The impact of a one month palliative care rotation on medical residents working in a tertiary cancer center in Jordan.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 168-168
Author(s):  
Omar M. Shamieh ◽  
Alia Alawneh ◽  
Wafa Ahamd ◽  
Sewar S Salmany ◽  
Barakat Altamimi ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Medical Residents ◽  
Cancer Center ◽  
Clinical Rotation ◽  
Life Care ◽  
The Impact ◽  
Tertiary Cancer Center

168 Background: Palliative care education and training remains inadequate for medical professionals especially in developing countries. We evaluated the impact of a one month palliative care clinical rotation on medical residents’ attitude, competency, and knowledge related to palliative care in a tertiary cancer center in Jordan. Methods: All transitional Internal Medicine residents rotated in a monthly palliative care rotation at King Hussein Cancer Center (KHCC), in Amman, Jordan, were requested to participate in this educational intervention study. A concise curriculum in palliative and end of life care, adapted from the Education for Physicians on End-Of-Life Care (EPEC) Curriculum and delivered by our faculty was piloted as a part of the clinical rotation. Residents spent one month in the inpatient palliative care unit, in addition to 10 hours of classroom interactive sessions. The curriculum comprised of five modules: 1- Principles of palliative care, 2- Pain management, 3- Management of distressing symptoms, 4- Communication skills, 5- End-of- life care. To assess our educational outcomes, we adapted a previously developed instruments by David Weisman and used by the National Residency Education in the United States. All Instruments were completed by each resident before and after the rotation, and included self-assessment of attitude, competency and a knowledge test comprising of 32-items of multiple choice questions. Results: Twenty of 27 (74%) residents who started the palliative care rotation completed the required education and had paired evaluations. There was improvement in all three instruments: 37% improvement in competence (p < 0.0001), 17% Improvement in knowledge (p = 0.015), and 5% improvement in attitude (p = 0.02). Conclusions: The one-month mandatory rotation improved knowledge, attitude and competence related to palliative care for medical residents.

First steps: Health and social care professionals beginning to address the palliative and end of life care needs of people with diverse gender identities and sexual orientations in Lebanon

Sexualities ◽  
2020 ◽  
pp. 136346072093238
Author(s):  
Claude Chidiac
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Social Stigma ◽  
Life Care ◽  
Care Needs ◽  
Mena Region ◽  
Healthcare Needs ◽  
Health And Social Care ◽  
The Impact

The available evidence demonstrates that lesbian, gay, bisexual, and transgender (LGBT) people face challenges when accessing palliative care services, and receive suboptimal care at the end of life. This is mainly attributed to assumed heterosexuality, lack of knowledge and understanding of LGBT issues and specific healthcare needs, discrimination, homophobia, and transphobia. In Lebanon, legal and institutional support for LGBT individuals is minimal, and palliative care provision remains scarce and fragmented. This compounds the impact of social stigma and marginalisation, and results in unrecognised palliative and end of life care needs for the LGBT individual. This short commentary discusses the development of an LGBT palliative care workshop in Lebanon, which was the first initiative of its kind in the Middle East and North Africa (MENA) region. It also explores how this initiative has led to further developments, and how these efforts can be replicated in other countries in the MENA region.

Outpatient palliative care at a tertiary cancer center: Perceptions, pathways, and pitfalls.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 28-28
Author(s):  
Kavitha Ramchandran ◽  
Sandy Trieu ◽  
Stephanie Harman ◽  
Judy Passaglia ◽  
Janet Rodriguez ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Cancer Center ◽  
Care Planning ◽  
Life Care ◽  
Code Status ◽  
Wide Range ◽  
Advance Care

