scholarly journals Cultures that collide: an ethnographic study of the introduction of a palliative care consultation team on acute wards

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Friedrichsen ◽  
Yvonne Hajradinovic ◽  
Maria Jakobsson ◽  
Kerstin Brachfeld ◽  
Anna Milberg
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Intervention Study ◽  
Daily Practice ◽  
Ethnographic Study ◽  
Consulting Services ◽  
Palliative Care Consultation ◽  
Consultation Team ◽  
Care Consultation ◽  
Acute Wards

Abstract Background Acute care and palliative care (PC) are described as different incompatible organisational care cultures. Few studies have observed the actual meeting between these two cultures. In this paper we report part of ethnographic results from an intervention study where a palliative care consultation team (PCCT) used an integrative bedside education approach, trying to embed PC principles and interventions into daily practice in acute wards. Purpose To study the meeting and interaction of two different care cultures, palliative care and curative acute wards, when a PCCT introduces consulting services to acute wards regarding end-of-life palliative care, focusing on the differences between the cultures. Methods An ethnographic study design was used, including observations, interviews and diary entries. A PCCT visited acute care wards during 1 year. The analysis was inspired by Spradleys ethnography. Results Three themes were found: 1) Anticipations meets reality; 2) Valuation of time and prioritising; and 3) The content and creation of palliative care. Conclusion There are many differences in values, and the way PC are provided in the acute care wards compared to what a PCCT expects. The didactic challenges are many and the PC require effort.

scholarly journals Palliative care consultation team on acute wards—an intervention study with pre-post comparisons

2016 ◽  
Vol 25 (2) ◽  
pp. 371-380 ◽  
Author(s):  
Maria Friedrichsen ◽  
Yvonne Hajradinovic ◽  
Maria Jakobsson ◽  
Per Milberg ◽  
Anna Milberg
Keyword(s):  
Palliative Care ◽  
Intervention Study ◽  
Palliative Care Consultation ◽  
Consultation Team ◽  
Care Consultation ◽  
Acute Wards

scholarly journals The Palliative Care Illusion on Acute Wards An Ethnographic Study of the Introduction of a Palliative Care Consultation Team

2021 ◽  
Author(s):  
Maria Friedrichsen ◽  
Yvonne Hajradinovic ◽  
Maria Jakobsson ◽  
Kerstin Brachfeld ◽  
Anna Milberg
Keyword(s):  
Palliative Care ◽  
Health Care Team ◽  
Ethnographic Study ◽  
Care Team ◽  
Team Members ◽  
Dying Patients ◽  
Palliative Care Consultation ◽  
Consultation Team ◽  
Care Consultation ◽  
Acute Wards

Abstract Acute care and palliative care are described as different incompatible organisational care cultures, with contrasts and contradictions. Few studies have observed the actual meeting between these two cultures. Purpose: To study the meeting and interaction of two different organisational care cultures, palliative care and curative acute wards, when a palliative care consultation team introduces consulting services to acute wards regarding end-of-life palliative care. Methods: An ethnographic study design was used, including observations, interviews and diary entries. A palliative care consultation team visited surgical and internal medicine wards during one year. An integrative bedside education approach was used, where physicians and nurses experienced in PC tried to embed PC principles and interventions into daily practice. The analysis was inspired by Spradley’s ethnography.Results: Three themes were found in the study: 1) Values, illusions, and wording in the acute care culture; 2) Didactic challenges and strategies, and 3) The palliative illusion becomes a fusion. On the acute wards, fast “turn over” was the goal of care: to treat patients quickly and send them home. Primary health care team members believed that they gave dying patients good care, a conclusion not supported by the palliative care team, who identified values problems and a knowledge shortage among all primary team members. Because the primary team did not have time for reflection regarding patients’ whole situation, and wanted to do as much as possible before “giving up”, their patients could be one hour from death before the primary team provided palliative care. After one year, primary team members wanted the palliative care consultation team to continue, since they felt they could not handle dying patients on their own.Conclusion: Palliative care consultation team make changes about end- of- life care when working with primary health care team members on acute wards. The didactic challenges are many and require efforts.

scholarly journals Barriers and Facilitators to Effective Inpatient Palliative Care Consultations: A Qualitative Analysis of Interviews With Palliative Care and Nonpalliative Care Providers

2018 ◽  
Vol 36 (3) ◽  
pp. 191-199 ◽  
Author(s):  
Meghan McDarby ◽  
Brian D. Carpenter
Keyword(s):  
Palliative Care ◽  
Nurse Practitioners ◽  
Care Service ◽  
Palliative Care Service ◽  
Educational Interventions ◽  
Care Providers ◽  
Palliative Care Consultation ◽  
Consultation Team ◽  
Care Consultation ◽  
Successful Collaboration

