scholarly journals Palliative care physicians’ motivations for models of practicing in the community: A qualitative descriptive study

2021 ◽  
pp. 026921632110550
Author(s):  
Abby Maybee ◽  
Samantha Winemaker ◽  
Michelle Howard ◽  
Hsien Seow ◽  
Alexandra Farag ◽  
...  
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Family Physician ◽  
Descriptive Study ◽  
Care Providers ◽  
Community Based ◽  
The Family ◽  
Consultation Model ◽  
Care Models ◽  
Qualitative Descriptive

Background: Internationally, both primary care providers and palliative care specialists are required to address palliative care needs of our communities. Clarity on the roles of primary and specialist-level palliative care providers is needed in order to improve access to care. This study examines how community-based palliative care physicians apply their roles as palliative care specialists, what motivates them, and the impact that has on how they practice. Design: A qualitative descriptive study using semi-structured virtual interviews of community-based palliative care specialists. We asked participants to describe their care processes and the factors that influence how they work. Setting/participants: A qualitative descriptive study using semi-structured virtual interviews of community-based palliative care physicians in Ontario, Canada was undertaken between March and June 2020. At interview end, participants indicated whether their practice approaches aligned with one or more models depicted in a conceptual framework that includes consultation (specialist provides recommendations to the family physician) and takeover (palliative care physician takes over all care responsibility from the family physician) models. Results: Of the 14 participants, 4 worked in a consultation model, 8 in a takeover model, and 2 were transitioning to a consultation model. Different motivators were found for the two practice models. In the takeover model, palliative care physicians were primarily motivated by their relationships with patients. In the consultation model, palliative care physicians were primarily motivated by their relationships with primary care. These differing motivations corresponded to differences in the day-to-day processes and outcomes of care. Conclusions: The physician’s personal or internal motivators were drivers in their practice style of takeover versus consultative palliative care models. Awareness of these motivations can aid our understanding of current models of care and help inform strategies to enhance consultative palliative care models.

scholarly journals Stakeholders’ views on identifying patients in primary care at risk of dying: a qualitative descriptive study using focus groups and interviews

2018 ◽  
Vol 68 (674) ◽  
pp. e612-e620 ◽  
Author(s):  
Robin Urquhart ◽  
Jyoti Kotecha ◽  
Cynthia Kendell ◽  
Mary Martin ◽  
Han Han ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Focus Groups ◽  
Early Identification ◽  
Primary Care Providers ◽  
Descriptive Study ◽  
Comparative Approach ◽  
Team Approach ◽  
Care Providers ◽  
Qualitative Descriptive

BackgroundStrategies have been developed for use in primary care to identify patients at risk of declining health and dying, yet little is known about the perceptions of doing so or the broader implications and impacts.AimTo explore the acceptability and implications of using a primary care-based electronic medical record algorithm to help providers identify patients in their practice at risk of declining health and dying.Design and settingQualitative descriptive study in Ontario and Nova Scotia, Canada.MethodSix focus groups were conducted, supplemented by one-on-one interviews, with 29 healthcare providers, managers, and policymakers in primary care, palliative care, and geriatric care. Participants were purposively sampled to achieve maximal variation. Data were analysed using a constant comparative approach.ResultsSix themes were prevalent across the dataset: early identification is aligned with the values, aims, and positioning of primary care; providers have concerns about what to do after identification; how we communicate about the end of life requires change; early identification and subsequent conversations require an integrated team approach; for patients, early identification will have implications beyond medical care; and a public health approach is needed to optimise early identification and its impact.ConclusionStakeholders were much more concerned with how primary care providers would navigate the post-identification period than with early identification itself. Implications of early identification include the need for a team-based approach to identification and to engage broader communities to ensure people live and die well post-identification.

scholarly journals Caring, sharing, preparing and declaring: how do hospices support prisons to provide palliative and end of life care? A qualitative descriptive study using telephone interviews

