Urgent Creation of a Palliative Care Team in a Small Hospital During the COVID Crisis

2020 ◽  
pp. 104990912097519
Author(s):  
Nydia Martinez ◽  
Hilah Tanev ◽  
Samuel Gurevich ◽  
Candilla Davis ◽  
Mirlande Cazeau ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Essential Element ◽  
Palliative Care Service ◽  
Palliative Care Team ◽  
South Florida ◽  
Care Team ◽  
Small Hospital ◽  
Comfort Care ◽  
Care Experience

The COVID-19 pandemic created a global health emergency that has changed the practice of medicine and has shown the need for palliative care as an essential element of hospital care. In our small South Florida hospital, a palliative care service was created to support the frontline caregivers. Thanks to the hospital support, our team was formed rapidly. It consisted of 3 advanced care practitioners, a pulmonary physician with palliative care experience and the cooperation of community resources such as hospice and religious support. We were able to support patients and their families facilitating communication as visitation was not allowed. We also addressed goals of care, providing comfort care transition when appropriate, and facilitating allocation of scarce resources to patients who were most likely to benefit from them. With this article we describe a simplified framework to replicate the creation of a Palliative Care Team for other hospitals that are experiencing this need.

Bowel obstruction with stage IV cancer: The benefit of introduction of formal palliative care service.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20573-e20573
Author(s):  
Moshim Kukar ◽  
Adrienne Groman ◽  
Yashodhara K. Satchidanand ◽  
Amy I. Alvarez-Perez ◽  
Kelli B. Dunn ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Bowel Obstruction ◽  
Care Service ◽  
Palliative Care Service ◽  
Stage Iv ◽  
Palliative Care Team ◽  
Care Team ◽  
Comorbid Conditions ◽  
Stage Iv Cancer

e20573 Background: Patients with stage IV cancer and bowel obstruction (BO) present a complicated management problem. The aim of this study was to evaluate the role of introduction of an organized palliative care service in the management of this complex disease process. Methods: We conducted a retrospective analysis of all patients admitted to the Roswell Park Cancer Institute with stage IV cancer and BO after the institution of formal palliative care service (PS) in 2009. This cohort was compared to a group prior to 2009 (No Palliative care service Group; NPS). The two groups were compared with respect to demographics, comorbid conditions, DNR status, laboratory parameters, medical, surgical management, length of stay and disposition status. Results: 28 patients were identified in PS group as compared to 40 patients in NPS group. The 2 groups were similar in terms of age, gender, race, comorbid conditions, primary site of cancer, chemotherapy, radiation therapy and weight loss. There was a statistically significant difference in the medication regimen provided, as those who had palliative care consults were more likely to receive alternative medications to standard anti-emetics (Table). The palliative care team followed 19/28 patients and 14/19 patients showed improvement in their symptoms (nausea, pain control) in initial 24 hours after the palliative care consult. 50 % ( n=14) of patients in PS group had a formal DNR order in place as compared to 15.4% in NPS group (p<0.001). In 9/14 patients the first discussion regarding DNR was held by palliative care team. A significantly higher percentage of patients were discharged to the hospice care in PS group (42.9% vs. 7.5%, p =0.006). Conclusions: BO in patients with stage IV cancer often poses a dilemma in the choice of surgery versus medical management. Palliative care consults, early in the hospitalization, may help improve symptom management, end of life discussions, better psychosocial support, discharge placements and will eventually translate to shorter length of stay. [Table: see text]

Breathlessness and opioid therapy: A retrospective chart analysis in 2,958 patients.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 192-192
Author(s):  
Benjamin Gronwald ◽  
Michael Wolff ◽  
Jan Gaertner ◽  
Patric Bialas ◽  
Marcus Niewald ◽  
...  
Keyword(s):  
Palliative Care ◽  
Palliative Care Service ◽  
Opioid Therapy ◽  
Palliative Care Team ◽  
Care Team ◽  
University Hospital ◽  
Chronic Obstructive ◽  
Prolonged Release ◽  
Common Symptom ◽  
Distressing Symptom

