Barriers to the Detection and Management of Depression by Palliative Care Professional Carers Among Their Patients: Perspectives From Professional Carers and Patients' Family Members

2012 ◽  
Vol 30 (1) ◽  
pp. 12-20 ◽  
Author(s):  
David Mellor ◽  
Marita P. McCabe ◽  
Tanya E. Davison ◽  
Denisa L. Goldhammer ◽  
David J. Hallford
Keyword(s):  
Palliative Care ◽  
Self Efficacy ◽  
Family Members ◽  
Family Characteristics ◽  
Care Providers ◽  
Individual Interviews ◽  
Care Services ◽  
Care Recipients ◽  
Palliative Care Services ◽  
Managerial Positions

Introduction: Clinical depression is highly prevalent yet underdetected and poorly managed within palliative care settings. Objectives: This qualitative study explored the identification, monitoring, and management of symptoms of depression in patients receiving palliative care from 2 juxtaposed perspectives that are of care providers and care recipients' family members. Examining the barriers that restrict professional carers detecting and managing depression in their patients was a central focus of the study. Methods: Focus groups were held with 18 professional carers, including 8 holding managerial positions, across 2 palliative care services, 1 regional and 1 metropolitan, which provided both inpatient and community-based care. Individual interviews were conducted with 10 family members of patients who had received or were receiving palliative care through these services. Results: Thematic analysis of these data identified that both professional carers and family members perceived that depression is a wide-spread concern for patients receiving palliative care; however, numerous barriers were identified that affect professional carers’ ability to identify depression. These included knowledge and training deficits, low self-efficacy, prioritization of physical concerns and time constraints, patient/family characteristics, and system/process issues. These themes (and related subthemes) are discussed in this article. Conclusions: Specialized training in depression is recommended for professional carers in order to improve their depression-related knowledge, detection skills, and self-efficacy. The ultimate goal of such training is to increase the rate of recognition of depression that in turn will lead to appropriate treatment for depressed patients.

Policy in palliative care

2015 ◽  
Author(s):  
David C. Currow ◽  
Stein Kaasa
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Health Care Providers ◽  
World Health ◽  
Care Providers ◽  
Care Services ◽  
Palliative Care Services ◽  
Organization Policy ◽  
Health Organization ◽  
Hospice Palliative Care

Hospice and palliative care services have developed in very different ways around the world. Most have been built on the momentum of visionary clinicians and funders who have responded to perceived needs from health-care providers, patients, families, and communities rather than in response to well-formed national policies with an adequately funded planning and development phase. This chapter describes the work that is being done at pan-national, national, and sub-national levels to create effective policies that can further the key work of hospice/palliative care, often after a large number of apparently unconnected local services have been well established. The chapter highlights that there are particular challenges in forming public policy on hospice/palliative care, especially the end-of-life component, and notes the importance of ‘patients’ voices’-the voice of the community which helps to inform health policies including end-of-life care. The chapter ends by describing a variety of country-specific and World Health Organization policy documents and legislation.

Ethnicity as a Factor

2015 ◽  
Author(s):  
Kimberly S. Johnson ◽  
Ramona L. Rhodes
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
African Americans ◽  
Health Care Providers ◽  
Cultural Beliefs ◽  
Ethnic Disparities ◽  
Care Providers ◽  
Care Services ◽  
Palliative Care Services ◽  
Advance Care

This chapter examines how race or ethnicity affects access to, and the quality of, palliative care by focusing on the experience of African Americans and Hispanics. More specifically, it considers how cultural beliefs, values, and preferences may influence care. It begins by looking at racial and ethnic disparities that exist throughout the health-care continuum, from disease prevention, early diagnosis, and curative treatment, to communication and pain management, lower rates of advance care planning, and lower utilization of hospice and palliative care services. It then explores the preferences of African Americans and Hispanics when it comes to end-of-life care, as well as the role of spirituality and faith in how they cope with illness. The chapter concludes by suggesting strategies and future directions for health-care providers, organizations, policymakers, and researchers on how to improve care for patients of diverse racial and ethnic backgrounds.