28 Background: To describe an outpatient palliative care program at a quaternary cancer center- Stanford Cancer Institute. Outpatient palliative care (PC) programs are still in their nascency. Best practices are still being developed and key performance metrics are being delineated. This is a description of Stanford Cancer Institute outpatient PC program. Methods: Observational study of the first six months of encounters to the outpatient PC program. Description of potential barriers to launch and growth, as well as description of resources required for continued success. Data evaluated included program volume, referral patterns, advance care planning, symptom assessment and team structure as collected by the clinical team. Results: Initial barriers to program initiation included lack of funding and infrastructure. Additional barriers included coordination between teams, flow of care (patients late for next appointments), and cultural perceptions of palliative care as equal to end of life care. There are 32 referring practitioners to the program. Over the first six months the outpatient PC program has seen growth with volume increasing from 10 consults per month to 26 consults per month for a total of 60 patients. At the time of initial consult, 11 of the 60 patients seen had an advance directive. Only 1 patient had a physician order for life sustaining treatment (POLST). Code status was documented in 21 of the 60 patients. Conclusions: Our program had multiple barriers to launch: perceptions that palliative care equaled end of life care, lack of infrastructure and funding, and difficulty with coordination between teams. With administrative support the program secured funding, developed infrastructure with the assistance of IT, Cancer Center administration, and Care Coordination. Consults now come from a wide range of providers. Based on preliminary data indicating a very low percentage of completion of these tasks by patients on initial consult there is need for outpatient palliative care for advance care planning. Future growth will include continued penetration of the cancer center, increasing volume of consults, and additional assessments of patient satisfaction, symptom improvement, and hospital utilization.

scholarly journals Prevalence and characteristics of prisoners requiring end-of-life care: A prospective national survey

2017 ◽  
Vol 32 (1) ◽  
pp. 6-16 ◽  
Author(s):  
Lionel Pazart ◽  
Aurélie Godard-Marceau ◽  
Aline Chassagne ◽  
Aurore Vivot-Pugin ◽  
Elodie Cretin ◽  
...  
Keyword(s):  
Palliative Care ◽  
General Population ◽  
End Of Life ◽  
National Survey ◽  
End Of Life Care ◽  
Terminal Illness ◽  
Prison Population ◽  
Critical Issue ◽  
Life Care ◽  
The Impact

Background: Ensuring adequate end-of-life care for prisoners is a critical issue. In France, data investigating the impact of laws allowing release of seriously ill prisoners are lacking. Aim: To assess the number and characteristics of prisoners requiring palliative care in French prisons. Design: A prospective, national survey collecting data over a 3-month period. Setting/participants: All healthcare units ( n = 190) providing care for prisoners in France. The prison population was 66,698 during the study period. Data collection concerned prisoners requiring end-of-life care, that is, with serious, advanced, progressive, or terminal illness and life expectancy <1 year. Results: Estimated annual prevalence of ill prisoners requiring end-of-life care was 15.2 (confidence interval: 12.5–18.3) per 10,000 prisoners. The observed number of prisoners requiring palliative care ( n = 50) was twice as high as the expected age- and sex-standardized number based on the general population and similar to the expected number among persons 10 years older in the free community. In all, 41 of 44 (93%) of identified ill prisoners were eligible for temporary or permanent compassionate release, according to their practitioner. Only 33 of 48 (68%) of ill prisoners requested suspension or reduction in their sentence on medical grounds; half (16/33) received a positive answer. Conclusion: The proportion of prisoners requiring palliative care is higher than expected in the general population. The general frailty and co-existing conditions of prisoners before incarceration and the acceleration of these phenomena in prison could explain this increase in end-of-life situations among prisoners.