192 Background: Breathlessness is a common and distressing symptom, which increases in many diseases as they progress and is difficult to manage. It is widely accepted that opioids are safe and effective for treating dyspnea, although no single opioid has an authorization for the treatment of breathlessness. The aims of the study were to assess prevalence rates of breathlessness as well as the treatment approaches especially with respect to opioid therapy in all patients cared by a hospital palliative care team in a university hospital over a period of five years. Methods: A systematic review of all electronically available records of patients under palliative care service from April 2010 – April 2015 was performed. Results: Breathlessness was the third most common symptom in our patient group behind fatigue and pain. Furthermore it was classified as the utmost distressing symptom of all. Many patients suffering from breathlessness were opioid-naive before contact with our palliative care team. Many of these patients were put on prolonged-release opioids together with short-acting opioids (mucosal fentanyl) as rescue medication for breathlessness. Opioid therapy was judged to be very effective by the majority of patients suffering from breathlessness however caused (cancer-related or due to a benign disease e.g. chronic obstructive pulmonary disease). Conclusions: In a large cohort of patients breathlessness is a major topic and is clearly positively influenceable by opioids. In our opinion it is longtime overdue to strive for an authorization for opioids against breathlessness.

scholarly journals Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Rasheed Ofosu-Poku ◽  
Michael Owusu-Ansah ◽  
John Antwi
Keyword(s):  
Palliative Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Clinical Care ◽  
Palliative Care Service ◽  
Palliative Care Team ◽  
Care Team ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services

Ghana’s chronic disease burden is on the rise. An essential aspect of clinical care in chronic disease management is to improve the quality of life of both patients and their families and to help them cope with the experience of life-limiting illness. Specialist palliative care services help reach this objective, especially in the context of complex psychosocial challenges and high symptom burden. It is, therefore, necessary that as many patients as possible get access to available specialist palliative care services. This paper explores the factors influencing referral of patients with nonmalignant chronic diseases for specialist palliative care. A qualitative approach was used to explore these factors from eight (8) participants—four (4) physician specialists and four (4) next of kin of patients with advanced nonmalignant chronic illness. Individual face-to-face interviews were conducted using a semistructured interview guide. Interviews were audio-recorded and data coded, themes and subthemes were identified, and thematic analysis was done. Barriers and motivators identified were categorized as either related to physicians, institution, or family. Barriers to referral were perception of the scope of palliative care, medical paternalism, lack of an institutional referral policy, poor human resource capacity of the palliative care team, and lack of awareness about the existence of specialist palliative care service. Poor economic status of the patient and family, poor prognosis, previous interaction with the palliative care team, and an appreciation of patients’ expectations of the healthcare system were identified as motivators for referral. The palliative care team must therefore increase awareness among other health professionals about their services and facilitate the development and availability of a clear policy to guide and improve referrals.

scholarly journals Implantação de um Programa Multiprofissional de Assistência em Cuidado Paliativo: Relato de Experiência / Implementation of a Multiprofessional Assistance Program in Palliative Care: Experience Report

2021 ◽  
Vol 15 (57) ◽  
pp. 436-449
Author(s):  
Ana Paula Ribeiro Toldo ◽  
Hildegard Magdalena Klever Krause ◽  
Inez Maria de Fátima Robert
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Care Service ◽  
Palliative Care Service ◽  
Chronically Ill ◽  
Assistance Program ◽  
Care Experience ◽  
Expected Time ◽  
Relief Of Suffering