The Role of Home Care in Palliative Care Services

2004 ◽  
Vol 5 (3) ◽  
pp. 151-157 ◽  
Author(s):  
Eileen Hanley
Keyword(s):  
Palliative Care ◽  
Staff Development ◽  
Home Care ◽  
End Of Life Care ◽  
Care Providers ◽  
Care Services ◽  
Palliative Care Services ◽  
Key Topics ◽  
Home Care Providers

This article addresses the increasing interest in end of life care and the need for improving access to palliative care services in patients/families served by the home care industry. The author discusses factors leading to this growing demand as well as some of the recent research conducted in the field of palliative care. The benefits of and underutilization of hospice services are discussed. The author addresses a variety of options for home care providers to consider expanding access to palliative care services including recent changes in regulation that allow for collaboration with Medicare certified hospice programs. A discussion of key topics to include in staff development initiatives related to palliative care is included as are education and clinical practice resources.

scholarly journals ‘Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multinational survey (CovPall)

2021 ◽  
pp. 026921632110006
Author(s):  
Lesley Dunleavy ◽  
Nancy Preston ◽  
Sabrina Bajwah ◽  
Andy Bradshaw ◽  
Rachel Cripps ◽  
...  
Keyword(s):  
Palliative Care ◽  
Good Practice ◽  
System Response ◽  
Free Text ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Teams ◽  
Palliative Care Services ◽  
Palliative Care Units

Background: Specialist palliative care services have a key role in a whole system response to COVID-19, a disease caused by the SARS-CoV-2 virus. There is a need to understand service response to share good practice and prepare for future care. Aim: To map and understand specialist palliative care services innovations and practice changes in response to COVID-19. Design: Online survey of specialist palliative care providers (CovPall), disseminated via key stakeholders. Data collected on service characteristics, innovations and changes in response to COVID-19. Statistical analysis included frequencies, proportions and means, and free-text comments were analysed using a qualitative framework approach. Setting/participants: Inpatient palliative care units, home nursing services, hospital and home palliative care teams from any country. Results: Four hundred and fifty-eight respondents: 277 UK, 85 Europe (except UK), 95 World (except UK and Europe), 1 missing country. 54.8% provided care across 2+ settings; 47.4% hospital palliative care teams, 57% in-patient palliative care units and 57% home palliative care teams. The crisis context meant services implemented rapid changes. Changes involved streamlining, extending and increasing outreach of services, using technology to facilitate communication, and implementing staff wellbeing innovations. Barriers included; fear and anxiety, duplication of effort, information overload and funding. Enablers included; collaborative teamwork, staff flexibility, a pre-existing IT infrastructure and strong leadership. Conclusions: Specialist palliative care services have been flexible, highly adaptive and have adopted low-cost solutions, also called ‘frugal innovations’, in response to COVID-19. In addition to financial support, greater collaboration is essential to minimise duplication of effort and optimise resource use. ISRCTN16561225 https://doi.org/10.1186/ISRCTN16561225

scholarly journals Pain talk in palliative care: A qualitative analysis

2019 ◽  
Author(s):  
Yijin Wu
Keyword(s):  
Palliative Care ◽  
Conversation Analysis ◽  
Care Provider ◽  
Terminally Ill ◽  
Care Providers ◽  
Care Services ◽  
Healthcare Settings ◽  
Palliative Care Setting ◽  
Palliative Care Services ◽  
Problematic Experiences

Abstract Aim Using the method of Conversation Analysis (CA), this study aims to demonstrate how the palliative care provider uses different types of interactional practices to address patient’s pain concerns. Background The delivery of palliative care services could be facilitated through effective communication. The method of conversation analysis is effective in improving communication skills. Conversation analysis, used in other healthcare settings, also is a useful way to explore the interactional details between palliative care providers and terminally ill patients. Method The data showed in this study are obtained from 2 videotapes of provider-patient interaction in palliative care settings. The videos and the initial transcript of them are collected from the Alexander St website http://ctiv.alexanderstreet.com, an educational resource presenting a large collection of psycho-therapeutic videos. The data is analyzed using the method of conversation analysis. Results In this study, an illustrative analysis is demonstrated to show the potential of conversation analysis for research on pain talk in palliative care. It has been shown that conversation analysis could contribute to unfolding the interactional details regarding “pain talk” in palliative care settings. Specifically, CA could provide a detailed a description and interpretation of the conversational practices used to construct palliative care provider participation in delivering pain talk. In addition, CA could also demonstrate the interactional resources by which patients disclose their experiences of physical and spiritual pain to the palliative care provider and the way how the palliative care provider responds to patient’s problematic experiences. Conclusion This study identifies five types of interactional resources which are used to deal with patient’s pain concerns in palliative care setting. A conversation analytical study of pain talk in palliative care could provide a turn-by-turn description of how the palliative care provider communicates with the terminally ill patient in terms of pain concerns. The findings in this study could inform how the palliative care provider initiates, delivers and develops a pain talk with the terminally ill patient effectively.

