scholarly journals Developing a local service to improve the provision of palliative care to people who use substances

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S195-S196
Author(s):  
Vyasa Immadisetty ◽  
Natasha Palipane ◽  
Tracy Reed ◽  
Srirupa Gupta ◽  
Beverley Pickett ◽  
...  
Keyword(s):  
Palliative Care ◽  
Substance Use ◽  
Systems Approach ◽  
Care Pathway ◽  
Healthcare Providers ◽  
Service Development ◽  
Care Seeking ◽  
Patient Identification ◽  
Teaching Resources ◽  
Symptom Palliation

AimsTo develop a new service model that engages and improves the provision of palliative care to PWUS.BackgroundAlthough people who use substances (PWUS) continue to die prematurely compared to the general population, they are now more likely to die from chronic diseases rather than from drug-related deaths. Challenges to providing palliative care to PWUS include delayed care-seeking behaviours, complex drug interactions and lack of healthcare provider experience.MethodAn informal factorial analysis elucidated population needs through: a review of local databases to estimate the prevalence of palliative need, a thematic review into the deaths of patients in specialist drug services and, a survey of health practitioners’ knowledge and attitudes. These informed the service development phase which involves three key components: 1. A systems approach to increasing patient identification, incorporating key multi-disciplinary stakeholders across hospital- and community-based care 2. Targeted training of healthcare providers and 3. Medicines management for symptom palliation amidst concurrent substance use (including substitution treatments).ResultThe palliative needs of PWUS are under-identified: the local substance service was not partaking in the palliative referral pathway. Only 7% of a local hospice's annual caseload was recognised as having substance use problems. The care pathway was described as fragmented. Although >80% of surveyed palliative care practitioners had experienced caring for PWUS, confidence and knowledge around managing withdrawal, pain and opioid substitution therapies was poor.ConclusionA new pathway is designed to identify PWUS and in their last year of life at key treatment points e.g., accident and emergency, ward-based care. The pathway will then streamline referrals to relevant specialist services depending on complexity of palliative/dependency need. Teaching resources and prescribing guidelines have been developed in collaboration with secondary care pain specialists.

scholarly journals Duration of intervals in the care seeking pathway for lung cancer in Bangladesh: A journey from symptoms triggering consultation to receipt of treatment

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257301
Author(s):  
Adnan Ansar ◽  
Virginia Lewis ◽  
Christine Faye McDonald ◽  
Chaojie Liu ◽  
Muhammad Aziz Rahman
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Rural Areas ◽  
Care Pathway ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Care Seeking ◽  
Healthcare Seeking ◽  
Lung Cancer Patients ◽  
Initial Care

Timeliness in seeking care is critical for lung cancer patients’ survival and better prognosis. The care seeking trajectory of patients with lung cancer in Bangladesh has not been explored, despite the differences in health systems and structures compared to high income countries. This study investigated the symptoms triggering healthcare seeking, preferred healthcare providers (including informal healthcare providers such as pharmacy retailers, village doctors, and “traditional healers”), and the duration of intervals in the lung cancer care pathway of patients in Bangladesh. A cross-sectional study was conducted in three tertiary care hospitals in Bangladesh among diagnosed lung cancer patients through face-to-face interview and medical record review. Time intervals from onset of symptom and care seeking events were calculated and compared between those who sought initial care from different providers using Wilcoxon rank sum tests. Among 418 study participants, the majority (90%) of whom were males, with a mean age of 57 ±9.86 years, cough and chest pain were the most common (23%) combination of symptoms triggering healthcare seeking. About two-thirds of the total respondents (60%) went to informal healthcare providers as their first point of contact. Living in rural areas, lower levels of education and lower income were associated with seeking care from such providers. The median duration between onset of symptom to confirmation of diagnosis was 121 days, between confirmation of diagnosis and initiation of treatment was 22 days, and between onset of symptom and initiation of treatment was 151 days. Pre-diagnosis durations were longer for those who had sought initial care from an informal provider (p<0.05). Time to first contact with a health provider was shorter in this study compared to other developed and developing countries but utilizing informal healthcare providers caused delays in diagnosis and initiation of treatment. Encouraging people to seek care from a formal healthcare provider may reduce the overall duration of the care seeking pathway.