2020 ◽  
pp. 026921632097919
Author(s):  
Chris McParland ◽  
Bridget Johnston
Keyword(s):  
Palliative Care ◽  
National Level ◽  
Descriptive Study ◽  
Direct Care ◽  
Equitable Access ◽  
Close Collaboration ◽  
Community Based ◽  
Telephone Interviews ◽  
Healthcare Needs ◽  
Qualitative Descriptive

Background: Older adults in prison have complex healthcare needs, and many will need palliative care before their sentence ends. Compared with prison-based hospices, little is known about the role played by community-based hospices in providing palliative care to people in prison Aim: To describe the roles Scottish hospices have adopted to support prisons to provide palliative care, and to discuss the international relevance of these findings in addressing the knowledge gap around community hospices supporting people in prison. Design: A qualitative descriptive study using semi-structured telephone interviews. Setting/participants: Representatives from all Scottish adult hospices were invited to take part in a short telephone interview and all ( N = 17) participated. Results: Four roles were identified: caring, sharing, preparing and declaring. Most hospices employed different combinations of roles. Five (30%) hospices were engaged in caring (providing direct care at the prison or the hospice). Eleven (65%) hospices were engaged in sharing (supporting the prison by sharing knowledge and expertise). Eleven (65%) hospices were engaged in preparing (making preparations to support prisons). All seventeen hospices were described as declaring (expressing a willingness to engage with prisons to provide care). Conclusions: There are differences and similarities in the way countries provide palliative care to people in prison: many are similar to Scotland in that they do not operate prison-based hospices. Variations exist in the level of support hospices provide. Ensuring that all people in prison have equitable access to palliative care will require close collaboration between prisons and hospices on a national level.

scholarly journals Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045997
Author(s):  
Abhijit Pakhare ◽  
Ankur Joshi ◽  
Rasha Anwar ◽  
Khushbu Dubey ◽  
Sanjeev Kumar ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Multivariate Analysis ◽  
Urban Slum ◽  
Primary Care Providers ◽  
Health Facilities ◽  
Care Providers ◽  
Community Based ◽  
Public Health Facilities ◽  
Care Facilities

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

scholarly journals “It’s Always Been a Second Class Cancer”: An Exploration of the Experiences and Journeys of Bereaved Family Carers of People with Sarcoma

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2670
Author(s):  
Moira O’Connor ◽  
Greta Smith ◽  
Ashleigh Pantaleo ◽  
Darren Haywood ◽  
Rhys Weaver ◽  
...  
Keyword(s):  
Palliative Care ◽  
Family Member ◽  
The Body ◽  
Social Constructionist ◽  
Family Carers ◽  
Writing Therapy ◽  
The Family ◽  
Qualitative Descriptive ◽  
Bereaved Family ◽  
Delays In Diagnosis

Sarcomas are a group of rare and aggressive cancers, which develop in bones and connective tissue throughout the body. Sarcomas account for only 1–2% of all cancers worldwide; however, mortality rates for sarcoma are high with approximately two in four sarcoma patients dying following a diagnosis. Delays in diagnosis, poor management of symptoms, patients’ high symptom loads and high carer burden are all associated with carer distress, which may lead to complications after bereavement. The experience of having a family member referred for palliative care is also distressing for carers, with the realisation that their family member is dying. This study aimed to explore the experiences of bereaved family carers of people diagnosed with sarcoma. A qualitative descriptive design using a social constructionist framework was adopted. Interviews were conducted with sixteen participants, and thematic analysis was used to identify patterns in the data. Four overarching themes emerged: beginning the journey; moving through treatment; transitioning to palliative care; and experiencing bereavement. The narratives were coherent and potent, and people reflected on their journeys. Interventions and supports for bereaved carers could include opportunities for counselling to support reflections, supports for developing a narrative such as writing therapy, and preparation for the death of the family member.

