Barriers to providing palliative care to patients with advanced cancer: A province-wide survey of oncology clinicians’ perceptions.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 88-88
Author(s):  
Sharon Watanabe ◽  
Sharlette Dunn ◽  
Madalene Earp ◽  
Lisa Shirt ◽  
Patricia Biondo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Theoretical Domains Framework ◽  
Allied Health Professionals ◽  
Behaviour Change Wheel ◽  
Tumor Group ◽  
Care Systems ◽  
Negative Perceptions ◽  
Multifaceted Interventions ◽  
Competing Priorities

88 Background: Despite known benefits, cancer care systems struggle to provide early, integrated palliative care (PC). Previously, we identified barriers to providing early PC as perceived by gastrointestinal oncology clinicians in Alberta, Canada (top barrier: time/competing priorities). Here, we expand on the previous study to better understand barriers to early PC for clinicians working with all tumor groups across Alberta. Methods: A 33-item survey was emailed to oncology clinicians in Alberta between November 2017 - January 2018. Questions were informed by Michie’s Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW) and queried (a) providing PC in oncology clinics, (b) referral to specialist PC consultation, and (c) working with PC consultants and homecare. Results: Respondents (n = 268) were nurses (42%), physicians (25%), and allied health professionals (20%). Barriers most frequently identified were "patients’ negative perceptions of PC” (68%), “my limited time/competing priorities” (66%), and "capability to manage patients’", social (65%) and spiritual (63%) concerns. These factors map to all three BCW domains: motivation, opportunity, and capability. In contrast, least frequently identified barriers were in clinician’s own motivation, e.g. perceived benefits of PC. There were few significant differences in response by tumor group or profession (χ2 test, responses coded: disagree [1-3], neutral [4], agree [5-7]). Most notably, tumor groups differed in their perception that “the criteria for PC services are too restrictive” (p = 0.003), while nurses and allied staff reported that patients’ negative perception of PC is a barrier more frequently than physicians (p = 0.003). Conclusions: Surveying across clinicians and tumor groups using Michie’s TDF/BCW revealed that the challenges to an early integrated PC approach include all three sources of behavior, though not equally for all clinicians. Determining this has allowed us to tailor multifaceted interventions, e.g. tip sheets to enhance capability, re-framing PC with patients, and earlier secondary PC nursing access, to enhance clinicians use and patients benefit from an early PC approach.

scholarly journals Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey

2021 ◽  
Vol 28 (2) ◽  
pp. 1483-1494
Author(s):  
Sharlette Dunn ◽  
Madelene A. Earp ◽  
Patricia Biondo ◽  
Winson Y. Cheung ◽  
Marc Kerba ◽  
...  
Keyword(s):  
Online Survey ◽  
Social Issues ◽  
Theoretical Domains Framework ◽  
Advanced Cancer Patients ◽  
Behaviour Change Wheel ◽  
Negative Perceptions ◽  
Cancer Types ◽  
Multifaceted Interventions ◽  
Competing Priorities ◽  
Pan Cancer

Despite the known benefits, healthcare systems struggle to provide early, integrated palliative care (PC) for advanced cancer patients. Understanding the barriers to providing PC from the perspective of oncology clinicians is an important first step in improving care. A 33-item online survey was emailed to all oncology clinicians working with all cancer types in Alberta, Canada, from November 2017 to January 2018. Questions were informed by Michie’s Theoretical Domains Framework and Behaviour Change Wheel (BCW) and queried (a) PC provision in oncology clinics, (b) specialist PC consultation referrals, and (c) working with PC consultants and home care. Respondents (n = 263) were nurses (41%), physicians (25%), and allied healthcare professionals (18%). Barriers most frequently identified were “clinicians’ limited time/competing priorities” (64%), “patients’ negative perceptions of PC” (63%), and clinicians’ capability to manage patients’ social issues (63%). These factors mapped to all three BCW domains: motivation, opportunity, and capability. In contrast, the least frequently identified barriers were clinician motivation and perceived PC benefits. Oncology clinicians’ perceptions of barriers to early PC were comparable across tumour types and specialties but varied by professional role. The main challenges to early integrated PC include all three BCW domains. Notably, motivation is not a barrier for oncology clinicians; however, opportunity and capability barriers were identified. Multifaceted interventions using these findings have been developed, such as tip sheets to enhance capability, reframing PC with patients, and earlier specialist PC nursing access, to enhance clinicians’ use of and patients’ benefits from an early PC approach.

scholarly journals The Changing Nature of Palliative Care: Implications for Allied Health Professionals’ Educational and Training Needs