scholarly journals Patient and caregiver experiences with advanced cancer care: a qualitative study informing the development of an early palliative care pathway

2020 ◽  
pp. bmjspcare-2020-002578
Author(s):  
Sadia Ahmed ◽  
Syeda Farwa Naqvi ◽  
Aynharan Sinnarajah ◽  
Gwen McGhan ◽  
Jessica Simon ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Cancer Care ◽  
Care Pathway ◽  
Healthcare Providers ◽  
Care Patient ◽  
Early Palliative Care ◽  
Telephone Interviews ◽  
Care Services ◽  
Life Threatening Illness

BackgroundPalliative care is an approach that improves the quality of life of patients and families facing challenges associated with life-threatening illness. In order to effectively deliver palliative care, patient and caregiver priorities need to be incorporated in advanced cancer care.AimThis study identified experiences of patients living with advanced colorectal cancer and their caregivers to inform the development of an early palliative care pathway.DesignQualitative patient-oriented study.Settings/participantsPatients receiving care at two cancer centres were interviewed using semistructured telephone interviews to explore their experiences with cancer care services received prior to a new developed pathway. Interviews were transcribed verbatim, and the data were thematically analysed.ResultsFrom our study, we identified gaps in advanced cancer care that would benefit from an early palliative approach to care. 15 patients and 7 caregivers from Edmonton and Calgary were interviewed over the phone. Participants identified the following gaps in advanced cancer care: poor communication of diagnosis, lack of communication between healthcare providers, role and involvement of the family physician, lack of understanding of palliative care and advance care planning.ConclusionsEarly palliative approaches to care should consider consistent and routine delivery of palliative care information, collaborations among different disciplines such as oncology, primary care and palliative care, and engagement of patients and family caregivers in the development of care pathways.

Healthcare Providers' Beliefs About Working with Patients with Substance Use Disorders

2014 ◽  
Author(s):  
L. C. van Boekel ◽  
E. P. M. Brouwers ◽  
J. van Weeghel ◽  
H. F. L. Garretsen
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Healthcare Providers

scholarly journals Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers

2021 ◽  
pp. 104990912110126
Author(s):  
Valeria Cardenas ◽  
Anna Rahman ◽  
Yujun Zhu ◽  
Susan Enguidanos
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Insurance Coverage ◽  
Healthcare Providers ◽  
Health Condition ◽  
Insurance Companies ◽  
Structured Interviews ◽  
Care Services ◽  
Home Based ◽  
Palliative Care Services

Background: Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. Aim: To identify patients’ and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. Design: We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. Setting/Participants: Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. Results: Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. Conclusion: Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.

scholarly journals Palliative care and complex chronic conditions since the perspective of healthcare professionals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Doñate-Martínez ◽  
L Llop ◽  
J Garcés
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Early Identification ◽  
Chronic Conditions ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Holistic View ◽  
Complex Chronic Conditions ◽  
Symptom Intensity