Outpatient Palliative Care and Aggressiveness of End-of-Life Care in Patients with Metastatic Colorectal Cancer

2017 ◽  
Vol 35 (1) ◽  
pp. 166-172 ◽  
Author(s):  
Si Won Lee ◽  
Hyun Jung Jho ◽  
Ji Yeon Baek ◽  
Eun Kyung Shim ◽  
Hyun Mi Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Emergency Department ◽  
Palliative Care ◽  
Metastatic Colorectal Cancer ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Emergency Department Visits ◽  
Life Care ◽  
The Impact

Background: Palliative care in outpatient setting has been shown to promote better symptom management and transition to hospice care among patients with advanced cancer. Nevertheless, specialized palliative care is rarely provided at cancer centers in Korea. Herein, we aimed to assess aggressiveness of end-of-life care for patients with metastatic colorectal cancer according to the use of outpatient palliative care (OPC) at a single cancer center in Korea. Methods: We performed a retrospective medical record review for 132 patients with metastatic colorectal cancer who died between 2011 and 2014. Fifty patients used OPC (OPC group), while 82 patients did not (non-OPC group). Indicators of aggressiveness of end-of-life care including chemotherapy use, emergency department visits, hospitalization, and utilization of hospice care were analyzed according to the use of OPC. Results: More patients in the OPC group were admitted to hospice than those in the non-OPC group (32% vs 17%, P = .047). The mean of inpatient days within 30 days of death was shorter for the OPC group than the non-OPC group (4.02 days vs 7.77 days, respectively, P = .032). There were no differences in the proportions of patients who received chemotherapy and visited the emergency department within 30 days from death. Conclusion: Among patients with metastatic colorectal cancer, OPC was associated with shorter inpatient days near death and greater hospice utilization. Further prospective studies are needed to evaluate the impact of OPC on end-of-life care in Korea.

Does post-registration palliative care education for nurses improve practice? A systematic review

2019 ◽  
Vol 25 (11) ◽  
pp. 552-564 ◽  
Author(s):  
Angela Thavaraj ◽  
Karen Gillett
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
Outcome Measures ◽  
End Of Life Care ◽  
Quantitative Data ◽  
Life Care ◽  
Care Education ◽  
Palliative Care Education ◽  
The Impact

Aims: We aimed to answer the question: what is the evidence that post-registration palliative care education for nurses improves practice? Background: The 2008 End of Life Care Strategy emphasised the need for a workforce equipped to provide high-quality end-of-life care for patients and their families. As registered nurses are the healthcare professionals spending most time with patients and families at the end of life, associated policy documents stress the importance of educating nurses to equip them with the necessary knowledge and skills to provide effective care. Despite education being a consistent recommendation, the ability of education to influence nursing practice is uncertain. Methods: We undertook a systematic review of literature using Joanna Briggs Institute Methodology for Mixed Methods by searching the Medline, Embase and CINAHL databases between January 2006 and December 2018. Findings: Ten studies met the inclusion criteria, seven contained quantitative data. Six demonstrated improvements in outcome measures, but not all results were statistically significant. Most quantitative data related to self-reported measures of confidence. Six studies contained qualitative findings that were categorised into themes: confidence, practice change, skills and proactivity. Conclusion: Little research exists exploring the impact of post-registration palliative care education for nurses. Existing outcome measures do not clearly demonstrate changes to end-of-life practice. Research is suggested to establish links between self-reported confidence and improvements to practice. Evaluation of the impact on practice should be an integral component of end-of-life education initiatives.

Predictors of home death and the quality of end-of-life care at a cancer center in Brazil.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24004-e24004
Author(s):  
Sarah Gomes ◽  
Danielle Silva ◽  
Júlia Sá ◽  
Thais Passarini ◽  
Matheus Viana ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
Palliative Care Team ◽  
Cancer Center ◽  
Life Care ◽  
Home Death

