What Do Chaplains Do: The Views of Palliative Care Physicians, Nurses, and Social Workers

2018 ◽  
Vol 36 (5) ◽  
pp. 396-401 ◽  
Author(s):  
Annelieke Damen ◽  
Dirk Labuschagne ◽  
Laura Fosler ◽  
Sean O’Mahony ◽  
Stacie Levine ◽  
...  
Keyword(s):  
Palliative Care ◽  
Social Workers ◽  
Spiritual Care ◽  
Treatment Decision ◽  
Palliative Care Team ◽  
Clear Understanding ◽  
Community Based ◽  
Treatment Decision Making ◽  
Written Comments ◽  
Broad Understanding

It is well accepted that attention to spiritual concerns is a core dimension of palliative care. It is similarly well accepted that chaplains are the spiritual care specialists who should address such concerns. However, what chaplains do when they provide care for patients and families is often poorly understood by their palliative care colleagues. Having a clear understanding of what chaplains do is important because it contributes to improved utilization of the spiritual care and other resources of the palliative care team and thereby to better care for patients and families. The aim of this study was to describe what palliative care physicians, nurses, and social workers understand about what chaplains do. Brief surveys were distributed to participants at 2 workshops for palliative care professionals in 2016. The survey was completed by 110 participants. The majority reported that they understood what chaplains do moderately well or very well. Thirty-three percent of the written comments about what chaplains do were very general; 25% were more specific. Only a small proportion of the participants were aware that chaplains provide care for the team, are involved in facilitating treatment decision-making, perform spiritual assessments, and bridge communication between the patient/family/team/community. Based on our survey, palliative care colleagues appear to have a broad understanding of what chaplains do but many may be unfamiliar with important contributions of chaplains to care for patients, families, and teams. These findings point to the need for ongoing education of palliative teams about what chaplains do in palliative care.

Integration of spiritual care into palliative care service delivery models

2021 ◽  
pp. 1072-1080
Author(s):  
Yvan Beaussant ◽  
Alexandra Nichipor ◽  
Tracy A. Balboni
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Care Delivery ◽  
Palliative Care Team ◽  
Care Team ◽  
Clear Understanding ◽  
Care Provision ◽  
Serious Illness ◽  
Palliative Care Teams ◽  
Religious Dimensions

Addressing spirituality within serious illness is a core dimension of palliative care delivery. However, spiritual care frequently lacks integration within the care of patients and families facing serious illness. This chapter discusses the integration of spiritual care into palliative care delivery. Requisite to this integration is a clear understanding of definitions and palliative care guidelines informing spiritual care provision. Furthermore, integration is informed and motivated by a large body of evidence showing how spiritual and religious factors frequently play salient roles in serious illness and influence palliative care outcomes. The integration of spiritual care into palliative care practice relies on a generalist–specialist model, within which all members of the interdisciplinary palliative care team are responsible for spiritual care provision. Non-spiritual care specialist members of the palliative care team are responsible for generalist spiritual care delivery, including taking spiritual histories and screening for spiritual needs. The care team also includes spiritual care specialists, typically board-certified chaplains, who provide in-depth spiritual care delivery to patients and families and aid the care team in understanding the spiritual and religious dimensions of care. Additionally, data regarding tested spiritual care interventions are discussed as potential tools palliative care teams can employ to improve patient care and outcomes. Finally, the integration of spiritual care into palliative care teams presents both opportunities and challenges that must be considered as efforts needed to foster more seamless spiritual care delivery within palliative care.

HSR19-089: Misperceptions Regarding Palliative and Hospice Care Among Cancer Patients: What Can We Learn from Patient-Reported Treatment Decision Making

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-089
Author(s):  
Sara Hayes ◽  
Brian M. Green ◽  
Shayna Yeates ◽  
Amrita Bhowmick ◽  
Kaitlyn McNamara ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Cancer Care ◽  
Hospice Care ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Treatment Decision Making ◽  
Diagnosis Of Cancer