Objective: To identify factors that hinder or facilitate the palliative care consultation team’s (PCCT) successful collaboration with other providers from the perspectives of both PCCT and nonpalliative specialists. Methods: Qualitative study, including semistructured interviews with PCCT and nonpalliative care providers from various specialties at 4 Midwestern hospitals. Interviews were audio-recorded and transcribed into written text documents for thematic analysis. Palliative care consultation team (n = 19) and nonpalliative care providers (n = 29) were interviewed at their respective hospital sites or via telephone. Palliative care consultation team providers included physicians, nurse practitioners, registered nurses, social workers, and one chaplain. Specialists included critical care physicians, surgeons, hospitalists, nephrologists, oncologists, and cardiologists. Results: Six themes emerged reflecting barriers to and facilitators of successful collaboration between the PCCT and other providers. Primary barriers included attitudes about palliative care, lack of knowledge about the role of the PCCT, and patient and family resistance. Facilitators included marketing of the palliative care service and education about the expertise of the PCCT. Conclusion: In order to engage in more effective collaboration with other specialty providers, the PCCT may consider strategies including structured educational interventions, increased visibility in the hospital, and active marketing of the utility of palliative care across disciplines.

scholarly journals Impact of a new palliative care consultation team on opioid prescription in a University Hospital

2009 ◽  
Vol 8 (1) ◽  
Author(s):  
Carlos Centeno ◽  
María Angustias Portela ◽  
Antonio Noguera ◽  
Antonio Idoate ◽  
Álvaro Sanz Rubiales
Keyword(s):  
Palliative Care ◽  
University Hospital ◽  
Opioid Prescription ◽  
Palliative Care Consultation ◽  
Consultation Team ◽  
Care Consultation

scholarly journals Palliative care consultation team: symptom relief in first 48 hours of hospitalization

2020 ◽  
Vol 73 (6) ◽  
Author(s):  
Magda Aparecida dos Santos Silva ◽  
Marcio Augusto Diniz ◽  
Ricardo Tavares de Carvalho ◽  
Toshio Chiba ◽  
Cibele Andrucioli de Mattos-Pimenta
Keyword(s):  
Palliative Care ◽  
Pain Relief ◽  
Symptom Relief ◽  
Symptom Assessment ◽  
Assessment System ◽  
Point Reduction ◽  
Palliative Care Consultation ◽  
Symptom Intensity ◽  
Consultation Team ◽  
Care Consultation

ABSTRACT Objective: To compare the relief of symptoms provided by palliative care consultation team (PCCT) compared to the traditional care team (TC), in patients with advanced cancer in the first 48 hours of hospitalization. Method: Allocated to PCCT Group and TC Group, this study assessed 290 patients according to the Edmonton Symptom Assessment System (ESAS) within the first 48 hours of hospitalization. The main outcome was a minimum 2-point reduction in symptom intensity. Results: At 48 hours, the PCCT Group had a 2-point reduction in the mean differences (p <0.001) in pain, nausea, dyspnea, and depression; and TC Group, on nausea and sleep impairment (p <0.001). Multiple Logistic Regression found for the PCCT Group a greater chance of pain relief (OR 2.34; CI 1.01-5.43; p = 0.049). Conclusion: There was superiority of the PCCT Group for pain relief, dyspnea and depression. There is a need for more studies that broaden the understanding of team modalities.

Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: Where do cost-savings come from?

2017 ◽  
Vol 31 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Peter May ◽  
Melissa M Garrido ◽  
J Brian Cassel ◽  
Amy S Kelley ◽  
Diane E Meier ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Advanced Cancer ◽  
Intervention Group ◽  
Cost Savings ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Consultation Team ◽  
Care Consultation

Background: Studies report cost-savings from hospital-based palliative care consultation teams compared to usual care only, but drivers of observed differences are unclear. Aim: To analyse cost-differences associated with palliative care consultation teams using two research questions: (Q1) What is the association between early palliative care consultation team intervention, and intensity of services and length of stay, compared to usual care only? (Q2) What is the association between early palliative care consultation team intervention and day-to-day hospital costs, compared to a later intervention? Design: Prospective multi-site cohort study (2007–2011). Patients who received a consultation were placed in the intervention group, those who did not in the comparison group. Intervention group was stratified by timing, and groups were matched using propensity scores. Setting/participants: Adults admitted to three US hospitals with advanced cancer. Principle analytic sample contains 863 patients ( nUC = 637; nPC EARLY = 177; nPC LATE = 49) discharged alive. Results: Cost-savings from early palliative care accrue due to both reduced length of stay and reduced intensity of treatment, with an estimated 63% of savings associated with shorter length of stay. A reduction in day-to-day costs is observable in the days immediately following initial consult but does not persist indefinitely. A comparison of early and late palliative care consultation team cost-effects shows negligible difference once the intervention is administered. Conclusion: Reduced length of stay is the biggest driver of cost-saving from early consultation for patients with advanced cancer. Patient- and family-centred discussions on goals of care and transition planning initiated by palliative care consultation teams may be at least as important in driving cost-savings as the reduction of unnecessary tests and pharmaceuticals identified by previous studies.

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