Impact of embedded palliative care providers compared to externally available palliative care services on the number of patients receiving palliative care referrals in a large community oncology practice.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12103-12103
Author(s):  
Garrett Young ◽  
Aaron J. Lyss ◽  
Johnetta Blakely ◽  
Leah Owens ◽  
Natalie R. Dickson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Solid Tumor ◽  
Care Provider ◽  
Care Providers ◽  
Intervention Period ◽  
Tumor Patients ◽  
Referral Rates ◽  
Care Services ◽  
Community Oncology ◽  
Palliative Care Services

12103 Background: Palliative care improves quality of life and may increase overall survival in patients with solid tumor malignancies. Despite having the ability to refer patients to in-home and external palliative care services, we observed low palliative care referral rates in our practice of 90 oncologists across 30 clinics. We tested whether embedding palliative care providers directly in clinic would improve palliative care referral rates for solid tumor patients. Methods: Between 2017 and 2020, we embedded an independent palliative care provider into five clinics across middle Tennessee. Access to external palliative care services was present both before and after the intervention. Using data from our EHR and billing systems, we performed a pre-post analysis measuring palliative care referrals in the six-month periods immediately before (pre-intervention period) and after (post-intervention period) a palliative care provider was embedded in each clinic. Statistical significance was assessed using Welch’s two sample t-test. Results: 8,636 unique solid tumor patients were seen in the five clinics during the study periods (Table). Despite having the ability to refer patients to external palliative care services in the pre-intervention period, the placement of a palliative care provider into clinic increased the number of solid tumor patients that received a palliative care referral per month at all clinics (min.: 200%; max.: 990%; median: 600%). Four of the five increases were statistically significant (p-values < 0.05). Conclusions: Even when external palliative care services are available, embedding palliative care providers into community oncology clinics significantly increases the rate of palliative care referrals for solid tumor patients. [Table: see text]

Access to palliative care services for limited English proficient patients with advanced NSCLC.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 99-99
Author(s):  
Bonnie Leung ◽  
Selina Wong ◽  
Kiran Malli ◽  
Cheryl Ho
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Median Time ◽  
Advanced Nsclc ◽  
Care Providers ◽  
Do Not Resuscitate ◽  
Care Services ◽  
Significant Difference ◽  
Palliative Care Services ◽  
Nsclc Patients

99 Background: More than a quarter of people living in British Columbia, Canada speak languages other than English in their homes. Immigrants often encounter communication challenges with their health care providers (HCPs), have poor health literacy, and have a limited understanding on navigating the health care system. NSCLC patients with limited English proficiency (LEP) may receive less palliative care services despite high symptom burden and significant needs due to these factors. The study goals were to observe the difference in access to community palliative home care (CPHC) and rate of completing a Do Not Resuscitate (DNR) form between NSCLC patients who are English proficient (EP) and LEP. Methods: All patients with advanced NSCLC referred to BC Cancer–Vancouver Centre in 2016 and received medical care were included (N=176). Patients seen with a medical interpreter were considered to be LEP. Demographics and clinical information were collected retrospectively. UVA using X2 test and Fisher’s exact test were used to compare EP and LEP patients. Mann-Whitney test was used to compare the median time from CPHC referral and signed DNR to death between EP and LEP patients. Results: Language of communication: English 65%, Cantonese 22%, Mandarin 6%, Korean 1%, Tagalog 1%, and other 5%. Baseline characteristics: median age 69 EP vs 76 LEP, female 44% EP vs 65% LEP, non-squamous 68% EP vs 72% LEP and squamous 14% EP vs 6% LEP. There was no difference in the rate of CPHC referral (87% EP vs 80% LEP, p=0.342) and signed DNR form (92% EP vs 89% LEP, p=0.549). The median time from CPHC referral to death was 10 weeks EP vs 15 weeks LEP (p=0.039). The median time from signed DNR to death was 5 weeks EP vs 6 weeks LEP (p=0.806). There was no statistically significant difference in location of death between the two groups: acute care 20% EP vs 24% LEP, home 27% EP vs 13% LEP, hospice 36% EP vs 39% LEP, and tertiary palliative care unit 17% EP vs 24% LEP (p=0.251). Conclusions: EP and LEP patients with NSCLC had similar rates of CPHC service referrals and end of life planning. This suggests assistance of medical interpreters at the time of oncology visits help message delivery between LEP patients and HCPs. LEP patients had earlier referrals to CPHC prior to death which may reflect an enhanced awareness and effort by HCPs to have earlier conversations with patients who may have language and cultural barriers with discussing goals of care. Good communication improves patients and their family’s understanding of the goals and scope of palliative care services and allow HCPs to better understand the patients’ wishes.

