Canada’s Evolving Medicare: End-of-Life Care

2020 ◽  
pp. 082585972092416
Author(s):  
Nicole MacPherson ◽  
Terrence Montague ◽  
John Aylen ◽  
Lesli Martin ◽  
Amédé Gogovor ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Life Care ◽  
Assisted Death ◽  
The Public ◽  
Hospice And Palliative Care ◽  
Over Time

A challenging issue in contemporary Canadian Medicare is the evolution of end-of-life care. Utilizing data from the 2016 and 2018 Health Care in Canada (HCIC) surveys, this paper compares the support and priorities of the adult public (n = 1500), health professionals (n = 400), and administrators (n = 100) regarding key components for end-of-life care just prior to and post legalization of medical assistance in dying (MAiD) in Canada. In 2016 and 2018, the public, health professionals and administrators strongly supported enhanced availability of all proposed end-of-life care options: pain management, hospice and palliative care, home care supports, and medically assisted death. In 2018, when asked which option should be top priority, the public rated enhanced medically assisted death first (32%), followed by enhanced hospice and palliative care (22%) and home care (21%). Enhanced hospice and palliative care was the top priority for health professionals (33%), while administrators rated enhanced medically assisted death first (26%). Despite legalization and increasing support for MAiD over time, health professionals have increasing fear of legal or regulatory reprisal for personal involvement in medically assisted death, ranging from 38% to 84% in 2018, versus 23% to 42% in 2016. While administrators fear doubled since 2016 (40%-84%), they felt the necessary system supports were in place to easily implement medically assisted death. Optimal management of end-of-life care is strongly supported by all stakeholders, although priorities for specific approaches vary. Over time, professionals increasingly supported MAiD but with a rising fear of legal/regulatory reprisal despite legalization. To enhance future end-of-life care patterns, continued measurement and reporting of implemented treatment options and their system supports, particularly around medically assisted death, are needed.

scholarly journals The public health end-of-life care movement: history, principles, and styles of practice

2018 ◽  
Author(s):  
Aliki Karapliagou ◽  
Allan Kellehear ◽  
Klaus Wegleitner
Keyword(s):  
Public Health ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Psychosocial Care ◽  
Care Practice ◽  
Life Care ◽  
The Public ◽  
Civic Practice ◽  
Practice Methods

This chapter briefly outlines the history, key concepts, and main practice methods from public health approaches to end-of-life care. Although linked to psychosocial care approaches, its main methods draw not from psychology or health services inspired approaches but rather from health promotion, community development, and civic engagement. Key methods covered include community volunteering, social networking, community engagement, and compassionate communities and cities. The aim of these kinds of approaches is to embed palliative care practice as a social and civic practice in all sectors of society and to ensure that palliative care as a policy is represented in all civic policies (e.g. schools, workplaces, faith groups, and cultural activities) and not solely in health 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.

scholarly journals Decision making in the end-of-life care of patients who are terminally ill with cancer – a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers.

2021 ◽  
Author(s):  
Angela Luna-Meza ◽  
Natalia Godoy-Casasbuenas ◽  
José Andrés Calvache ◽  
Eduardo Diaz ◽  
Fritz Gempeler ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Home Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
End Of Life Decisions ◽  
Care Plans ◽  
Qualitative Descriptive ◽  
Imminent Death