Healthcare ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 112 ◽  
Author(s):  
Deidre D. Morgan ◽  
Deb Rawlings ◽  
Carly J. Moores ◽  
Lizzie Button ◽  
Jennifer J. Tieman
Keyword(s):  
Professional Development ◽  
Palliative Care ◽  
Clinical Practice ◽  
Health Professionals ◽  
Online Survey ◽  
Allied Health ◽  
Further Education ◽  
Allied Health Professionals ◽  
Cross Sectional ◽  
Education Access

CareSearch is an Australian Government Department of Health funded repository of evidence-based palliative care information and resources. The CareSearch Allied Health Hub was developed in 2013 to support all allied health professionals working with palliative care clients in all clinical settings. This cross-sectional online survey sought to elicit allied health professionals palliative care experiences and subsequent considerations for educational and clinical practice needs. The survey was disseminated nationally via a range of organisations. Data was collected about palliative care knowledge, experience working with palliative care clients and professional development needs. Data were evaluated by profession, experience and practice setting. In total, 217 respondents answered one or more survey questions (94%). Respondents (65%) reported seeing >15 palliative care clients per month with 84% seen in hospital and community settings. Undergraduate education underprepared or partially prepared allied health professionals to work with these clients (96%) and 67% identified the need for further education. Access to postgraduate professional development was limited by available backfill and funding. Study findings support the importance of free, accessible, relevant educational and professional development resources to support clinical practice. This is particularly relevant for allied health professionals who have limited opportunities to attend formal professional development sessions.

scholarly journals Barriers and facilitators to knowledge transfer and exchange in palliative care research

2018 ◽  
Vol 23 (4) ◽  
pp. 131-136 ◽  
Author(s):  
William George Kernohan ◽  
Mary Jane Brown ◽  
Cathy Payne ◽  
Suzanne Guerin
Keyword(s):  
Palliative Care ◽  
Knowledge Transfer ◽  
Research Knowledge ◽  
Professional Networks ◽  
Knowledge Transfer And Exchange ◽  
Practice Models ◽  
Semistructured Interviews ◽  
Negative Perceptions ◽  
Effective Transfer ◽  
Competing Priorities

In order to ensure the effective transfer of research knowledge to those who can effect positive changes in practice, models of knowledge transfer and exchange (KTE) are required. Limited evidence exists as to how palliative care researchers use existing models to support their practice and to what extent they are perceived as effective. We set out to identify factors that influence KTE planning and implementation through semistructured interviews with experienced palliative care researchers in Ireland. Issues around KTE were drawn out through thematic analysis. Nine interviews were held with investigators on eight research projects. Ten themes were identified and categorised as either barriers or facilitators to KTE. Perceived barriers included inadequate time and funding, limited institutional capacity, competing priorities, weak communication channels and negative perceptions of palliative care. Perceived facilitators included dedicated time and resources, aligned priorities, strong professional networks, multipronged approach and KTE experience. In order to improve the quality, acceptability and reach of palliative research, it is vital that researchers improve their understanding of KTE within the context of palliative care, moving beyond academic dissemination to achieve research-informed practice by overcoming barriers to KTE through facilitated action. This study provides an overview of factors that influence KTE planning and implementation among palliative care researchers.

The contribution to palliative care of allied health professions

2019 ◽  
pp. 673-714
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Allied Health ◽  
Occupational Therapists ◽  
Health Professions ◽  
Palliative Care Team ◽  
Allied Health Professionals ◽  
Music Therapists ◽  
Allied Health Professions ◽  
Parent Discipline

This chapter outlines the key work of allied health professionals within the palliative care team. Palliative care has been very successful at taking ideas, values, and techniques from other disciplines in healthcare. Such borrowing of ideas has nearly always included considerable adaptation from the parent discipline. However, the notion of cross-boundary, interdisciplinary working is now highly developed in palliative care. Some disciplines such as medicine and nursing have become core parts of the specialist team, whereas others have been accessed on an as-required basis. Increasingly, individual allied health professions have seen the need to evolve the palliative care specialism within the generic discipline. Allied health professionals include occupational therapists, physiotherapists, nutritional experts, speech and language therapists, clinical psychologists, social workers, chaplains, pharmacists, and art and music therapists.

