COVID-19 and Palliative Care Through the Provider Perspective

IntroductionCare homes (CHs) play a vital role in the delivery of care towards the end of life (National Institute for Health Research 2017; Public Health England 2017) yet little is known about specialist palliative care (SPC) support in this setting.AimTo increase understanding of how SPC services support adult CHs in England and identify from a SPC provider perspective the challenges and enablers to good quality SPC.MethodSPC services working directly with CHs in the community in England were invited to complete an online survey. Content analysis enabled qualitative data to be described.Results108 services participated. A range of challenges were identified including CH staff turnover lack of funding and retention of CH staff knowledge skills and competency.Proposed ways to reduce/resolve challenges included:Increased commissioning of SPC staff to work directly with CHs particularly to provide education/trainingStrategic centralised and longer–term approaches to funding to facilitate continuity of support to CHsMandatory SPC core competencies and accessible training for CH staff to facilitate the prioritisation and uptake of trainingIncreased collaboration within and across organisations including regulators commissioners and providers of SPC CH and GP services to increase consistency and quality of SPC education and resident careConclusionsThe data are of national relevance and enhances our understanding of the challenges and potential enablers to CH support from a SPC provider perspective. Increased funding and cross-organisational collaboration are thought to be important instruments for change. The views of others including CH staff should be sought.References. National Institute for Health Research. Advancing care – Research with care homes 2017. Available at: https://www.dc.nihr.ac.uk/themed-reviews/care-home-research.htm [Accessed: 29th May 2018]. Public Health England. Briefing 1 – Care home bed provision and potential end of life care need in people aged 75 or older in England2017. Available at: http://www.endoflifecareintelligence.org.uk/resources/publications/carehomes [Accessed: 29th May 2018]

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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.

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