Enteral Feeding in Palliative Care: Cultural Aspects and Beyond

Background: There is a need for improved primary palliative care (PC) education and resident comfort with providing end-of-life care. Objective: Utilize a new instrument derived from published PC competencies to assess baseline Internal Medicine (IM) resident knowledge and self-efficacy in PC to identify educational gaps and create new PC curricula. Design: We created a 2-part instrument including a Knowledge Test (KT) and a Self-Efficacy Inventory (SEI) addressing 18 PC resident competencies across 5 domains: Pain and Symptom Management (PSM), Communication (COMM), Psychosocial, Spiritual, and Cultural Aspects of Care (PSC), Terminal Care and Bereavement (TCB), and Palliative Care Principles and Practice (PCPP). Setting/Subjects: The instrument was emailed to IM residents at our institution during academic years 2015-2016 and 2016-2017. Measurements: Basic descriptive statistics were performed for the KT and SEI. Mean Rank Analysis and One-way ANOVA were utilized for the KT and SEI, respectively. Congruence was calculated between knowledge and self-efficacy. Results: The mean score on the KT was 73% (range 33-80%). There was no significant difference in knowledge among post-graduate year cohorts. Self-efficacy scores were lower for interns overall and in PCPP, TCB, and COMM domains. Knowledge was concordant with self-efficacy in 42% of participants, higher than self-efficacy in 10% of participants, and lower than self-efficacy in 48% of participants. Conclusions: For approximately half of respondents, high self-efficacy in PC did not correlate with high PC knowledge. A more focused curriculum is needed to help IM residents facilitate mastery of PC competencies by graduation.

Download Full-text

Ethnic and cultural aspects of palliative care

10.1093/med/9780199656097.003.0009 ◽

2015 ◽

Cited By ~ 1

Author(s):

LaVera Crawley ◽

Jonathan Koffman

Keyword(s):

Palliative Care ◽

End Of Life Care ◽

World Health ◽

Life Care ◽

Cultural Aspects ◽

Physical Conditions ◽

Appropriate Treatment ◽

Definition Of ◽

Health Organization

This chapter attempts to identify ‘differences that make a difference’ when individuals and groups negotiate institutions and practices for palliative and end-of-life care. Two influences on the practice of palliative care-immigration and health disparities-are examined. The World Health Organization definition of palliative care specifies two goals: improving quality of life of patients and families and preventing and relieving suffering. It identifies three ‘colour blind’ strategies for meeting those goals: early identification, impeccable assessment, and (appropriate) treatment. Lastly, the definition addresses four domains of care: (1) problems related to pain, (2) physical conditions, (3) the psychosocial, (4) and the spiritual. This chapter specifically addresses these goals, strategies, and domains in relation to delivering quality palliative care in cross- or multicultural settings.

Download Full-text

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

British Journal of Nursing ◽

10.12968/bjon.2021.30.17.1010 ◽

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.

Download Full-text

Palliative care in Eastern Europe

Oxford Textbook of Palliative Nursing ◽

10.1093/med/9780199332342.003.0080 ◽

2015 ◽

pp. 1144-1159

Author(s):

Nicoleta Mitrea ◽

Daniela Mosoiu

Keyword(s):

Palliative Care ◽

Eastern Europe ◽

Demographic Data ◽

Cultural Aspects ◽

Success Stories ◽

General Perspective

This chapter on palliative care in Eastern Europe is divided into several sections, including a general perspective, in which demographic data, cultural aspects, common characteristics of countries in Eastern Europe are presented, and a review of individual countries in the region with examples of success stories presented by leaders from those countries.

Download Full-text

Using Online Learning and Interactive Simulation To Teach Spiritual and Cultural Aspects of Palliative Care to Interprofessional Students

Journal of Palliative Medicine ◽

10.1089/jpm.2012.0038 ◽

2012 ◽

Vol 15 (11) ◽

pp. 1240-1247 ◽

Cited By ~ 45

Author(s):

Matthew S. Ellman ◽

Dena Schulman-Green ◽

Leslie Blatt ◽

Susan Asher ◽

Diane Viveiros ◽

...

