Health Care Providers ◽  
Thematic Analysis ◽  
Healthcare Providers ◽  
Discharge Process ◽  
Care Providers ◽  
Community Based ◽  
Qualitative Systematic Review

Background: Transitioning from the hospital to community is a vulnerable point in patients’ care trajectory, yet little is known about this experience within the context of palliative care. While some studies have examined the patient and caregiver experience, no study to date has synthesized the literature on the healthcare provider’s perspective on their role and experience facilitating these transitions. Aim: The purpose of this systematic review was to understand the experience and perspective of healthcare providers who support the transition of patients receiving palliative care as they move from acute care to community settings. Design: A qualitative systematic review of studies using thematic analysis as outlined by Thomas and Harden. PROSPERO: ID # CRD42018109662. Data Sources: We searched four databases: MEDLINE, Embase, ProQuest and CINAHL for studies published in English from 1995 until May 22, 2020. Four reviewers screened records using the following selection criteria: (1) peer-reviewed empirical study, (2) adult sample, (3) qualitative study design, (4) perspective of healthcare providers, and (5) included a component of transitions between acute to community-based palliative care. Study findings were analyzed using thematic analysis which entailed: (1) grouping the findings into recurring themes; (2) iteratively referring back to the articles to obtain nuances of the theme and quotations; and (3) defining and solidifying the themes. Results: Overall 1,791 studies were identified and 15 met inclusion criteria. Studies were published recently (>2015, n = 12, 80%) and used a range of qualitative methods including semi-structured interviews, focus groups, and field interviews. Three core themes related to the role and experience of healthcare providers were identified: (1) assessing and preparing for transition; (2) organizing and facilitating the logistics of transition; and (3) coordinating and collaborating transitional care across sectors. The majority of studies focused on the discharge process from acute care; there was a lack of studies exploring the experiences of healthcare providers in the community who receive patients from acute care and provide them with palliative care at home. Conclusion: This review identified studies from a range of relatively high-income countries that included a diverse sample of healthcare providers. The results indicate that healthcare providers experience multiple complex roles during the transition facilitation process, and future research should examine how to better assist clinicians in supporting these transitions within the context of palliative care provision.

Healthcare providers’ views and experiences of non-specialist palliative care in hospitals: A qualitative systematic review and thematic synthesis

2020 ◽  
Vol 34 (5) ◽  
pp. 605-618 ◽  
Author(s):  
Mary Nevin ◽  
Geralyn Hynes ◽  
Valerie Smith
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Acute Care ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Specialist Palliative Care ◽  
Care Needs ◽  
Thematic Synthesis ◽  
Qualitative Systematic Review ◽  
Palliative Care Needs

Background: Healthcare providers working in hospitals are frequently exposed to patients with palliative care needs. For most patients, these reflect non-specialist rather than specialist palliative care needs. Embedding palliative care principles early in patients’ disease trajectories within acute care delivery in hospitals, however, is a challenge. How to best understand the experiences of those providing non-specialist palliative care in hospitals has not been systematically assessed. Aim: To synthesise the evidence on healthcare providers’ views and experiences of non-specialist palliative care in hospitals. Design: A qualitative systematic review and thematic synthesis using Thomas and Harden’s thematic synthesis framework. Data sources: Databases of MEDLINE, CINAHL, PsycINFO and EMBASE were searched from date of inception to March 2018. Studies were eligible for inclusion if they reported on healthcare providers’ views and experiences of non-specialist palliative care in hospitals. Studies were appraised for quality but not excluded on that basis. The review was prospectively registered with the International Prospective Register of Systematic Reviews. Results: Thirty-nine papers of 37 studies were included, representing 985 hospital healthcare providers’ views and experiences. Four major analytical themes emerged; ‘Understanding of Palliative Care’, ‘Complexities of Communication’, ‘Hospital Ecosystem’ and ‘Doctors and Nurses – a Different Lens’. Conclusions: Non-specialist palliative care in hospitals is operationalised as care in the last weeks and days of life. The organisation of acute care, inter-disciplinary working practices, clinician attitudes, poor communication structures and lack of education and training in palliative care principles exacerbates poor implementation of this care earlier for patients in hospitals.

scholarly journals Managing Sexual Dysfunction For Women With Breast Cancer: The Perspective Of Health Care Providers In North East Malaysia.

