scholarly journals Exploring the quality of Life at the end of Life (Qual-E) Instrument with Australian Palliative Care Hospital Patients: Hurdles and Directions

2014 ◽  
Vol 30 (1) ◽  
pp. 16-23 ◽  
Author(s):  
Anne Wilkinson ◽  
Susan Slatyer ◽  
Kylie McCullough ◽  
Anne Williams
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Care Hospital ◽  
Hospital Patients

scholarly journals Acute-Care Hospital Use Patterns Near End-of-Life for Cancer Patients Who Die in Hospital in Canada

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 109s-109s
Author(s):  
J. Tung ◽  
K. Decaria ◽  
D. Dudgeon ◽  
E. Green ◽  
R. Shaw Moxam ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Acute Care ◽  
End Of Life Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Life Care

Background: Acute-care hospitals have a role in managing the needs of people with cancer when they are at the end-of-life; however, overutilization of hospital care at the end-of-life results in poorer quality of life and can worsen the patient's experience. Early integration of comprehensive palliative care can greatly reduce unplanned visits to the emergency department, reduce avoidable admissions to hospital, shorten hospital stays, and increase the number of home deaths as well as improve the quality of life of patients with advanced cancer. Aim: To describe the current landscape of acute-care hospital utilization near the end-of-life across Canada and indirectly examine access to palliative care in cancer patients who die in hospital. Methods: Data were obtained from the Canadian Institute for Health Information. The analysis was restricted to adults aged 18+ who died in an acute care hospital in 2014/15 and 2015/16 for nine provinces and three territories. The Discharge Abstract Database was used to extract acute-care cancer death abstracts. Data on intensive care unit (ICU) admissions includes only facilities that report ICU data. Results: Acute care utilization at end-of-life remains commonplace. In Canada (excluding Québec), 43% (48,987) of deaths from cancer occurred in acute-care hospitals, with 70% admitted through the emergency department (ED). In the last six months of life, cancer patients dying in hospital had a median cumulative length of stay ranging from 17 to 25 days, depending on the province. Between 18.1% and 32.8% of patients experienced two or more admissions to the hospital in the last month of life. The proportion of cancer patients admitted to the ICU in the last 14 days of life ranged from 6.4% to 15.1%. Patient demographics (age, sex, place of residence) and clinical factors (cancer type) were often predictors of hospital utilization at end-of-life and likely point to inequities in access to palliative and end-of-life care. Conclusion: Despite previous patient surveys indicating that patients would prefer to receive care and spend their finals days at home or in a hospice, there appears to be overuse of and overreliance on acute care hospital services near the end-of-life in Canada. The high rates of hospital deaths and admissions through the ED at the end-of-life for cancer patients may signal a lack of planning for impeding death and inadequate availability of or access to community- and home-based palliative and end-of-life care services. Acute care hospitals may have a role in managing the health care needs of people affected by cancer; however, end-of-life care should be an option in other settings that align with patient preferences. Standards or practice guidelines to identify, assess and refer patients to palliative care services earlier in their cancer journey should be developed and implemented to ensure optimal quality of life.

Cost effectiveness in palliative care setting

2018 ◽  
Vol 21 (2) ◽  
pp. 62-71
Author(s):  
Henry O’Lawrence ◽  
Rohan Chowlkar
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Hospice Care ◽  
Home Health ◽  
Data Set ◽  
Content Type ◽  
Care Services ◽  
The Cost

