Development and validation of the clinician palliative perception scale (CPPS).

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 179-179
Author(s):  
Aaron Kee Yee Wong
Keyword(s):  
Palliative Care ◽  
Hospital Staff ◽  
Service Improvement ◽  
Care Provision ◽  
Self Confidence ◽  
Care Services ◽  
Dying Patients ◽  
Tertiary Teaching ◽  
Palliative Care Services ◽  
Development And Validation

179 Background: Worldwide healthcare systems identify a need to provide better evidence based service models for palliative care. There is little data and no standard tool that informs clinicians’ perceptions on palliative care to identify areas for service improvement and education. We aimed to develop and validate a tool to determine perceptions of hospital staff on palliative care provision, self confidence in providing palliative care, and predictors and barriers to requesting assistance. Methods: 604 hospital clinicians were recruited in person and online from a large metropolitan public tertiary teaching hospital network involving 5 campuses and 2 medical schools. They completed the CPPS (Clinician Palliative Perception Scale). Principal components analysis, exploratory factor analysis, and logistic regression were performed to examine the factor structure and relationship to clinical practice. Results: Four factors were extracted: confidence in providing palliative care, requesting assistance, global perceptions on palliative care provision, and barriers to referring. Increased confidence was significantly associated with increased likelihood of referring or requesting assistance and also associated with a good global perception on palliative care provision. Confidence was also significantly associated with years of experience and with spending > 50% time looking after dying patients. Good perception of palliative care provision was highest among oncologists. Conclusions: This is the largest quantitative study ever done looking at perceptions of palliative care provision among health professionals. The CPPS is a valid and reliable tool useful for both practice and research. Its 4 identified constructs are consistent with literature on perceptions and utilisation of palliative care services. Barriers to referring involved misconceptions that palliative care would prematurely shorten patient lifespans. Others did not refer due to confidence in their own skill. This tool can be used to correlate these constructs against other solid outcome measures to assist in service improvement and identifying research needs. It can also be used to determine clinicians’ educational requirements.

Sustainability of Palliative Care in a Rural Hospital in Tanzania: A Longitudinal and Prospective 4-Year Study

2020 ◽  
Vol 35 (3) ◽  
pp. 192-198
Author(s):  
Reino Torsti Ilmari Pöyhiä ◽  
Emmanuel Owden Mwalumuli ◽  
Aida Charles Mtega ◽  
Jackson John Vegula
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Hospital Staff ◽  
Oral Solution ◽  
Rural Hospital ◽  
Care Services ◽  
Advanced Planning ◽  
Palliative Care Services ◽  
Sub Saharan

Background: Palliative care has been developed in recent years in many sub-Saharan countries in Africa due to activities of African Association for Palliative Care. Palliative care units have been established also in most hospitals in Tanzania. Yet very little is known about their functions. Long-term studies about the sustainability of palliative care have not been carried out. Methods: The attitudes of 101 members of hospital staff and persons in charge of palliative care services of Ilembula District Designated Hospital (IDDH), Tanzania, were assessed using a modified and prevalidated questionnaire annually in 2014 to 2017. The inquiries were executed on randomly allocated days. Also, the patient and economy registries were analyzed. Additional qualitative data were obtained in personal interviews and during observational visits twice a year at the IDDH. Results: Ilembula District Designated Hospital has a true multiprofessional palliative care team, which provides services in the hospital, in the villages, and at homes. The activities are based on careful 5-year planning and budgeting. Up to 17 villages have been included in the services. Ninety-five percent of the patients were HIV infected. Short-acting morphine oral solution was the only available strong opioid. The hospital staff evaluated palliative care as good or excellent; 50% of the staff would need more support in the end-of-life care. Conclusions: A sustainable palliative care service can be built in a Tanzanian rural hospital if an advanced planning and budgeting are made. In Tanzania, the biggest group of palliative care patients are still HIV-infected individuals. There is a lack of opioids in the country.

Issues for General Practitioners Caring for Dying Patients in the Home

1999 ◽  
Vol 5 (2) ◽  
pp. 9 ◽  
Author(s):  
Annette Street ◽  
Jeanine Blackford ◽  
Anne Turley ◽  
Judy Kelso
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Terminally Ill ◽  
Team Approach ◽  
Fee For Service ◽  
Quality Health Care ◽  
Care Services ◽  
Dying Patients ◽  
Palliative Care Services ◽  
Counselling Program

General practitioners have a central role in the provision of quality health care to the terminally ill patient and family in their own homes. Staff from the Department of Human Services were concerned that GPs were experiencing stress through their increasing role in the provision of palliative care and that there was a need for a fee-for-service stress counselling program for them. A small qualitative study was conducted to verify this perceived need. Semi-structured telephone interviews were conducted with 50 GPs selected from a sample of metropolitan attendees at postgraduate educational activities or doctors known to palliative care services. GPs faced a number of issues in their care for terminally ill people in the community but a fee-for-service counselling program was deemed unnecessary. Evidence from the study confirmed that effective communication strategies between GPs, palliative care services and acute hospitals, an interdisciplinary team approach, and improved understanding between health professionals would enhance the quality of care for dying people and their caregivers.