Abstract Background According to the WHO, palliative care (PC) is applicable early in the course of illness together with other curative therapies. Early PC has demonstrated beneficial effects on quality of life and symptom intensity among cancer patients. However, PC is not as early integrated on the care pathway of complex chronic conditions (CCC). This abstract presents barriers and needs identified to effectively implement early PC on CCC performed under the EU-funded InAdvance project (ref.: 825750). Methods Semi-structured interviews were performed with 16 healthcare professionals (HPs) from primary care and hospital settings working with older patients with CCC in Valencia (Spain). Results Interviews reported that main needs identified to provide early PC are: (a) coordinated strategies between multi-setting HPs to an early identification of CCC patients in need of PC; (b) adequate resources to attend patients' PC needs from a holistic view, i.e. psychosocial and spiritual needs; and (c) early integration of basic PC at primary care teams. The main barriers identified were: (a) stereotypes associated to the traditional PC approach; (b) poor knowledge from HPs of the PC holistic approach; and (c) lack of specific protocols or pathways for CCC in need of PC. Conclusions Specific skills and resources are the most relevant needs to effectively provide early PC among patients with CCC. First, it is urgent to demystify the negative culture-related vision of PC that is commonly associated to sedation and last days of a person's life. Also, multidisciplinary HPs require specific training to identify and provide early PC tailored to CCC. And, it is required a strategic and multi-setting organizational approach with fluent information flow and coordinated roles. Key messages Healthcare expenditure would be considerably reduced, especially at hospital and emergency units, with an early identification of patients with CCC in need of PC. Empowering primary HPs in PC would improve the quality of care of patients with CCC.

scholarly journals Engineering Solutions to COVID-19 and Racial and Ethnic Health Disparities

2021 ◽  
Author(s):  
Gilda A. Barabino
Keyword(s):  
Health Disparities ◽  
Black Community ◽  
Systems Approach ◽  
Healthcare Providers ◽  
Structural Racism ◽  
Communities Of Color ◽  
Collective Response ◽  
Design Skills

AbstractThe role of engineers in response to the COVID-19 pandemic and in the elimination of health disparities, while not always visible, has important implications for the attainment of impactful solutions. The design skills, systems approach, and innovative mindset that engineers bring all have the potential to combat crises in novel and impactful ways. When a disparities lens is applied, a lens that views gaps in access, resources, and care, the engineering solutions are bound to be more robust and equitable. The disproportionate impact of COVID-19 on the Black community and other communities of color is linked to inequities in health rooted in a centuries long structural racism. Engineers working collaboratively with physicians and healthcare providers are poised to close equity gaps and strengthen the collective response to COVID-19 and future pandemics.

Assisting People With Their Living, Not Their Dying: Health Professionals’ Perspectives of Palliative Care and Opioids in ILD

2021 ◽  
pp. 104990912110186
Author(s):  
Lauren Russo ◽  
Karen Willis ◽  
Natasha Smallwood
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Palliative Care ◽  
Health Care System ◽  
Therapeutic Relationships ◽  
Specialist Palliative Care ◽  
Cross Sectional ◽  
Symptom Palliation ◽  
Care System

Objectives: Interstitial lung disease (ILD) is a debilitating and life-limiting condition, requiring multi-disciplinary care. While guidelines recommend early specialist palliative care referral to improve symptoms and quality of life, few patients access such care towards the end-of-life. This study aimed to explore clinicians’ perspectives regarding specialist palliative care and opioids to understand barriers to optimal care and guide clinical practice improvement initiatives. Methods: A cross-sectional, exploratory, qualitative study was undertaken with Australian respiratory clinicians caring for people with ILD (n = 17). In-depth, semi-structured interviews were audio-recorded, transcribed verbatim and coded. Thematic analysis was undertaken to extrapolate recurring ideas from the data. Results: Four themes were identified: 1) understanding how to improve patient care and support, 2) the need to dispel stigmatized beliefs and misconceptions, 3) the importance of trusted relationships and good communication and 4) the challenges of navigating the health-care system. Participants discussed the need to implement early specialist palliative care and symptom palliation to alleviate symptoms, provide emotional support and augment quality of life. Participants described challenges accessing palliative care and opioids due to stigmatized beliefs amongst patients and clinicians and difficulties navigating the health-care system. Trusted therapeutic relationships with patients and strong inter-disciplinary partnerships with collaborative education and communication were perceived to improve patients’ access to symptom palliation. Conclusion: Specialist palliative care and opioids were believed to improve patients’ quality of life, however, many barriers can make accessing such care challenging. To address these issues, multi-disciplinary collaboration, high-quality communication and trusted therapeutic relationships are crucial throughout the ILD illness journey.