e24004 Background: Early palliative care has shown an improvement in the quality of life of cancer patients by reducing overtreatment at the end of life and improving symptomatic control. Little is known about the quality of death in developing countries. End-of-life cancer care varies widely, and very few centers evaluate it systematically. The aim of the present study is to analyze the impact of follow-up of cancer patients by an outpatient palliative care team (OPCT) on the end-of-life outcomes at a Cancer Center in Brazil. Methods: We retrospectively retrieved data from electronic medical records of cancer patients who were treated at a Cancer Center in Brazil and who died from cancer or associated complications during the year of 2020. They were divided into two groups: OPCT and No-OPCT. OPCT group was followed-up by a multidisciplinary team composed of physician, nurse, physiotherapist, psychologist, nutritionist, social worker, speech-language therapist, and pharmacist, who regularly evaluated cancer patients during their treatments at outpatient setting. During COVID-19 pandemic, some patients were evaluated by telemedicine appointments. No-OPCT group was followed-up by cancer physicians exclusively. We performed univariate comparisons and multivariate analysis by Cox proportional hazards model. p < 0.05 was deemed as statistically significant. Results: A total of 315 patients were included in the study: OPCT (N=122) and No-OPCT (N=193). The groups were well balanced in relation to median age (61yo vs 63yo), gender (women: 51% vs 54%), and TNM stage (stage IV: 69% vs 65%). Gastrointestinal and breast cancers were the most prevalent. The rate of home death was 44% in the OPCT group, compared to 16% in the No-OPCT group (p<0.001). The rate of admission in intensive care unit in the last 30 days of life (ICU30) was 13% vs 10%, respectively (p=0.413). Likewise, the rate of patients treated with chemotherapy in the last 30 days of life (CT30) was 42% vs 51% (p=0.146). In multivariate analysis, follow-up by the OPCT was the strongest independent predictor of home death (Table). In contrast, ICU30 and CT30 were inversely correlated with this outcome. Age, gender, and TNM stage did not have influence on the place of death. Conclusions: Follow-up by an OPCT had a strong positive impact on end-of-life care of cancer patients in a country which does not have Hospice culture. The OPCT was able to offer home death to a greater number of patients, with proximity to caregivers, and respect to their beliefs and values. Our data highlight the importance of early conversations about goals of care, prognostic awareness, and end-of-life preferences, while also reinforcing the need of early referral to a palliative care team.[Table: see text]

Transitioning end-of-life care from hospital to the community: case report

2021 ◽  
Vol 30 (17) ◽  
pp. 1010-1014
Author(s):  
Pedro Lino ◽  
Mary Williams
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospital Setting ◽  
Community Setting ◽  
Life Care ◽  
Cultural Aspects ◽  
Advance Care ◽  
Increasing Demand ◽  
The Impact

Palliative/end-of-life care is an integral part of the district nursing service. There is increasing demand for palliative care to be delivered in the community setting. Therefore, there is a need for excellent collaboration between staff in primary and secondary care settings to achieve optimum care for patients. This article critically analyses the care delivered for a palliative patient in the hospital setting and his subsequent transition to the community setting. The importance of effective communication, holistic assessment in palliative care, advance care planning, organisational structures and the socio-cultural aspects of caring for patients at the end of life are discussed. Additionally, the article highlights the impact of substandard assessment and communication and the consequent effect on patients and families.

scholarly journals Inappropriate end-of-life cancer care in a generalist and specialist palliative care model: a nationwide retrospective population-based observational study

2020 ◽  
pp. bmjspcare-2020-002302
Author(s):  
Manon S Boddaert ◽  
Chantal Pereira ◽  
Jeroen Adema ◽  
Kris C P Vissers ◽  
Yvette M van der Linden ◽  
...  
Keyword(s):  
Palliative Care ◽  
Observational Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Population Based ◽  
Exposure Group ◽  
Life Care ◽  
Patients With Cancer ◽  
Timely Access ◽  
The Impact