Abstract NS3: The Influence of Chinese Culture on Caregiving Role Perceptions Among Stroke Caregivers

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Xichenhui Qiu ◽  
Janet W SIT ◽  
Haixia Feng
Keyword(s):  
Filial Piety ◽  
Chinese Culture ◽  
Qualitative Content Analysis ◽  
Descriptive Study ◽  
Structured Interviews ◽  
Day Range ◽  
Analysis Process ◽  
The Family ◽  
Qualitative Descriptive ◽  
Spouse Caregivers

Introduction: Among the estimated 22.5 million stroke survivors in China, 78% of them require home care. Previous research has indicated that culture can have a significant impact on caregivers’ perceptions of the caregiving role. There is a dearth of research on stroke caregivers’ perceptions within the Chinese culture. Objective: To explore how Chinese culture influences the perceptions of the caregiving role among stroke caregivers. Methods: In this qualitative descriptive study, 14 stroke caregivers were recruited from a 1800-bed regional hospital in China. Caregivers were on average 58 years old (range 46-74), 78% female, 50% spouse-caregivers and 50% children-caregivers. Caregivers spent on average 14 hours per day (range 5-24) providing care. All were 1st time caregivers who had provided stroke caregiving < 12 months. Individual, semi-structured interviews were conducted. Qualitative content analysis was performed. Strategies to achieve trustworthiness include triangulation of the data in the analysis process, member checking and peer debriefing. Results: Three themes emerged from the interviews. (1) Caregiving is a natural expected part of life. All caregivers accepted caregiving for the sick family member as an expected part of life. This perception is deeply rooted in Chinese culture. (2) Caregiving is a culturally prescribed obligation. Spouse caregivers believe that it is their moral obligation to take care of their sick life partner. Female caregivers emphasized their position and role in the family to take up caregiving for sick relative. (3) Caregiving is an expression of reciprocal love within the immediate family. Tangible caregiving and support during adversity are viewed as expression of reciprocal love among family members. Particularly, the children-caregivers believed in the virtue of filial piety and perceived stroke caregiving as a means of repaying their parents. Conclusions: Our findings highlight an underlying acceptance and devotion of undertaking stroke caregiving within the Chinese culture. Researchers and clinicians that plan to develop an intervention to support Chinese stroke caregivers need to consider integrating these findings.

scholarly journals Understanding the role of the family physician in early psychosis intervention

BJPsych Open ◽  
2018 ◽  
Vol 4 (6) ◽  
pp. 447-453 ◽  
Author(s):  
Kelly K. Anderson ◽  
Suzanne Archie ◽  
Richard G. Booth ◽  
Chiachen Cheng ◽  
Daniel Lizotte ◽  
...  
Keyword(s):  
Primary Care ◽  
Administrative Data ◽  
Family Physician ◽  
Psychiatric Treatment ◽  
First Episode Psychosis ◽  
First Episode ◽  
Health Administrative Data ◽  
Episode Psychosis ◽  
The Family

BackgroundThe family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.AimsOur objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.MethodWe will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.DiscussionThese findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.Declaration of interestNone.

scholarly journals Assistência psiquiátrica prestada por técnicos de enfermagem

2018 ◽  
Vol 12 (3) ◽  
pp. 618
Author(s):  
Aldo Mattos ◽  
Marciana Fernandes Moll ◽  
Mariana Oliveira Souto ◽  
Moisés Augusto De Paiva Neves
Keyword(s):  
Mental Disorders ◽  
Participant Observation ◽  
Practical Implication ◽  
Descriptive Study ◽  
Analysis Technique ◽  
The Family ◽  
Data Production ◽  
Qualitative Descriptive ◽  
Care Practices