Keyword(s):

Palliative Care ◽

Online Learning ◽

Interactive Simulation ◽

Cultural Aspects

Download Full-text

Barriers to Palliative Care in Pediatric Oncology in Switzerland: A Focus Group Study

Journal of Pediatric Oncology Nursing ◽

10.1177/1043454219871082 ◽

2019 ◽

Vol 37 (1) ◽

pp. 35-45 ◽

Cited By ~ 2

Author(s):

Michael Rost ◽

Eva De Clercq ◽

Milenko Rakic ◽

Tenzin Wangmo ◽

Bernice Elger

Keyword(s):

Palliative Care ◽

Pediatric Oncology ◽

Financial Resources ◽

Pediatric Palliative Care ◽

Outpatient Services ◽

Focus Group Study ◽

Early Integration ◽

Team Meetings ◽

Cultural Aspects ◽

Oncology Providers

Introduction: For children with cancer, early integration of pediatric palliative care in conjunction with curative treatments is recommended. In Switzerland, pediatric palliative care is mostly provided by an interdisciplinary primary oncology team that is mainly composed of nurses. However, only a small fraction of children receive pediatric palliative care and only a minority of them in a timely manner. The main aim was to identify barriers to the provision of pediatric palliative care in Swiss pediatric oncology. Method: This qualitative study consisted of five focus groups. In total, 29 pediatric oncology providers participated (13 nurses, 11 physicians, 4 psycho-oncologists, 1 social worker). Data were analyzed employing applied thematic analysis. Results: Analysis revealed eleven barriers: lack of financial resources, lack of prejob education regarding pediatric palliative care, lack of awareness in politics and policy making, absence of a well-established nationwide bridging care system, insufficient psychosocial and professional supervision for staff, understaffing, inadequate infrastructure of hospitals, asymmetry of factual and emotional knowledge between parents and providers, cultural aspects, irrational parental hopes, and “the unspoken.” Discussion: Awareness should be raised for pediatric palliative care (in particular in demarcation from palliative care in adults) among politics and policy makers which could lead to increased financial resources that, in turn, could be used to improve bridging care, hospital’s infrastructure, and team support. More flexibility for care determining factors is needed, for example, with respect to convening team meetings, short-termed staffing, and reimbursement at the interface between inpatient and outpatient services.

Download Full-text

A New Competency-Based Instrument to Assess Resident Knowledge and Self-Efficacy in Primary Palliative Care

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119855612 ◽

2019 ◽

Vol 37 (2) ◽

pp. 117-122 ◽

Cited By ~ 1

Author(s):

Kristen M. Moyer ◽

Laura J. Morrison ◽

John Encandela ◽

Catherine Kennedy ◽

Matthew S. Ellman

Keyword(s):

Palliative Care ◽

Factor Analysis ◽

Psychometric Properties ◽

Self Efficacy ◽

Item Analysis ◽

Educational Interventions ◽

Management Communication ◽

Cultural Aspects ◽

Internal Medicine Residents ◽

Competency Based

Context: There is a need to improve both primary palliative care (PPC) education and its assessment in graduate medical education (GME). We developed an instrument based on published palliative care (PC) competencies to assess resident competency and educational interventions. Objectives: To describe the development and psychometric properties of a novel, competency-based instrument to measure resident knowledge and self-efficacy in PPC. Methods: We created a 2-part instrument comprised of a knowledge test (KT) and a self-efficacy inventory (SEI) addressing 18 consensus, core PC resident competencies across 5 domains: pain and symptom management; communication; psychosocial, spiritual, and cultural aspects of care; terminal care and bereavement; and PC principles and practice. The instrument was distributed to 341 internal medicine residents during academic years 2015 to 2016 and 2016 to 2017. A standard item analysis was performed on the KT. Internal consistency (Cronbach α) and variable relationships (factor analysis) were measured for the SEI. Results: One hundred forty-four residents completed the survey (42% response). For 15 KT items, difficulty ranged from 0.17 to 0.98, with 7 items ranging 0.20 to 0.80 (typical optimum difficulty); discrimination ranged from 0.03 to 0.60 with 10 items ≥0.27 (good to very good discrimination). Cronbach α was 0.954 for 35 SEI items. Factor analysis of combined 2015 to 2016 items yielded 4 factors explaining the majority of variance for the entire set of variables. Conclusion: Our instrument demonstrates promising psychometric properties and reliability in probing the constructs of PC and can be further utilized in PC GME research to assess learners and evaluate PPC educational interventions.

Download Full-text

Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0207 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1356-1362

Author(s):

Laurence Tan Lean Chin ◽

Yu Jun Lim ◽

Wan Ling Choo

Keyword(s):

Palliative Care ◽

End Of Life ◽

Multidisciplinary Team ◽

Biopsychosocial Model ◽

Family Members ◽

Clinical Decisions ◽

Goals Of Care ◽

Complex Needs ◽

Aspiration Risk ◽

Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

Download Full-text