scholarly journals Developing Palliative Care in Low-Resource Countries in Asia

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 164s-164s
Author(s):  
C. Goh
Keyword(s):  
Palliative Care ◽  
Low Income ◽  
Oral Morphine ◽  
World Health ◽  
Asia Pacific ◽  
Care Needs ◽  
Care Services ◽  
Tertiary Teaching ◽  
Palliative Care Services ◽  
Palliative Care Needs

Background and context: According to the World Health Organization (WHO) global atlas which maps palliative care needs worldwide, just over 50% of the palliative care needs reside in Asia. Development of palliative care services in Asia is patchy, with a few high income countries, such as Singapore and Japan, with palliative care services integrated into the health system. In the vast majority of countries, particularly low-income and middle-income countries (LMICs), such services are lacking or only available in a few centers. Aim: To develop palliative care services in countries with no services. Strategy/Tactics: The Asia Pacific Hospice Palliative Care Network (APHN) is a nongovernmental organization which supports the development of palliative care in the Asia Pacific region. Since 2012 , it has developed a comprehensive program to build capacity for palliative care in several countries in the region, including Myanmar, Sri Lanka and Bangladesh. Program/Policy process: Coconceptualized and funded by the Lien Foundation, the APHN sends interdisciplinary teams of volunteer faculty to these countries to run a training of trainers program over a period of three years. Major tertiary institutions were chosen as partners, with the understanding that palliative care services would be set up once a team had been trained. An interdisciplinary team of doctors, nurses, social workers and pharmacists from each institution went through the training program together. Individuals with potential to become champions for palliative care in these countries were given further training through a clinical fellowship program at established institutions in the region. During the training participants would be expected to start palliative care services in their institutions, which will become training centers for palliative care in the future. Concomitantly, a program of advocacy for medications essential for palliative care, such as oral morphine, was also undertaken. Outcomes: Six modules of the training course were completed in each of the three countries. A corps of 20 to 30 master trainers completed the training. In each of those countries, one or more palliative care services were started in major tertiary teaching hospitals. Oral morphine availability was greatly enhanced. The master trainers organized training within their hospitals, and also for the public. Other outcomes include the recognition of palliative care as a specialty, the introduction of palliative care into undergraduate medical and nursing curricula, and development of postgraduate courses in palliative care. What was learned: It was important to target institutions which were willing establish palliative care services. An interdisciplinary group of faculty was able to teach and inspire the trainees to take up the discipline. A drug availability program was essential to provide the tools to work with.

Palliative care in catastrophic disasters and humanitarian crises

2021 ◽  
pp. 1020-1026
Author(s):  
Anne Wilkinson ◽  
Marianne Matzo
Keyword(s):  
Palliative Care ◽  
Vulnerable Populations ◽  
Care Delivery ◽  
Disaster Medicine ◽  
Care Services ◽  
Dying Patients ◽  
Humanitarian Crises ◽  
Health Related ◽  
Palliative Care Services ◽  
Negative Impacts

Both catastrophic disasters and humanitarian crises can have widespread, long-term, and often unpredictable negative impacts, causing shortages of safe water, food, shelter, transportation, and sanitation as well as the displacement of large numbers of people and the loss of many lives. Routinely ignored in disaster and humanitarian planning are those socially and medically vulnerable populations living in the affected community who are dependent on the existing healthcare system for survival, making them particularly predisposed to the risk of harm or death due to the event. Because of their unique needs, extra steps need to be taken in order to reduce the likelihood that vulnerable populations will suffer injury, disease, or even death. Serious health-related suffering resulting from illness or injury stemming from a natural or man-made crisis could be ameliorated by the inclusion of palliative care services in planning and response activities. While the primary goal of disaster medicine is to maximize the number of lives saved and to ensure the best outcomes for the community as a whole, a holistic and fully compassionate response necessitates a secondary goal of minimizing the physical and psychological suffering of those whose lives may be shortened by a crisis event. In order to effectively provide palliative care services in crisis situations, all care delivery sites, especially triage and alternative care sites, will need clearly articulated protocols, trained staff (including personnel with palliative care, mental health, and spiritual counselling skills), supplies (including those necessary for appropriate pharmacological treatment), and appropriate space for dying patients.

scholarly journals Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature

2020 ◽  
Vol 5 (5) ◽  
pp. e002368 ◽  
Author(s):  
MacKenzie Clark MacRae ◽  
Owais Fazal ◽  
James O'Donovan
Keyword(s):  
Palliative Care ◽  
Scoping Review ◽  
Low Income ◽  
Health Workers ◽  
Care Provision ◽  
Review Of The Literature ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Services ◽  
Palliative Care Services