scholarly journals Healthcare professionals’ experiences of inter-professional collaboration during patient’s transfers between care settings in palliative care: A focus group study

2020 ◽  
pp. 026921632096874
Author(s):  
Fien Mertens ◽  
Zoë Debrulle ◽  
Evelyn Lindskog ◽  
Luc Deliens ◽  
Myriam Deveugele ◽  
...  
Keyword(s):  
Palliative Care ◽  
Focus Group ◽  
Home Care ◽  
Continuity Of Care ◽  
Healthcare Professionals ◽  
Family Members ◽  
Professional Collaboration ◽  
Group Discussions ◽  
Care Services ◽  
Palliative Care Services

Background: Continuity of care is challenging when transferring patients across palliative care settings. These transfers are common due to the complexity of palliative care, which has increased significantly since the advent of palliative care services. It is unclear how palliative care services and professionals currently collaborate and communicate to ensure the continuity of care across settings, and how patient and family members are involved. Aim: To explore healthcare professionals’ experiences regarding the communicative aspects of inter-professional collaboration and the involvement of patient and family members. Design: Qualitative design, including focus group discussions. Setting/participants: The study focused on one palliative care network in Belgium and involved all palliative care settings: hospital, hospital’s palliative care unit, home care, nursing home. Nine group discussions were conducted, with diverse professionals ( n = 53) from different care settings. Results: Timely and effective inter-professional information exchange was considered fundamental. A perceived barrier for interprofessional collaboration was the lack of a shared electronic health record. Efficiency regarding multidisciplinary team meetings and inter-professional communication were subject to improvement. A striking study finding was the perceived insufficient open communication of specialists towards patients and the lack of shared decision making. This not only hampered advance care planning discussions and early integration of palliative home care, but also the functioning of other professionals. Conclusion: From the perspective of the integrated care framework, several areas of improvement on different levels of care and collaboration are identified. Support from policymakers and researchers is required to achieve integrated palliative care in regional networks.

scholarly journals Community Education for a Dignified Last Phase of Life for Migrants: A Community Engagement, Mixed Methods Study among Moroccan, Surinamese and Turkish Migrants

2020 ◽  
Vol 17 (21) ◽  
pp. 7797
Author(s):  
Xanthe de Voogd ◽  
Dick L. Willems ◽  
Bregje Onwuteaka-Philipsen ◽  
Marieke Torensma ◽  
Jeanine L. Suurmond
Keyword(s):  
Palliative Care ◽  
Mixed Methods ◽  
Community Engagement ◽  
Community Education ◽  
Real Life ◽  
Added Value ◽  
Individual Interviews ◽  
Turkish Migrants ◽  
Care Services ◽  
Palliative Care Services

Community engagement and -education are proposed to foster equity in access to care and to ensure dignity of migrant patients in the last phase of life, but evidence is lacking. We evaluated nine community educational interactive meetings about palliative care (136 participants totally)- co-created with educators from our target groups of Moroccan, Surinamese and Turkish migrants—with a mixed methods approach, including 114 questionnaires, nine observations, nine interviews with educators, and 18 pre- and post- group- and individual interviews with participants. Descriptive and thematic analysis was used. 88% of the participants experienced the meetings as good or excellent. Educators bridged an initial resistance toward talking about this sensitive topic with vivid real-life situations. The added value of the educational meetings were: (1) increased knowledge and awareness about palliative care and its services (2) increased comprehensiveness of participant’s wishes and needs regarding dignity in the last phase; (3) sharing experiences for relief and becoming aware of real-life situations. Community engagement and -education about palliative care for migrants effectively increases knowledge about palliative care and is a first step towards improved access to palliative care services, capacity building and a dignified last phase of life among migrants.

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