2021 ◽  
Author(s):  
Siti Balqis Chanmekun ◽  
Maryam Mohd Zulkifli ◽  
Rosediani Muhamad ◽  
Norhasmah Mohd Zain ◽  
Wah Yun Low ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sexual Dysfunction ◽  
Sexual Health ◽  
Health Care Providers ◽  
Thematic Analysis ◽  
Healthcare Providers ◽  
Phenomenological Approach ◽  
Care Providers ◽  
North East ◽  
East Malaysia

Abstract Purpose: Management of female sexual dysfunction (FSD) is vital for women with breast cancer due to the devastating consequences, which include marital disharmony and reduced quality of life. We explore healthcare providers’ (HCPs) perceptions and experiences in managing FSD for women living with breast cancer using phenomenological approach. Methods: This qualitative study was conducted using a face-to-face interview method to HCPs from two tertiary hospitals in North East Malaysia. The interviews were recorded, transcribed verbatim, and transferred to NVivo ® for data management. The transcriptions were analyzed using thematic analysis. Results: Three key barriers were identified through the thematic analysis: a scarcity of related knowledge; the influence of socio-cultural ideas about sex; and the speciality-centric nature of the healthcare system. Most HCPs interviewed had a very narrow understanding of sexuality, were unfamiliar with the meaning of FSD, and felt their training on sexual health issues to be very limited. They viewed talking about sex to be embarrassing to both parties that is, both to HCPs and patients and was therefore not a priority. They focused more on their specialty hence limited the time to discuss sexual health and FSD with their patients. Conclusion: Therefore, interventions to empower the knowledge, break the sociocultural barriers and improve the clinic settings are crucial for HCPs in managing FSD confidently.

scholarly journals Community-Based Intervention to Increase Usage of Medication Disposal Bins

2019 ◽  
Author(s):  
Sanjhavi Agarwal ◽  
Jordan Burr ◽  
Charis Darnell ◽  
Brett Ellison ◽  
Amir El-Khalili ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Healthcare Providers ◽  
Health Centers ◽  
P Value ◽  
Care Providers ◽  
Community Based ◽  
Before And After ◽  
Provider Knowledge ◽  
Informational Intervention ◽  
Medication Disposal

Despite the existence of medical waste disposal sites, many patients do not know how to discard their unused and expired medications. The goal of this project is to assess health care providers’ knowledge regarding proper medication disposal (PMD) and to measure the effectiveness of a brief provider informational intervention regarding PMD. Changes in knowledge were evaluated using paper pre and post surveys. The surveys were administered anonymously before and after the presentation. Principal findings: A total of 55 healthcare providers (Clinic A n = 25, Clinic B n = 28) received the PMD presentation. 52 (95%) completed the pre and post surveys. Pre-intervention knowledge of PMD was higher in Clinic B where there was an existing medication disposal box (92% accuracy) compared to Clinic B which did not have a medical disposal bin (52% accuracy). Surveys results showed improvement in 36% of Clinic A participants and 14.3% of Clinic B participants (p value = 0.0086). Based on these findings, we can conclude that the presence of a medication disposal bin is positively correlated with provider knowledge regarding PMD. This may be used to encourage the institution of medication disposal bins in more health centers and an increase in medical staff knowledge of the practice.

Bedrails and Falls in Nursing Homes: A Systematic Review

2020 ◽  
pp. 105477382090780
Author(s):  
David Huynh ◽  
Olivia N. Lee ◽  
Phuong M. An ◽  
Twyla A. Ens ◽  
Cynthia A. Mannion
Keyword(s):  
Systematic Review ◽  
Nursing Homes ◽  
Health Care Providers ◽  
Assisted Living ◽  
Fall Prevention ◽  
Adult Population ◽  
Healthcare Providers ◽  
Primary Data ◽  
Care Providers ◽  
Prevention Measures

Bedrail use for fall prevention in elderly clients (>65 years) is controversial. Some healthcare providers believe bedrails prevent falls, while others think they are ineffective and dangerous. A systematic review was conducted to address: “For older adults living in nursing homes, does more or less bedrail use reduce the incidence of falls?” We searched HealthStar, MEDLINE, CINAHL, Academic Search complete ProQuest and Canadian Health Research Collection using “elder*,” “bedrail*,” “fall*,” and “assisted-living*.” After filtering for primary data, English records, older adult population, relationship between bedrails and falls, fourteen studies remained. Results suggest using alternative fall prevention measures, and bedrails are either beneficial, harmful, or do not influence falls. Bedrail reduction with fall prevention interventions led to no changes in fall frequency. Ambiguity persists regarding fall frequencies and bedrail use without using other fall prevention strategies. Educating health care providers on fall prevention is key to patient safety.

scholarly journals Palliative Care Transitions from Acute Care to Community-Based Care—A Systematic Review (FR420A)