Resumo: Cuidado paliativo é uma abordagem que ampara a assistência do profissional de saúde nos cuidados aos doentes em situação de intenso sofrimento, decorrente de doença que ameaça a continuidade da vida, tendo como objetivo promover alívio do sofrimento e qualidade de vida do paciente e familiares, dentro das medidas possíveis e até o fim da vida. O estudo teve por objetivo realizar e descrever a implantação e implementação de um programa multiprofissional de assistência em Cuidado Paliativo. O estudo caracterizado como uma pesquisa ação, apresenta 5 fases para o desenvolvimento da proposta do serviço. Com a implementação do programa, pode-se proporcionar a humanização da equipe multiprofissional no trato aos pacientes e familiares. Dentre as expectativas que se atribuíram à proposta de criação de um serviço de cuidado paliativo, sua criação e aplicação foram realizadas dentro do tempo esperado, além de um aproveitamento e resultados maior do que os previamente previstos.Palavras-Chave: Cuidado paliativo; doentAbstract: Palliative care is an approach that supports the assistance of health professionals in the care of patients in situations of intense suffering, resulting from a disease that threatens the continuity of life, aiming to promote relief of suffering and quality of life for patients and their families, within of possible measures and until the end of life. The study aimed to carry out and describe the implementation and implementation of a multiprofessional assistance program in Palliative Care. The study characterized as action research, presents 5 phases for the development of the service proposal. With the implementation of the program, the humanization of the multidisciplinary team in dealing with patients and families can be provided. Among the expectations that were attributed to the proposal to create a palliative care service, its creation and application were carried out within the expected time, in addition to a better use and results than those previously expected. Keywords: Palliative care; chronically ill; assistance.e crônico; assistência.  

CUIDADO PALIATIVO NA UNIDADE DE TERAPIA INTENSIVA

2019 ◽  
Vol 1 (2) ◽  
pp. 68-94
Author(s):  
Raquel JESUS Melânia de Jesus Tassini ◽  
Joseph Fabiano Guimarães Santos ◽  
Maria Emídia de Melo Coelho
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
End Of Life Care ◽  
Critical Care Unit ◽  
Care Service ◽  
Palliative Care Service ◽  
Life Care ◽  
Comfort Care ◽  
Terapia Intensiva

No cotidiano da prática da medicina de urgência e emergência, mais especificamente na terapia intensiva, surgem diversas situações onde o paciente encontra-se na condição de um processo de morte inexorável, e muitas vezes já com o suporte avançado de vida instalado. Diante desta realidade, cada vez mais presente, necessitamos de intervenções que amenizem os sofrimentos consequentes à mesma, em que a capacidade humana de compaixão e misericórdia possam prevalecer. Neste estudo fez-se revisão sistemática, na busca de estudos observacionais e intervencionistas, além de estudos de revisão sistemática e meta-análise, obtidos através de pesquisa eletrônica realizada no banco de dados do Pubmed e Medline. O período pesquisado foi entre 2006 a 2018. Os termos pesquisados foram: “intensive care unit”, “critical care unit”, “palliative care”, “improving palliative care”, “palliative care service”, “palliative care consult”, “end-of-life care”, “comfort care” e “supportive care”. Fez-se descrição didática dos diversos aspectos encontrados na revisão, onde avaliou-se a importância e necessidade da integração dos cuidados paliativos com a terapia intensiva, por se tratar de uma opção com elevada eficiência e eficácia para dar suporte na assistência aos pacientes, principalmente àqueles com doença terminal e seus familiares. Conclui-se ser imprescindível a educação sobre a filosofia, princípios e prática dos cuidados paliativos na equipe multiprofissional, assim como nos especialistas envolvidos no cuidado do paciente.

scholarly journals ‘Death is difficult in any language’: A qualitative study of palliative care professionals’ experiences when providing end-of-life care to patients from culturally and linguistically diverse backgrounds

2018 ◽  
Vol 32 (8) ◽  
pp. 1419-1427 ◽  
Author(s):  
Anna Green ◽  
Natalia Jerzmanowska ◽  
Marguerite Green ◽  
Elizabeth A Lobb
Keyword(s):  
Palliative Care ◽  
Patient Group ◽  
Care Service ◽  
Palliative Care Service ◽  
Linguistically Diverse ◽  
Care Staff ◽  
Culturally And Linguistically Diverse ◽  
Comfort Care ◽  
Provider Perceptions ◽  
Diverse Backgrounds