Background: Despite NCCN Guidelines and clear definition of palliative care, patients often carry misperceptions about palliative care and how it can be beneficially integrated into a patient’s care plan. In order to better understand the misinformation about palliative and hospice care, this study aims to assess patient-healthcare provider (HCP) communication regarding treatment decisions. Methods: An online survey was conducted with individuals who have had a diagnosis of cancer (n=1,517) to better understand their healthcare experiences as well as the impact their cancer diagnosis had on their quality of life. Measures included agreement scale questions assessing patient information needs surrounding treatment decision making. Open-ended questions where respondents were prompted to provide a written response allowed researchers to further assess patients’ understanding of palliative and hospice care. Responses to agreement-scale questions were evaluated using descriptive statistics. Openended question responses were analyzed using Dedoose qualitative data analysis software. Results: Among patients with a diagnosis of cancer, there were a broad range of patient misperceptions regarding palliative care, hospice care, and how they are used in cancer care. The majority of respondents (81%) stated that their HCP played a role when deciding on their treatment plan. Despite this, only 46% were confident they knew about the treatment’s impact on their daily life, 56% were confident they knew about the potential side effects of treatment, and 57% felt they had all of the information they needed. Themes identified through qualitative analysis include: patient conflation of palliative and hospice care, belief that palliative and hospice care are only relevant to end-of-life decision-making, and uncertainty about whether quality of life can actually be improved. Conclusions: Institutions and HCPs are recommended to integrate palliative care into cancer care. However, as this research shows, oncology patients are often misinformed about the benefits of palliative care. This follows a parallel concern of patients making treatment decisions without optimal information. A potential factor behind this unmet need may be lack of effective communication between patient and HCP. Palliative care may be mentioned by the HCP, but not discussed with enough empathy or depth, leading to patient misunderstanding and lack of inclusion in treatment plans.

Patterns of hospitalization and toxicity among patients undergoing cancer chemotherapy in community-based oncology practice in Brazil

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19678-19678
Author(s):  
P. E. Pizao ◽  
L. M. Katayama ◽  
A. J. Sagarra
Keyword(s):  
Cancer Chemotherapy ◽  
Negative Impact ◽  
Treatment Decision ◽  
Outpatient Setting ◽  
Quality Assurance Program ◽  
Current Evidence ◽  
Controlled Clinical Trial ◽  
Community Based ◽  
Gastrointestinal Complications ◽  
Treatment Decision Making

19678 Background: In Brazil, most cancer patients receive treatment outside the controlled clinical trial setting and at community- based clinics. In this scenario, data on treatment-related toxicity and its complications are seldom reported. Chemotherapy is frequently referred to as an excessively toxic treatment modality and this perception may have a negative impact on treatment decision-making. Methods: This is a single institution, prospective study. Eligible population consisted of all patients with solid tumors undergoing chemotherapy, between January/2005 and November/2006, at this community-based private oncology clinic with a multidisciplinary staff (physicians, nurses, pharmacists, nutrition and psycology experts). Treatment-related hospitalization (TRH) was defined as any hospitalization starting within 4 weeks after a chemotherapy session. Data concerning tumor-related symptoms and chemotherapy-induced toxicity were prospectively collected by a single physician. Results: A total of 59 patients were hospitalized during the study period. Median hospitalized patients′ age was 61 years and 58% were female. Most frequent tumor types were breast (36%), colorectal (14%), pancreatic (14%) and ovarian (9%) cancers. 34 (57%) of the 59 hospitalizations were classified as TRH. Febrile neutropenia (27%) and gastrointestinal complications (26%) were the main reasons for TRH. The median length of TRH was 4 days. 6/34 (17%) patients died during TRH: 5 died as a result of complications caused by disease progression (not chemotoxicity); 1 patient died as a consequence of chemotherapy-induced neutropenia and sepsis. TRH′s were associated to only 2% (34) of the 2203 chemotherapy sessions performed. Conclusions: Current evidence-based, consensus-guideline-oriented, cancer chemotherapy, administered by a multidisciplinary team of specialists, was associated to a low rate of treatment-related hospitalizations. Generally, chemotherapy-induced toxicity was reversible and manageable in the outpatient setting. The permanent monitoring and reporting of treatment-related toxicities is feasible in community-based clinical practice as part of a quality-assurance program. No significant financial relationships to disclose.

scholarly journals Where is the voice of social work in the multi disciplinary palliative care team?

2016 ◽  
Vol 24 (2) ◽  
pp. 49-60 ◽  
Author(s):  
Mary James
Keyword(s):  
Palliative Care ◽  
Social Work ◽  
Social Workers ◽  
Palliative Care Team ◽  
Care Team ◽  
The Social ◽  
Hospice Patients ◽  
The Voice ◽  
Multi Disciplinary Team

In the medical world, audits are frequently conducted to assess performance ideals and generate better outcomes for staff and patients. Audits are not such a common measure in social work. In order to begin to find a place to articulate the value of social work within the work of Hospice, a snapshot survey was taken of referrals within Hospice programmes within a specified three month period. The results of the audit revealed some striking commonalities as well as variations which may reflect the communities the Hospices operate within. The results of four other audits taken within the social work literature are presented. Snapshot ‘quotes’ taken from international researchers set a foundation for social workers to articulate the value of their role within palliative care. It is argued that unless social workers begin to articulate the value of their skills, they are in danger of becoming a forgotten voice in the multi disciplinary team caring for the needs of Hospice patients and families. 