Rehabilitation: additional palliative care approaches

2017 ◽  
pp. 1229-1234 ◽  
Author(s):  
Matthew Maddocks ◽  
Sheila Payne
Keyword(s):  
Palliative Care ◽  
Family Caregivers ◽  
Health Professionals ◽  
Goal Attainment ◽  
Assistive Devices ◽  
Goal Attainment Scaling ◽  
Allied Health Professionals ◽  
Direct Benefits ◽  
The Family ◽  
Drug Interventions

Palliative care and rehabilitation share many common traits. When codelivered, these specialties can provide a holistic, patient-centred approach to care that maximizes function irrespective of diagnosis. This chapter considers how palliative care and rehabilitation can be delivered together in practice, and outlines commonly used interventions with examples of evidence from hospice, acute, and community care settings. The text covers treatments offered by different allied health professionals, including physical activity and exercise, hydrotherapy, non-drug interventions for breathlessness, adaptations, and assistive devices, as well as speech and language, music, and art therapies. Thereafter, the chapter looks at how palliative rehabilitation treatments can be evaluated, both using conventional outcome measures and through the use of goal setting and goal attainment scaling. In addition to direct benefits to patients, rehabilitation approaches offer secondary benefits for family caregivers, especially when deterioration leads to the family assisting with physical caregiving and transfers.

scholarly journals Perspectives of hematology oncology clinicians about integrating palliative care in oncology

2020 ◽  
Vol 27 (6) ◽  
Author(s):  
R. Booker ◽  
S. Dunn ◽  
M.A. Earp ◽  
A. Sinnarajah ◽  
P.D. Biondo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hematologic Malignancies ◽  
Solid Tumours ◽  
Limited Time ◽  
Targeted Interventions ◽  
Referral Criteria ◽  
Negative Perceptions ◽  
Survey Responses ◽  
Competing Priorities ◽  
Substantial Change

  Patients with hematologic malignancies receive palliative care (pc) less frequently and later than patients with solid tumours. We compared survey responses of hematology oncology clinicians with other oncology clinicians to better understand their challenges with providing primary pc or using secondary pc. Patients’ negative perceptions of pc and limited time or competing priorities were challenges for all clinicians. Compared with other oncology clinicians, more hematology oncology clinicians perceived pc referral criteria as too restrictive (40% vs. 22%, p = 0.021) and anticipated that integrating pc supports into their practice would require substantial change (53% vs. 28%, p = 0.014). This study highlights barriers that may need targeted interventions to better integrate pc into the care of patients with hematologic malignancies.

Triage and resource allocation during crisis medical surge conditions (pandemics and mass casualty situations)

2020 ◽  
Vol 7 (1) ◽  
pp. 45-55
Author(s):  
Paul Hoehner ◽  
David H. Beyda ◽  
William P. Cheshire ◽  
Robert E. Cranston ◽  
John T. Dunlop ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Medical Association ◽  
Health Professionals ◽  
Task Force ◽  
Position Statement ◽  
Mass Casualty ◽  
Medical Conditions ◽  
Direct Response ◽  
Allied Health Professionals ◽  
A Current

The Christian Medical and Dental Associations (CMDA) was founded in 1931 and is made up of the Christian Medical Association (CMA) and the Christian Dental Association (CDA). CMDA has a current membership of over 19,000 physicians, dentists, and other allied health professionals. During and in direct response to the pressing urgencies of the COVID-19 universal pandemic of 2020 the President of CMDA commissioned a special task force to provide current and future Christian reflection and guidance on triage and resource allocation policies during pandemics and other forms of crisis surge medical conditions (e.g., mass casualty situations). This is a condensed version of the CMDA special task force position statement. 

Māori Research(er) in Three Poems

2018 ◽  
Vol 2 (1) ◽  
pp. 35
Author(s):  
Jacquie Kidd
Keyword(s):  
Palliative Care ◽  
Health Literacy ◽  
Cultural Identity ◽  
Focus Groups ◽  
Health Professionals ◽  
Bell Hooks ◽  
Face To Face ◽  
The Third ◽  
Ruth Behar ◽  
Seeking Help

These three poems re-present the findings from a research project that took place in 2013 (Kidd et al. 2018, Kidd et al. 2014). The research explored what health literacy meant for Māori patients and whānau when they accessed palliative care. Through face-to-face interviews and focus groups we engaged with 81 people including patients, whānau, bereaved loved ones, support workers and health professionals. The poems are composite, written to bring some of our themes to life. The first poem is titled Aue. This is a Māori lament that aligns to English words such as ‘oh no’, or ‘arrgh’, or ‘awww’. Each stanza of the poem re-presents some of the stories we heard throughout the research. The second poem is called Tikanga. This is a Māori concept that encompasses customs, traditions and protocols. There are tikanga rituals and processes that guide all aspects of life, death, and relationships. This poem was inspired by an elderly man who explained that he would avoid seeking help from a hospice because ‘they leave tikanga at the door at those places’. His choice was to bear his pain bravely, with pride, within his cultural identity. The third poem is called ‘People Like Me’. This is an autoethnographical reflection of what I experienced as a researcher which draws on the work of scholars such as bell hooks (1984), Laurel Richardson (1997) and Ruth Behar (1996). These and many other authors encourage researchers to use frustration and anger to inform our writing; to use our tears to fuel our need to publish our research.

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