BackgroundCommunity health workers (CHWs) are currently deployed in improving access to palliative care in a limited number of low-income or middle-income countries (LMICs). This review therefore aimed to document evidence from LMICs regarding (1) where and how CHWs are currently deployed in palliative care delivery, (2) the methods used to train and support CHWs in this domain, (3) the evidence surrounding the costs attached with deploying CHWs in palliative care provision and (4) challenges and barriers to this approach.MethodsWe conducted a systematic scoping review of the literature, adhering to established guidelines. 11 major databases were searched for literature published between 1978 and 2019, as well as the grey literature.Findings13 original studies were included, all of which were conducted in sub-Saharan African countries (n=10) or in India (n=3). Ten described a role for CHWs in adult palliative care services, while three described paediatric services. Roles for CHWs include raising awareness and identifying individuals requiring palliative care in the community, therapeutic management for pain, holistic home-based care and visitation, and provision of psychological support and spiritual guidance. Reports on training context, duration and outcomes were variable. No studies conducted a formal cost analysis. Challenges to this approach include training design and sustainability; CHW recruitment, retention and support; and stigma surrounding palliative care.ConclusionDespite relatively limited existing evidence, CHWs have important roles in the delivery of palliative care services in LMIC settings. There is a need for a greater number of studies from different geographical contexts to further explore the effectiveness of this approach.

Ten-Year Trends of Utilization of Palliative Care Services and Life-Sustaining Treatments and Hospital Costs Associated With Patients With Terminally Ill Lung Cancer in the United States From 2005 to 2014

2019 ◽  
Vol 36 (12) ◽  
pp. 1105-1113 ◽  
Author(s):  
Jinwook Hwang ◽  
Jay Shen ◽  
Sun Jung Kim ◽  
Sung-Youn Chun ◽  
Mutsumi Kioka ◽  
...  
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Palliative Care ◽  
Hospital Cost ◽  
Statistical Significance ◽  
Hospital Costs ◽  
The United States ◽  
Care Services ◽  
Dying Patients ◽  
Palliative Care Services

Background: Palliative care services and life-sustaining treatments are provided to dying patients with lung cancer in the United States. However, data on the utilization trends of palliative care services and life-sustaining treatments of dying patients with lung cancer are not available. Methods: This study was a retrospective analysis of the National Inpatient Sample data (2005-2014) and included patients with lung cancer, aged ≥ 18 years, who died in the hospitals. Claims data of palliative care services and life-sustaining treatments that contained systemic procedures, local procedures, or surgeries were extracted. Compound annual growth rates (CAGRs) using Rao-Scott correction for χ2 tests were used to determine the statistical significance of temporal utilization trends of palliative care services and life-sustaining treatments and their hospital costs. Multilevel multivariate regressions were performed to identify factors associated with hospital costs. Results: A total of 120 144 weighted patients with lung cancer died in the hospitals and 41.9% of them received palliative care services. The CAGRs of systemic procedures, local procedures, surgeries, palliative care services, and hospital cost were 3.42%, 3.48%, 6.08%, 18.5%, and 5.0% (all P < .001), respectively. Increased hospital cost was attributed to systemic procedures (50.6%), local procedures (74.4%), and surgeries (68.5%; all P < .001), respectively. Palliative care services were related to decreasing hospital costs by 28.6% ( P < .001). Conclusion: The temporal trends of palliative care services indicate that their utilization has increased gradually. Palliative care services were associated with reduced hospital costs. However, life-sustaining treatments were associated with increased hospital costs.

Volunteering in hospice and palliative care in the United Kingdom

2018 ◽  
Author(s):  
Ros Scott
Keyword(s):  
Palliative Care ◽  
United Kingdom ◽  
Care Services ◽  
The United Kingdom ◽  
Strategic Direction ◽  
Palliative Care Services ◽  
History Of ◽  
The Uk ◽  
Hospice And Palliative Care ◽  
Changing Role

This chapter explores the history of volunteers in the founding and development of United Kingdom (UK) hospice services. It considers the changing role and influences of volunteering on services at different stages of development. Evidence suggests that voluntary sector hospice and palliative care services are dependent on volunteers for the range and quality of services delivered. Within such services, volunteer trustees carry significant responsibility for the strategic direction of the organiszation. Others are engaged in diverse roles ranging from the direct support of patient and families to public education and fundraising. The scope of these different roles is explored before considering the range of management models and approaches to training. This chapter also considers the direct and indirect impact on volunteering of changing palliative care, societal, political, and legislative contexts. It concludes by exploring how and why the sector is changing in the UK and considering the growing autonomy of volunteers within the sector.

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