Abstract Background: In Colombia, recent legislation regarding end-of-life decisions includes palliative sedation, advance directives and euthanasia. We analysed which aspects influence health professionals´ decisions regarding end-of-life medical decisions and care for cancer patients.Methods: Qualitative descriptive–exploratory study based on phenomenology using semi-structured interviews. We interviewed 28 oncologists, palliative care specialists, general practitioners and nurses from three major Colombian institutions, all involved in end-of-life care of cancer patients: Hospital Universitario San Ignacio and Instituto Nacional de Cancerología in Bogotá and Hospital Universitario San José in Popayan. Results: When making decisions regarding end-of-life care, professionals consider: 1. Patient’s clinical condition, cultural and social context, in particular treating indigenous patients requires special skills. 2. Professional conditions: training in palliative care and experience in discussing end-of-life options and fear of legal consequences. Physicians indicate that many patients deny their imminent death which hampers shared decision-making and conversations. They mention frequent unclarity regarding who initiates conversations regarding end-of-life decisions with patients and who finally takes decisions. Patients rarely initiate such conversations and the professionals normally do not patients directly for their preferences. Fear of confrontation with family members and lawsuits leads doctors to carrying out interventions such as initiating artificial feeding techniques and cardiopulmonary resuscitation, even in absence of expected benefits. The opinions regarding the acceptability of palliative sedation, euthanasia and use of medications to accelerate death without the patients´ explicit request vary greatly. 3. Conditions of the insurance system: limitations exist in the offer of oncology and palliative care services for important proportions of the Colombian population. Colombians have access to opioid medications, barriers to their application are largely in delivery by the health system, the requirement of trained personnel for intravenous administration and ambulatory and home care plans which in Colombia are rare.Conclusions: to improve end-of-life decision making, Colombian physicians and patients need to openly discuss wishes, needs and care options and prepare caregivers. Promotion of palliative care education and development of palliative care centres and home care plans is necessary to facilitate access to end-of-life care. Patients and caregivers’ perspectives are needed to complement physicians’ perceptions and practices. Key Message: The results highlight the importance of improving access to end-of-life care in Colombia, and diminish the “denial of imminent death” among patients and caregivers to facilitate end-of-life discussions and shared decisions; interventions to prepare caregivers and promote home care.

HIV/AIDS

2015 ◽  
Author(s):  
Meera Pahuja ◽  
Jessica S. Merlin ◽  
Peter A. Selwyn
Keyword(s):  
Palliative Care ◽  
Chronic Disease ◽  
End Of Life ◽  
End Of Life Care ◽  
Opportunistic Infections ◽  
Hiv Care ◽  
Accelerated Ageing ◽  
Life Care ◽  
Life Issues ◽  
Over Time

In less than two decades, AIDS has been transformed from a rapidly fatal, untreatable illness to a manageable chronic disease. Early in the AIDS epidemic, HIV care and palliative care were inseparable; over time, these two treatment paradigms diverged. In the developed world, and to a lesser but increasing extent in the developing world, decreasing mortality rates have resulted in growing numbers of HIV-infected patients living with the disease for many years. As this long-surviving population increases, the challenges of chronic disease management, an expanding range of co-morbidities, and a process that has been described as ‘accelerated ageing’, have all emerged to present new needs and opportunities for palliative care expertise. Earlier in the epidemic, palliative care for AIDS focused primarily on end-of-life care and pain and symptom management related to the manifestations of AIDS-specific opportunistic infections and malignancies. Currently, pain and symptoms may be related to these as well as other co-morbid chronic diseases which commonly occur in HIV-infected patients, including cardiovascular, pulmonary, renal, hepatic, metabolic, and neurocognitive complications. Attention to these symptoms, quality of life issues, and psychosocial problems in long-surviving patients over many years will be increasingly important to support engagement with care and effective adherence with antiretroviral therapy over time. End-of-life care, while less frequent, also remains important, as patients may still die from AIDS, or even more commonly, from end-organ failure, non-AIDS defining malignancies, and/or other complications of ageing and chronic co-morbid disease. All these converging factors have now resulted in a new need for the re-integration of HIV care and palliative care, both to help HIV-infected patients live better and longer, as well as manage late-stage and end-of-life issues when they emerge.

scholarly journals Undergraduate palliative care education in the United Arab Emirates: a nationwide assessment of medical school deans

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thana Harhara ◽  
Halah Ibrahim
Keyword(s):  
Palliative Care ◽  
Medical Students ◽  
Medical School ◽  
End Of Life ◽  
United Arab Emirates ◽  
Health Professionals ◽  
End Of Life Care ◽  
Successful Implementation ◽  
Life Care ◽  
High Quality

Abstract Background The provision of comprehensive, high quality palliative care (PC) is a global public health concern. In the United Arab Emirates (UAE), palliative medicine services are limited, and most patients in need of PC are treated in the acute hospital setting, where health professionals of all specialties provide treatment. Improving end-of-life care requires teaching medical students, residents, and other healthcare professionals about PC. The purpose of this study was to assess the current status of PC education in medical schools in the UAE, and to identify barriers to successful implementation of a PC and end-of-life curriculum. Methods The authors conducted semi-structured interviews with deans from all medical schools in the UAE. Data were analyzed using qualitative content analysis. Results All medical school deans in our study recognized the importance of inculcating palliative and end-of-life care into the undergraduate curriculum, but there was substantial variability in implementation, with opportunities for improvement. Barriers to the successful implementation of an undergraduate PC curriculum include (1) lack of student awareness and interest in PC, (2) inconsistent clinical exposure to PC, (3) lack of specialized PC faculty, (4) limited clinical facilities for PC training, (5) lack of a multidisciplinary approach to PC education, and (6) cultural barriers to PC education. Conclusions Understanding challenges to teaching PC in the undergraduate medical curriculum can help inform educational interventions to improve PC knowledge and skills for UAE medical students. Curricular and policy reform are necessary to educate a future generation of health professionals, who can provide high quality palliative care services to UAE patients and their families.