ObjectivesTo evaluate the impact of provision and timing of palliative care (PC) on potentially inappropriate end-of-life care to patients with cancer in a mixed generalist—specialist PC model.MethodA retrospective population-based observational study using a national administrative health insurance database. All 43 067 adults in the Netherlands, who were diagnosed with or treated for cancer during the year preceding their death in 2017, were included. Main exposure was either generalist or specialist PC initiated >30 days before death (n=16 967). Outcomes were measured over the last 30 days of life, using quality indicators for potentially inappropriate end-of-life care.ResultsIn total, 14 504 patients (34%) experienced potentially inappropriate end-of-life care; 2732 were provided with PC >30 days before death (exposure group) and 11 772 received no PC or ≤30 days before death (non-exposure group) (16% vs 45%, p<0.001). Most patients received generalist PC (88%). Patients provided with PC >30 days before death were 5 times less likely to experience potentially inappropriate end-of-life care (adjusted OR (AOR) 0.20; (95% CI 0.15 to 0.26)) than those with no PC or PC in the last 30 days. Both early (>90 days) and late (>30 and≤90 days) PC initiation had lower odds for potentially inappropriate end-of-life care (AOR 0.23 and 0.19, respectively).ConclusionTimely access to PC in a mixed generalist—specialist PC model significantly decreases the likelihood of potentially inappropriate end-of-life care for patients with cancer. Generalist PC can play a substantial role.

End-of-life Care of Aboriginal Peoples in Remote Locations: Language Issues

2007 ◽  
Vol 13 (1) ◽  
pp. 18 ◽  
Author(s):  
Pam McGrath ◽  
Hamish Holewa
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Research Literature ◽  
Aboriginal Peoples ◽  
Care Practice ◽  
Life Care ◽  
Language Groups ◽  
The Impact ◽  
Published Research

To date, there is scant research literature that explores the provision of end-of-life care to Aboriginal peoples in Australia. In particular, there is a lack of published research available on issues at the interface of Aboriginal languages and English during palliative care. The complexity and importance of the issue for palliative care provision, however, is demonstrated by the fact that in Australia, Aboriginality is itself a very broad category, containing many distinct language groups and subcultures. Thus, although to date there is some mention of the problems associated with language in the literature, there is scant research on the topic of the provision of palliative care to Aboriginal peoples in remote areas. The following findings from a recent two-year National Health and Medical Research Council (NHMRC) study are provided to address this hiatus. The findings provide insights on the impact of language difference on palliative care practice for Aboriginal peoples in the Northern Territory of Australia.

Impact of a multifaceted strategy in end-of-life care in a tertiary hospital: A quasi-experimental study

2021 ◽  
pp. 174239532110584
Author(s):  
Soraya Camargo Ito Suffert ◽  
Luciana Silveira Campos ◽  
Newton Barros ◽  
Claudia Giuliano Bica
Keyword(s):  
Palliative Care ◽  
Hospital Stay ◽  
End Of Life ◽  
End Of Life Care ◽  
Test Period ◽  
Life Care ◽  
Average Hospital Stay ◽  
Average Hospital ◽  
Quasi Experimental ◽  
The Impact

Objective To evaluate the impact of a multifaceted strategy for quality end-of-life care in a tertiary public hospital in Brazil. Methodology The study design was quasi-experimental. The multifaceted strategy was applied between January and June 2017, and involved training the healthcare team in end-of-life discussions, the creation and documentation of advance directives, and consultation with the team specialized in palliative care. The periods analyzed were the pre-test period (Time 1, July 2015 to June 2016) and the post-test period (Time 2, July 2017 to June 2018). Results Time 1 involved 302 deaths, with an average hospital stay of 21 days; Time 2 involved 410 deaths, with an average hospital stay of 16 days. Patients were prescribed morphine (44.04% vs. 36.3% [ p = 0.367]), methadone (9.60% vs. 4.39% [ p = 0.247]), midazolam (43.05% vs. 47.80% [ p = 0.73]), blood transfusions (31.13% vs. 24.63% [ p = 0.828]), enteral feeding (56.62% vs. 38.54% [ p = 0.59]) and antibiotic therapy (50.73% vs. 50.73% [ p = 0.435]). Conclusion This study found no changes in the end-of-life care quality indicators after the strategy was implemented. Multimodal educational strategies that develop communication skills in palliative care may enhance the quality of end-of-life care.

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