scholarly journals Operation of a hospital palliative care service: a fourth-generation evaluation

2019 ◽  
Vol 72 (2) ◽  
pp. 383-390 ◽  
Author(s):  
Carla Simone Leite de Almeida ◽  
Sonia Silva Marcon ◽  
Laura Misue Matsuda ◽  
Luciane Prado Kantorski ◽  
Bianca Sakamoto Ribeiro Paiva ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Comparative Method ◽  
Interpersonal Relationship ◽  
Care Home ◽  
Palliative Care Service ◽  
Surgical Oncology ◽  
Fourth Generation ◽  
Structured Interviews ◽  
Fourth Generation Evaluation

ABSTRACT Objective: Qualitatively evaluate the operation of a palliative care service in oncology. Methodology: Qualitative study conducted in a service in southern Brazil based on a fourth generation evaluation. Between September 2014 and June 2015, 460 hours of operation were observed, and 45 semi-structured interviews and five negotiation meetings were conducted; data were analyzed using the constant comparative method. Results: Potential services are: provision of outpatient palliative care, home and inpatient care provided by a multidisciplinary and support team, meeting the patient’s biological, psychological, social and spiritual needs. Study limitations: ineffective communication between clinical and surgical oncology and palliative care sectors, lack of specialized training for professionals and in interpersonal relationship issues among team members. Final Consideration: For palliative care progress in the service, some arrangements are required to enhance integrality of care.

Referral Practices of Oncologists to Specialized Palliative Care

2012 ◽  
Vol 30 (35) ◽  
pp. 4380-4386 ◽  
Author(s):  
Kirsten Wentlandt ◽  
Monika K. Krzyzanowska ◽  
Nadia Swami ◽  
Gary M. Rodin ◽  
Lisa W. Le ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Surgical Oncology ◽  
Disease Course ◽  
Radiation Oncologists ◽  
Canadian Association ◽  
Medical Oncologists ◽  
Referral Practices ◽  
Specialized Palliative Care

Purpose To describe current referral practices of oncologists to specialized palliative care (SPC) and define demographic characteristics, practice situations, and opinions associated with referral. Methods Physician members of the Canadian Association of Medical Oncologists, Canadian Association of Radiation Oncologists, and Canadian Society of Surgical Oncology were invited to participate in an anonymous survey assessing SPC referral practices. Participants received two e-mailed and two mailed invitations. Results The response rate was 72% (603 of 839 physicians); 37% were medical oncologists/hematologists, 50% were radiation oncologists, and 12% were surgical oncologists. Ninety-four percent reported that SPC was available to them, but only 37% reported that these services accepted patients on chemotherapy. Eighty-four percent referred terminally ill patients usually/always, but generally for uncontrolled symptoms or discharge planning late in the disease course. One third would refer to SPC earlier if it was renamed supportive care. Predictors of higher referral frequency included comprehensiveness of available SPC services (P = .004), satisfaction with SPC availability (P < .001), SPC acceptance of patients receiving chemotherapy (P < .001), and oncologist ease with referring patients to a palliative care service before they were close to death (P < .001). Controlling for specialty, predictors of referral at diagnosis or during chemotherapy, rather than later, included satisfaction with SPC service availability (P < .001) and SPC service acceptance of patients on chemotherapy (P < .001). Conclusion Oncologists referred patients frequently to SPC, but generally late in the disease course for patients with uncontrolled symptoms. Availability of comprehensive SPC, especially for patients receiving chemotherapy, and persisting definitional issues seem to be the main barriers preventing timely referral.

scholarly journals Assessment of components of crack users’ attention network

2020 ◽  
Vol 73 (1) ◽  
Author(s):  
Leandro Barbosa de Pinho ◽  
Christine Wetzel ◽  
Jacó Fernando Schneider ◽  
Agnes Olschowsky ◽  
Marcio Wagner Camatta ◽  
...  
Keyword(s):  
Care Service ◽  
Comparative Method ◽  
Family Members ◽  
Fourth Generation ◽  
Attention Network ◽  
Constant Comparative Method ◽  
The Military ◽  
Fourth Generation Evaluation ◽  
Crack Users ◽  
Crack User