How does parental status influence preferences for cancer treatment and palliative care?

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 65-65
Author(s):  
Devon Check ◽  
Eliza Park ◽  
Katherine Elizabeth Reeder-Hayes ◽  
Deborah Mayer ◽  
Allison Mary Deal ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Cancer Treatment ◽  
Metastatic Cancer ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Family Characteristics ◽  
Parental Status ◽  
Treatment Decision Making ◽  
Parental Concerns

65 Background: When patients with metastatic cancer have dependent children, they may be less likely to acknowledge the terminal nature of their illness and more willing to accept toxic treatments for small improvements in survival, compared to patients without children. Our mixed methods study sought to clarify the role of parental concerns in treatment decision-making. Methods: We recruited 63 patients with metastatic cancer who have children <18 to complete measures of physical and social wellbeing. 47 (75%) also participated in a semi-structured interview, which included questions about whether parental status influences patients’ decisions about anti-cancer treatment and whether patients would consider using palliative care, including hospice. We used univariable logistic regression to examine the relationship between patient and family characteristics and 3 outcomes: 1) influence of parental status on treatment decision-making, 2) interest in palliative care, and 3) interest in hospice. We used participants’ qualitative comments to describe the context for their preferences. Results: Average patient age was 44; average number of children was 2, and average child age was 13. 70% of patients reported that being a parent influences their treatment decisions. 64% cited parental status as motivation for life-extending treatment. 15% prioritized preserving parental functioning. Half of patients said they would consider using palliative care, and 57% said they would consider using hospice. Reasons for disinterest in palliative care and hospice included concerns about being perceived as giving up and children’s exposure to death at home. Parents with older children (OR 0.85, p=0.03), and those with increased social support (OR 0.96, p=0.05) had lower odds of reporting an influence of parental status on treatment decisions. Children’s age (OR 0.85, p=0.02) and low performance status (OR 4.3, p=0.02) were associated with palliative care interest. Conclusions: Parental concerns may influence treatment decision-making for metastatic cancer patients with children. Information about parental concerns may help oncologists to align treatment with patients’ priorities.

Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: A qualitative exploration of consumer and health care professional perspectives

2018 ◽  
Vol 32 (8) ◽  
pp. 1369-1377 ◽  
Author(s):  
Lisha Kuruvilla ◽  
Greg Weeks ◽  
Peter Eastman ◽  
Johnson George
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Palliative Care ◽  
Focus Groups ◽  
Current Model ◽  
Medication Management ◽  
Palliative Care Team ◽  
Specialist Palliative Care ◽  
Community Based

Background: Pharmacists have a key role to play in optimisation of medication regimens and promotion of medication safety. The role of specialist pharmacists as part of the multidisciplinary palliative care team, especially in the primary care setting, is not widely recognised. Aim: To explore the perspectives of stakeholders about the gaps in the current model of community palliative care services in relation to medication management and to assess their opinions pertaining to the role of a specialist palliative care pharmacist in addressing some of those gaps. Design: Qualitative study utilising three focus groups involving 20 stakeholders. Thematic analysis was carried out using a framework approach and interpreted in the context of the Chronic Care Model for improving primary care for patients with chronic illness. Setting/Participants: Setting was a large regional Australian palliative care service. Participants included palliative care consumers and clinicians specifically patients, caregivers, physicians, nurses and pharmacists. Results: Five major themes emerged from the focus groups: access to resources, medicines and information; shared care; challenges of polypharmacy; informal caregiver needs and potential roles of a palliative care pharmacist. Gaps in access to medicines/resources, training for generalist practitioners, communication between treating teams and lack of support for patients and carers were cited as factors adversely impacting medication management in community-based palliative care. Conclusion: While community-based palliative care is an essential aspect of meeting the health care demands of an ageing society, the current model has several gaps and limitations. An appropriately qualified and skilled pharmacist within the palliative care team may help to address some of the gaps in relation to medication access and appropriateness.

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