Purpose The purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the hypotheses of this study. Home health care and hospice care services have the potential to avert hospital admissions in patients requiring palliative care, which significantly affects medicare spending. With the aging population, it has become evident that demand of palliative care will increase four-fold. It was determined that current spending on end-of-life care is radically emptying medicare funds and fiscally weakening numerous families who have patients under palliative care during life-threatening illnesses. The study found that a majority of people registering for palliative and hospice care settings are above the age group of 55 years old. Design/methodology/approach Different variables like length of stay, mode of payment and disease diagnosis were used to filter the available data set. Secondary data were utilized to test the hypothesis of this study. There are very few studies on hospice and palliative care services and no study focuses on the cost associated with this care. Since a very large number of the USA, population is turning 65 and over, it is very important to analyze the cost of care for palliative and hospice care. For the purpose of this analysis, data were utilized from the National Home and Hospice Care Survey (NHHCS), which has been conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Descriptive statistics, χ2 tests and t-tests were used to test for statistical significance at the p<0.05 level. Findings The Statistical Package for Social Sciences (SPSS) was utilized for this result. H1 predicted that patients in the age group of 65 years and up have the highest utilization of home and hospice care. This study examined various demographic variables in hospice and home health care which may help to evaluate the cost of care and the modes of payments. This section of the result presents the descriptive analysis of dependent, independent and covariate variables that provide the overall national estimates on differences in use of home and hospice care in various age groups and sex. Research limitations/implications The data set used was from the 2007 NHHCS survey, no data have been collected thereafter, and therefore, gap in data analysis may give inaccurate findings. To compensate for this gap in the data set, recent studies were reviewed which analyzed cost in palliative care in the USA. There has been a lack of evidence to prove the cost savings and improved quality of life in palliative/hospice care. There is a need for new research on the various cost factors affecting palliative care services as well as considering the quality of life. Although, it is evident that palliative care treatment is less expensive as compared to the regular care, since it eliminates the direct hospitalization cost, but there is inadequate research to prove that it improves the quality of life. A detailed research is required considering the additional cost incurred in palliative/hospice care services and a cost-benefit analysis of the same. Practical implications While various studies reporting information applicable to the expenses and effect of family caregiving toward the end-of-life were distinguished, none of the previous research discussed this issue as their central focus. Most studies addressed more extensive financial effect of palliative and end-of-life care, including expenses borne by the patients themselves, the medicinal services framework and safety net providers or beneficent/willful suppliers. This shows a significant hole in the current writing. Social implications With the aging population, it has become evident that demand of palliative/hospice care will increase four-fold. The NHHCS have stopped keeping track of the palliative care requirements after 2007, which has a negative impact on the growing needs. Cost analysis can only be performed by analyzing existing data. This review has recognized a huge niche in the evidence base with respect to the cost cares of giving care and supporting a relative inside a palliative/hospice care setting. Originality/value The study exhibited that cost diminishments in aggressive medications can take care of the expenses of palliative/hospice care services. The issue of evaluating result in such a physically measurable way is complicated by the impalpable nature of large portions of the individual components of outcome. Although physical and mental well-being can be evaluated to a certain degree, it is significantly more difficult to gauge in a quantifiable way, the social and profound measurements of care that help fundamentally to general quality of care.

scholarly journals Healing at the End of Life: The Voice of the Patient

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Cory Ingram
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Lived Experience ◽  
End Of Life ◽  
Life Story ◽  
Patient Centered ◽  
Whole Person ◽  
Centered Care ◽  
The Impact

In palliative care we have the privilege to care for seriously ill people and their families. Some people value capturing their life story or illness journey on film. I have been fortunate to have been invited into the lives of many people close the end of life for a heartfelt conversation.On an interactive iPad incorporated in the poster, the recorded narrative of patients and one bereft spouse the poster audience will experience the lived experience of people close to the end of life as they reflect on their lives. The narratives will demonstrate how each lived with a new found improved quality of life in the face of increasing symptoms, declining functioning and the approaching end of life; otherwise known as healing. Topics of healing and quality of life, patient-centered care, dignity, human development, spirituality and love will be the focus of their stories. The stories lay bare the very practical, emotional, existential, and personal experience central to our provision of whole person care through palliative care. The poster audience will experience a renewed sense of the impact of a dedicated approach to whole person care as experienced through those on the receiving end.

scholarly journals Intervenção em cuidados paliativos: conhecimento e percepção dos enfermeiros

2018 ◽  
Vol 12 (5) ◽  
pp. 1325
Author(s):  
Hashilley Alberto da Silva ◽  
Gleice Kelle Beserra Viana ◽  
Ana Karine Girão Lima ◽  
Carla Monique Lopes Mourão ◽  
Ana Luiza Almeida de Lima
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Care Hospital ◽  
Chi Square ◽  
Calidad De Vida ◽  
Before And After ◽  
Data Collection Instrument ◽  
Post Test ◽  
Nursing Quality