RESUMOObjetivo: investigar as práticas assistenciais dos técnicos de Enfermagem às pessoas com transtornos mentais. Método: estudo qualitativo, descritivo, com produção de dados por meio da observação participante dos cuidados prestados por 12 técnicos de Enfermagem. As observações foram registradas em um diário de campo e submetidas à técnica de Análise de Conteúdo, na modalidade Análise Temática. Resultados: destacou-se a medicalização do cuidado e as intervenções não medicamentosas centraram-se na higienização, alimentação e sono. Nesse sentido, esses profissionais transferiram ao familiar/acompanhante parte de suas responsabilidades como a observação do paciente, a oferta das refeições, a condução para o banho, a organização do leito e o acompanhamento para a realização dos exames. A conduta mais empática ocorria na alta hospitalar quando se dialogava e organizava os pertences do paciente e do acompanhante para conduzi-los à portaria. Conclusão: o tema é relevante e os resultados sinalizam a importância da qualificação dos técnicos de Enfermagem para cuidarem de pessoas com transtornos mentais. Faz-se necessário que esses profissionais integrem habilidades relacionais às habilidades técnicas, o que corresponde à principal implicação prática dos resultados desta investigação. Descritores: Enfermagem; Psiquiatria; Hospitalização; Assistência; Hospitais gerais; Medicalização. ABSTRACTObjective: to investigate nursing care practices of people with mental disorders. Method: qualitative, descriptive study, with data production through participant observation of the care provided by 12 Nursing technicians. The observations were recorded in a field diary and submitted to the Content Analysis technique, in the Thematic Analysis modality. Results: the medicalization of care was emphasized and non-medication interventions focused on hygiene, feeding and sleep. In this sense, these professionals transferred to the family member / companion part of their responsibilities such as patient observation, meal offerings, bathing, bed organization and follow-up for the examinations. The most empathic behavior occurred at hospital discharge when the patient and the companion's belongings were discussed and organized to lead them to the door. Conclusion: the theme is relevant and the results indicate the importance of the qualification of Nursing technicians to care for people with mental disorders. It is necessary that these professionals integrate skills related to technical skills, which corresponds to the main practical implication of the results of this research. Descriptors: Nursing; Psychiatry; Hospitalization; Assistance; Hospitals, General; Medicalization.RESUMENObjetivo: investigar las prácticas asistenciales de los técnicos de Enfermería a las personas con trastornos mentales. Método: estudio cualitativo, descriptivo, con producción de datos por medio de la observación participante de los cuidados prestados por 12 técnicos de Enfermería. Las observaciones fueron registradas en un diario de campo y sometidas a la técnica de Análisis de Contenido, en la modalidad Análisis Temático. Resultados: se destacó la medicalización del cuidado y las intervenciones no medicamentosas se centraron en la higienización, alimentación y sueño. En este sentido, estos profesionales transfirieron al familiar / acompañante parte de sus responsabilidades, como la observación del paciente, la oferta de las comidas, la conducción para el baño, la organización del lecho y el acompañamiento para la realización de los exámenes. La conducta más empática ocurría en el alta hospitalaria, cuando se dialogaba y organizaban las pertenencias del paciente y del acompañante para conducirlos a la portería. Conclusión: el tema es relevante y los resultados señalan la importancia de la calificación de los técnicos de Enfermería para cuidar de personas con trastornos mentales. Se hace necesario que estos profesionales integren habilidades relacionales a las habilidades técnicas, lo que corresponde a la principal implicación práctica de los resultados de esa investigación. Descriptores: Enfermería; Psiquiatría; Hospitalización; Asistencia; Hospitales Generales; Medicalización.

scholarly journals Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals (Preprint)

2020 ◽  
Author(s):  
Inga Hunter ◽  
Phoebe Elers ◽  
Caroline Lockhart ◽  
Hans Guesgen ◽  
Amardeep Singh ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Information Needs ◽  
Sensor Data ◽  
Care Providers ◽  
Community Based ◽  
Age In Place

BACKGROUND Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. OBJECTIVE The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. METHODS Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. RESULTS The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. CONCLUSIONS The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

scholarly journals Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals

10.2196/24157 ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. e24157
Author(s):  
Inga Hunter ◽  
Phoebe Elers ◽  
Caroline Lockhart ◽  
Hans Guesgen ◽  
Amardeep Singh ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Information Needs ◽  
Sensor Data ◽  
Care Providers ◽  
Community Based ◽  
Age In Place

Background Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. Objective The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. Methods Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. Results The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. Conclusions The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

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