Background: Ethnic minority patients have unique challenges in accessing health services. These include language difficulties, unfamiliarity with the health system, lower rates of cancer screening and survival, higher rates of reported side effects from cancer treatment and poorer quality of life. Little is known about this patient group when transitioning to palliative care. Aim: To elicit the experiences of palliative care health professionals when providing care for patients from culturally and linguistically diverse backgrounds which differ from mainstream Australian language and culture. Design: An emergent qualitative design, informed by theoretical and procedural direction from grounded theory research. Setting/participants: Four focus groups held with palliative care staff ( n = 28) in a single specialist palliative care service in Australia. Results: The following themes emerged: (1) determining the rules of engagement around discussion of diagnosis and prognosis, (2) navigating the challenge of language to patient understanding, (3) understanding migration experiences to establish trust, (4) maintaining the balance between patient safety and comfort care, (5) providing a good death experience through accommodation of beliefs, and (6) navigating the important role of family members while privileging patient preferences. Conclusion: Underlying provider perceptions of caring for patients was that death is difficult in any language. Care was conceptualised as considering cultural and linguistic backgrounds within individualistic care. Understanding the migration experience and building trust were key elements of this individualised approach. Acknowledgement of the key role played by families in patient care and safety are strategies to minimise barriers and understand the concerns of this patient group.

scholarly journals Delivering Pediatric Palliative Care: From Denial, Palliphobia, Pallilalia to Palliactive

Children ◽  
2018 ◽  
Vol 5 (9) ◽  
pp. 120 ◽  
Author(s):  
Stefan Friedrichsdorf ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Symptom Control ◽  
Palliative Care Service ◽  
The United States ◽  
Pediatric Palliative Care ◽  
Emotional Impact ◽  
Optimal Care ◽  
Comfort Care ◽  
Serious Illness

Among the over 21 million children with life-limiting conditions worldwide that would benefit annually from a pediatric palliative care (PPC) approach, more than eight million would need specialized PPC services. In the United States alone, more than 42,000 children die every year, half of them infants younger than one year. Advanced interdisciplinary pediatric palliative care for children with serious illnesses is now an expected standard of pediatric medicine. Unfortunately, in many institutions there remain significant barriers to achieving optimal care related to lack of formal education, reimbursement issues, the emotional impact of caring for a dying child, and most importantly, the lack of interdisciplinary PPC teams with sufficient staffing and funding. Data reveals the majority of distressing symptoms in children with serious illness (such as pain, dyspnea and nausea/vomiting) were not addressed during their end-of-life period, and when treated, therapy was commonly ineffective. Whenever possible, treatment should focus on continued efforts to control the underlying illness. At the same time, children and their families should have access to interdisciplinary care aimed at promoting optimal physical, psychological and spiritual wellbeing. Persistent myths and misconceptions have led to inadequate symptom control in children with life-limiting diseases. Pediatric Palliative Care advocates the provision of comfort care, pain, and symptom management concurrently with disease-directed treatments. Families no longer have to opt for one over the other. They can pursue both, and include integrative care to maximize the child’s quality of life. Since most of the sickest children with serious illness are being taken care of in a hospital, every children’s hospital is now expected to offer an interdisciplinary palliative care service as the standard of care. This article addresses common myths and misconceptions which may pose clinical obstacles to effective PPC delivery and discusses the four typical stages of pediatric palliative care program implementation.

The approach for development of palliative care team database

2015 ◽  
Vol 10 (2) ◽  
pp. 901-905
Author(s):  
Hiroyuki Watanabe ◽  
Miwako Eto ◽  
Keiichi Yamasaki
Keyword(s):  
Palliative Care ◽  
Palliative Care Team ◽  
Care Team
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