Community nurses' participation in palliative care research: The Dignity Care Pathway

2013 ◽  
Vol 18 (7) ◽  
pp. 326-331 ◽  
Author(s):  
Jane Andrew ◽  
Bridget Johnston ◽  
Constantina Papadopoulou
Keyword(s):  
Palliative Care ◽  
Care Pathway ◽  
Care Research

The bidirectional mistrust

2018 ◽  
Vol 28 (5) ◽  
pp. 1336-1350 ◽  
Author(s):  
Annica Björkman ◽  
Martin Salzmann-Erikson
Keyword(s):  
Demographic Data ◽  
Healthcare Providers ◽  
Online Communication ◽  
The Body ◽  
Care Seeking ◽  
Content Type ◽  
Descriptive Research ◽  
Body Of Knowledge ◽  
Care Seeking Behavior ◽  
Seeking Behavior

Purpose The purpose of this paper is to explore and describe online communication about the experiences and attitudes toward Swedish Healthcare Direct, a national telephone advice nursing (TAN) service. Design/methodology/approach A descriptive research design was adopted using a six-step netnographic method. Three Swedish forums were purposefully selected and data from the virtual discussions were collected. Findings Three themes emerged: expectancy and performativity of the nurses, absurdity in accessibility and the scrutinizing game. The most prominent finding was the scrutinizing game, which included aspects of bidirectional mistrust from both nurses and callers. Another salient finding was the attitudes that callers held toward nurses who used a technique interpreted as “passing the buck.” Research limitations/implications The use of a nethnographic method is novel in this area of research. Consequently, the body of knowledge has regarding telephone advise nursing service has significantly been broadened. A limitation in this study is that demographic data for the posters are not available. Practical implications Bidirectional distrust is an important issue that must be acknowledged by TAN services, since it might damage the service on a fundamental level. Healthcare providers, politicians, and researchers should account for the power and availability of virtual discussions when seeking consumers’ opinions and evaluating the quality of the care provided. Originality/value This analysis of the ongoing discussions that take place on the internet provides insight into callers’ perceptions of a national TAN service. The bidirectional mistrust found from both the nurses and the callers might be a threat to callers’ compliance with the advice given and their care-seeking behavior.

scholarly journals Challenges of paediatric palliative care in the intensive care unit during the COVID-19 pandemic

2021 ◽  
Vol 27 (6) ◽  
pp. 303-315
Author(s):  
Marzieh Hasanpour ◽  
Mamak Tahmasebi ◽  
Masoud Mohammadpour ◽  
Batool Pouraboli ◽  
Fahimeh Sabeti
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Healthcare Providers ◽  
Clinical Team ◽  
Management Support ◽  
Breaking Bad ◽  
Paediatric Palliative Care ◽  
Home Based ◽  
Purposeful Sampling

Background: The integration of paediatric palliative care into the Iranian health system is essential. Aims: The aim of this study was to identify the challenges of palliative care in the paediatric intensive care unit during COVID-19 through the experiences of healthcare providers. Methods: A qualitative study with content analysis approach was conducted. Fifteen physicians and nurses were selected by purposeful sampling. The semi-structured, in-depth interviews were applied in the data collection. Findings: Ten main categories were extracted from data analysis, including ‘caring in COVID-19’, ‘communication and family centre care’, ‘breaking bad news’, palliative care training’, ‘pain and symptom management’, ‘support of the child, family and clinical team’, ‘physical environment’, ‘guidelines’, ‘specialised staff’ and ‘home based palliative care’. Conclusion: Palliative care in the PICU faces several challenges, especially during COVID-19, but the clinical team are making every attempt to improve the comprehensive care of children and their families. Telehealth is important in COVID-19, and education is also a key component to improve palliative care in the PICU in Iran.

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