RESUMOObjetivo: avaliar a percepção dos enfermeiros sobre cuidado paliativo antes e depois de uma intervenção. Método: estudo quantitativo, quase experimental, desenvolvido nas unidades de um hospital de atenção secundária. O instrumento de coleta de dados foi adaptado de um estudo realizado com anestesiologistas, esses foram analisados no programa Excel e organizados em tabelas, sendo aplicado o teste estatístico de qui-quadrado de Pearson, com tabelas que apresentam os valores obtidos dentro de categorias distintas, mas que eram relacionáveis. Foi calculada, também, a proporção das diferenças entre as respostas do pré-teste e pós-teste, sendo considerados significantes os resultados com p<0,05. Resultados: houve predominância dos profissionais antes da intervenção que escolheram a expressão Morte Digna para designar cuidado paliativo (72,9%). Após a intervenção, os profissionais escolheram a expressão Qualidade de Vida (55,9%). Conclusão: a percepção dos enfermeiros acerca dos cuidados paliativos foi deficiente. Esse fato esteve associado à deficiência na formação técnico-científica ainda na graduação. A intervenção realizada promoveu melhoria da compreensão de conceitos relacionados ao cuidado paliativo colaborando para a assistência diferenciada e promotora da qualidade de vida dos profissionais. Descritores: Cuidados Paliativos; Enfermagem; Qualidade de Vida; Assistência Hospitalar.ABSTRACTObjective: to evaluate nurses' perception of palliative care before and after an intervention. Method: quantitative, almost experimental study, developed in the units of a secondary care hospital. The data collection instrument was adapted from a study carried out with anesthesiologists, these were analyzed in the Excel program and organized into tables, being applied the statistical test of chi-square of Pearson, with tables that present the values obtained within distinct categories, but that they were relatable. The proportion of differences between pre-test and post-test responses was also calculated, and the results with p <0.05 were considered significant. Results: there was a predominance of professionals before the intervention who chose the term Digned Death to designate palliative care (72.9%). After the intervention, professionals chose the term Quality of Life (55.9%). Conclusion: nurses' perception about palliative care was deficient. This fact was associated to the deficiency in the technical-scientific formation still in the graduation. The intervention promoted an improvement of the understanding of concepts related to palliative care collaborating for differentiated assistance and promoting the quality of life of professionals  Descriptors: Palliative Care, Nursing, Quality of Life, Hospital Care.RESUMENObjetivo: evaluar la percepción de los enfermeros sobre el cuidado paliativo antes y después de una intervención. Método: estudio cuantitativo, casi experimental, desarrollado en las unidades de un hospital de atención secundaria. El instrumento de recolección de datos fue adaptado de un estudio realizado con anestesiólogos, se analizaron en el programa Excel y organizados en tablas, siendo aplicado el test estadístico de chi-cuadrado de Pearson con tablas que presentan los valores obtenidos dentro de categorías distintas, pero que eran relacionables. Se calculó, también, la proporción de las diferencias entre las respuestas del pre-test y post-test, siendo considerados significantes los resultados con p <0,05. Resultados: hubo predominancia de los profesionales antes de la intervención que eligieron la expresión Muerte Digna para designar cuidado paliativo (72,9%). Después de la intervención, los profesionales escogieron la expresión Calidad de Vida (55,9%). Conclusión: la percepción de los enfermeros acerca de los cuidados paliativos fue deficiente. Este hecho estuvo asociado a la deficiencia en la formación técnica-científica aún en la graduación. La intervención realizada promovió la mejora de la comprensión de conceptos relacionados al cuidado paliativo, colaborando para la asistencia diferenciada y promotora de la calidad de vida de los profesionales. Descriptores: Cuidados Paliativos, Enfermeira, Calidad de Vida, Atención Hospitalaria.

scholarly journals Shifting Palliative Care Paradigm in Primary Care From Better Death to Better End-of-Life : A Swiss Pilot Study

2021 ◽  
Author(s):  
Johanna Sommer ◽  
Christopher Chung ◽  
Dagmar M. Haller ◽  
Sophie Pautex
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Palliative Care ◽  
Pilot Study ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Communication Skills ◽  
Advanced Cancer Patients