End-of-life care in multiple sclerosis

2021 ◽  
Vol 17 (4) ◽  
pp. 170-170
Author(s):  
Megan Roberts
Keyword(s):  
Multiple Sclerosis ◽  
Palliative Care ◽  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Resource Constraints ◽  
Life Care

Palliative care is an aspect of the support needed by those living with multiple sclerosis and their loved ones that is often overlooked, due to resource constraints and lack of awareness. Megan Roberts outlines the ways in which health professionals can support their patients at the end of life, signposting to helpful resources.

The experiences of health professionals, patients, and families with truth disclosure when breaking bad news in palliative care: A qualitative meta-synthesis

2021 ◽  
pp. 1-12
Author(s):  
Elizabeth M. Miller ◽  
Joanne E. Porter ◽  
Michael S. Barbagallo
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Terminal Care ◽  
Bad News ◽  
Breaking Bad News ◽  
Life Care ◽  
Truth Disclosure ◽  
Breaking Bad

Abstract Objective Disclosing the truth when breaking bad news continues to be difficult for health professionals, yet it is essential for patients when making informed decisions about their treatment and end-of-life care. This literature review aimed to explore and examine how health professionals, patients, and families experience truth disclosure during the delivery of bad news in the inpatient/outpatient palliative care setting. Methods A systemized search for peer-reviewed, published papers between 2013 and 2020 was undertaken in September 2020 using the CINAHL, Medline, and PsycInfo databases. The keywords and MeSH terms (“truth disclosure”) AND (“palliative care or end-of-life care or terminal care or dying”) were used. The search was repeated using (“bad news”) AND (“palliative care or end-of-life care or terminal care or dying”) terms. A meta-synthesis was undertaken to synthesize the findings from the eight papers. Results Eight papers were included in the meta-synthesis and were represented by five Western countries. Following the synthesis process, two concepts were identified: “Enablers in breaking bad news” and “Truth avoidance/disclosure.” Several elements formed the concept of Enablers for breaking bad news, such as the therapeutic relationship, reading cues, acknowledgment, language/delivery, time/place, and qualities. A conceptual model was developed to illustrate the findings of the synthesis. Significance of results The conceptual model demonstrates a unique way to look at communication dynamics around truth disclosure and avoidance when breaking bad news. Informed decision-making requires an understanding of the whole truth, and therefore truth disclosure is an essential part of breaking bad news.

Sikh religion and palliative care

2020 ◽  
pp. bmjspcare-2020-002425
Author(s):  
Amarjodh Singh Landa ◽  
Bhajneek Kaur Grewal ◽  
Rajinder Singh
Keyword(s):  
Palliative Care ◽  
Everyday Life ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
God's Will ◽  
Clinical Scenarios ◽  
Over Time ◽  
Philosophical Understanding

Over time, end of life care has been heavily influenced by the systems of religion, ethics and spirituality. The Sikh religion was started by Guru Nanak Dev Ji in 1469. It has a unique philosophical understanding of life, death and God which can be relevant to commonly encountered clinical scenarios. Concepts such as ‘Ik-Oankar’, Hukam (God’s will), ego and karma all influence how practising Sikhs respond to situations in everyday life. Understanding the spiritual underpinnings of the Sikh religion is therefore important for clinicians caring for this group of patients. This article will explore the fundamental concepts of the Sikh religion and how these apply to common scenarios encountered within palliative care.

A Hospice and Palliative Care Bed Dedicated to Patients Admitted to the Emergency Department for End-of-Life Care

2014 ◽  
Vol 33 (4) ◽  
pp. 403-406 ◽  
Author(s):  
Pierre Lafond ◽  
E. Chalayer ◽  
M. Roussier ◽  
E. Weber ◽  
Q. Lacoin-Reynaud ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Hospice And Palliative Care
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