2020 ◽  
Vol 59 (2) ◽  
pp. 457
Author(s):  
Sarina Isenberg ◽  
Tieghan Killackey ◽  
Allison Kurahashi ◽  
Chris Walsh ◽  
Kirsten Wentlandt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Acute Care ◽  
Care Transitions ◽  
Community Based

scholarly journals Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments

BMJ Open ◽  
2017 ◽  
Vol 7 (5) ◽  
pp. e014719 ◽  
Author(s):  
Mark Harrison ◽  
Katherine Milbers ◽  
Marie Hudson ◽  
Nick Bansback
Keyword(s):  
Systematic Review ◽  
Healthcare Provider ◽  
Discrete Choice ◽  
Health Care Providers ◽  
Healthcare Providers ◽  
Choice Experiments ◽  
Discrete Choice Experiments ◽  
Care Providers ◽  
Healthcare Interventions ◽  
Heterogeneity Of Preferences

ObjectivesTo review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and whether comparisons are made at the aggregate level or account for individual heterogeneity; and (2) quantify the extent to which they demonstrate concordance of patient and healthcare provider preferences.MethodsA systematic review searching Medline, EMBASE, Econlit, PsycINFO and Web of Science for DCEs using patient and healthcare providers. Inclusion criteria: peer-reviewed; complete empiric text in English from 1995 to 31July 2015; discussing a healthcare-related topic; DCE methodology; comparing patients and healthcare providers.DesignSystematic review.ResultsWe identified 38 papers exploring 16 interventions in 26 diseases/indications. Methods to analyse results, determine concordance between patient and physician values, and explore heterogeneity varied considerably between studies. The majority of studies we reviewed found more evidence of mixed concordance and discordance (n=28) or discordance of patient and healthcare provider preferences (n=12) than of concordant preferences (n=4). A synthesis of concordance suggested that healthcare providers rank structure and outcome attributes more highly than patients, while patients rank process attributes more highly than healthcare providers.ConclusionsDiscordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully report the framing of the questions and investigate the heterogeneity of preferences within groups and how these compare.

scholarly journals The importance of providing palliative care for patients with severe COVID-19 in Indonesia

2021 ◽  
Author(s):  
Christantie Effendy ◽  
Martina Sinta Kristanti
Keyword(s):  
Palliative Care ◽  
Health Care Providers ◽  
Health Workers ◽  
Psychosocial Support ◽  
Healthcare Providers ◽  
Care Providers ◽  
Case Scenario ◽  
Severe Condition ◽  
Dying With Dignity ◽  
The Common

Patients with Coronavirus Disease 2019 (COVID-19), particularly those with a severe condition, might not survive. Pandemic situation challenges the healthcare providers in addressing palliative care to the patients. This paper aimed to describe the importance of providing palliative care for patients with severe COVID-19 in Indonesia. We used a case scenario to illustrate the common condition experienced by a patient with severe COVID-19. Health care providers in Indonesia could address palliative care for patients with COVID-19 by focusing on controlling the symptoms, avoiding futile intervention, and connecting the patients and their families. Nurses need to consider the patients’ needs for family supports, even though not in physical or psychosocial support, and help the patients who need end-of-life care to be dying with dignity. Communication technology must be utilized optimally by healthcare providers to realize the communication among the patients, families, and health workers. 

scholarly journals Spiritual Care in Advanced Dementia from the Perspective of Health Providers: A Qualitative Systematic Review

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Lucía Rocío Camacho-Montaño ◽  
Jorge Pérez-Corrales ◽  
Marta Pérez-de-Heredia-Torres ◽  
Ana María Martin-Pérez ◽  
Javier Güeita-Rodríguez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Qualitative Research ◽  
Health Care Providers ◽  
Spiritual Care ◽  
Spiritual Needs ◽  
Health Providers ◽  
Care Providers ◽  
Advanced Dementia ◽  
Research Guidelines ◽  
Qualitative Systematic Review

Background. Worldwide, 47 million people suffer from dementia. Despite recognizing the importance of spirituality within dementia care, it is still unclear how this should be integrated into dementia services. Aim. To explore the perspective of health professionals regarding the spiritual care of people with advanced dementia. Methods. A qualitative systematic review was performed following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines for the study design. The inclusion criteria included original articles published from January 2008 to March 2019, using either qualitative or mixed methods. The quality of the articles included was evaluated using the consolidated criteria for reporting qualitative research, Standards for Reporting Qualitative Research, and the Critical Appraisal Skills Programme. Synthesis of findings was performed using thematic analysis. Results. Twelve studies were included in the review. Seventeen categories were identified, grouped into four themes: (1) the perception of spirituality, including the failure to address the same, (2) the spiritual needs of people with advanced dementia, (3) spiritual needs from health care providers, and (4) addressing spirituality, with the following categories: music, significant activities, among others. Conclusions. Spirituality is not formally addressed in this population, and professionals do not feel confident enough to be able to integrate spirituality in their care. It is necessary to identify and record the spiritual needs of people with advanced dementia, as well as to design specific care programs.

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