Abstract Background: Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late.The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods: Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues.3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis.Results: 8 PCPs were trained. PCPs failed to recruit patients for fear of imposing additional loads on their patients. PCPs changed their approach of advanced cancer patients. They became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life.Conclusions: PCPs failed to recruit advanced cancer patients, but reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life.Trial registration : The ethics committee of the canton of Geneva approved the study (2018-00077 Pilot Study) in accordance with the Declaration of Helsinki

The Promise of Palliative Care

Pained ◽  
2020 ◽  
pp. 203-206
Author(s):  
Michael D. Stein ◽  
Sandro Galea
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Social Workers ◽  
Hospice Care ◽  
Care Plan ◽  
Life Care ◽  
High Quality ◽  
Life Threatening

This chapter assesses palliative care. Palliative care focuses on improving the quality of life for people with life-threatening illnesses by involving a team of nurses, doctors, social workers, and clergy in a care plan. Hospice care—administered in dedicated units and in services delivered at home—has been slowly expanding over the past two decades, but the increasing percentage of patients who use hospice for less than 7 days suggests that the full benefits of end-of-life palliative care are not being realized. Meanwhile, the use of unwanted, aggressive end-of-life care, often inconsistent with patient preferences, remains pervasive. For palliative care to be effective, it must be supported by government policies and insurer incentives; it must also be owned by communities, which must continue to ask for help in designing and paying for high-quality palliative care for patients and their caregiving families.

Palliative Care in Transplantation

2019 ◽  
pp. 148-162
Author(s):  
Emily B. Rivet ◽  
Jeffrey M. Stern ◽  
Karunasai Mahadevan ◽  
Danielle Noreika
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Organ Failure ◽  
End Of Life ◽  
Waiting Times ◽  
Organ Transplant ◽  
Integrated Approach ◽  
Life Planning ◽  
Transplant Candidates

Organ transplantation is a field where patients often have significant palliative care needs but frequently lack access to palliative care due to a variety of barriers, including some commonly encountered as well as others specific to this patient population. Organ system failure is necessary to qualify for transplantation. Morbidity and mortality of the particular organ failure syndrome have a profound impact on quality of life. Also, the donor process adds another patient group that may benefit from palliative care. For solid-organ transplant candidates, long waiting times on organ transplant lists and limited organ availability shape the patient experience. Death while waiting for transplant for some conditions is not unusual. Furthermore, there is variability in the ability to replace organ function and how these modalities impact quality of life and end-of-life care. An integrated approach introducing end-of-life planning and palliative care early in the course for patients with organ failure awaiting transplant would improve patient knowledge and possibly symptom management and empower patient decision-making at the end of life.

scholarly journals Chemotherapy use and quality of life in cancer patients at the end of life: an integrative review

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Elham Akhlaghi ◽  
Rebecca H. Lehto ◽  
Mohsen Torabikhah ◽  
Hamid Sharif Nia ◽  
Ahmad Taheri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Palliative Chemotherapy ◽  
Palliative Therapy ◽  
Related Quality ◽  
Health Related

Abstract Background When curative treatments are no longer available for cancer patients, the aim of treatment is palliative. The emphasis of palliative care is on optimizing quality of life and provided support for patients nearing end of life. However, chemotherapy is often offered as a palliative therapy for patients with advanced cancer nearing death. The purpose of this review was to evaluate the state of the science relative to use of palliative chemotherapy and maintenance of quality of life in patients with advanced cancer who were at end of life. Materials and methods Published research from January 2010 to December 2019 was reviewed using PRISMA guidelines using PubMed, Proquest, ISI web of science, Science Direct, and Scopus databases. MeSH keywords including quality of life, health related quality of life, cancer chemotherapy, drug therapy, end of life care, palliative care, palliative therapy, and palliative treatment. Findings 13 studies were evaluated based on inclusion criteria. Most of these studies identified that reduced quality of life was associated with receipt of palliative chemotherapy in patients with advanced cancer at the end of life. Conclusion Studies have primarily been conducted in European and American countries. Cultural background of patients may impact quality of life at end of life. More research is needed in developing countries including Mideastern and Asian countries.

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