ABSTRACT Objective: Assess components of the Psychosocial Attention Network (RAPS) in crack user care in a Rio Grande do Sul municipality. Method: Qualitative study based on Fourth Generation Evaluation. Data collection occurred in 2014, through participating observation and interviews based on the Hermeneutic-Dialectic Circle. Ten uses, eleven family members, seven managers and eight workers at a Psychosocial Attention Center participated. The Constant Comparative Method was used for data analysis. Results: Difficulties were observed in the network articulation with the general hospital, due to prejudice and the lack of structure of the team. SAMU’s (Mobile Emergency Care Service) dependence on the Military Brigade for the service indicates a frailty of the network. The need to re-think the way therapeutic farms operate in the network is a consensus. Conclusion: RAPS is being implemented and its concretization depends on the involvement of professionals, managers and social control of users and family members.

scholarly journals Patient and family perceptions of hospice services: ‘I knew they weren’t like hospitals’

2013 ◽  
Vol 5 (3) ◽  
pp. 206 ◽  
Author(s):  
Yvonne Bray ◽  
Felicity Goodyear-Smith
Keyword(s):  
Palliative Care ◽  
Ethnic Diversity ◽  
Care Service ◽  
Family Members ◽  
Ethnic Disparities ◽  
Palliative Care Service ◽  
Cultural Groups ◽  
Structured Interviews ◽  
Information Giving ◽  
Family Perceptions

INTRODUCTION: The vision for palliative care service provision in New Zealand is for all people who are dying and their families to have timely access to culturally appropriate, quality palliative care services. An Auckland hospice’s records show that the ethnically diverse population statistics were not reflected in the referrals for hospice services. The aim of this research was to gain a patient-and-their-family perspective on the hospice, including exploration of components of service care that could be improved for various cultural groups. METHODS: Patients currently under the care of the hospice and family members were recruited from hospice records. Semi-structured interviews were conducted to explore the emerging issues. The study collected data from a purposive sample of 18 palliative care patients or carer family members, ranging in age from 39 to 81 years, who reflected the ethnic diversity of the population of the region. Interviewing was carried out by an experienced research assistant and continued until data saturation was reached. FINDINGS: Four key themes emerged – hospice personnel’s approach to patients, quality of service, cultural barriers, and strategies for future improvement. It was determined that the latter two were the most significant to address in this article. CONCLUSION: The study revealed the need for information-giving and education, including public profiling of the hospice to strengthen community involvement. Strategies to reduce ethnic disparities include strengthening the awareness of, and access to, services by connecting with cultural groups through churches, community and specific cultural media. KEYWORDS: Cultural competency; hospice care; palliative care; patient education; terminal care

scholarly journals Evaluation of intersectoral resources in the composition of care networks for crack users

2017 ◽  
Vol 21 (4) ◽  
Author(s):  
Leandro Barbosa de Pinho ◽  
Christine Wetzel ◽  
Jacó Fernando Schneider ◽  
Agnes Olschowsky ◽  
Marcio Wagner Camatta ◽  
...  
Keyword(s):  
Comparative Method ◽  
Psychosocial Care ◽  
Metropolitan Region ◽  
Fourth Generation ◽  
Community Resources ◽  
Structured Interviews ◽  
The Public ◽  
The Military ◽  
Fourth Generation Evaluation ◽  
Crack Users

Abstract Objective: To evaluate the intersectoral resources in the composition of care networks for crack users. Method: Evaluative, qualitative study based on the Fourth Generation Evaluation. The participants were 10 users, 11 family members, eight workers, and seven managers from a municipality in the metropolitan region of Porto Alegre/Rio Grande do Sul, Brazil. Data were collected in 2014 through observation and semi-structured interviews. The analysis occurred by the constant comparative method. Results: Stakeholders have discussed how the Public Prosecutor's Office and the Military Brigade are inserted in the network, since they carry out actions that often are not compatible with the psychosocial care proposal. The need for expansion and maintenance of liaisons with community resources was identified. Conclusion: It is noted the need for sector integration and participation of all social agents from different spheres in order to promote and evaluate the practices and policies of care for crack users.

scholarly journals 77 National Audit of Care At the End of Life (NACEL)—Round Two Findings

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
D Hibbert
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Service ◽  
Palliative Care Service ◽  
Care Plan ◽  
Specialist Palliative Care ◽  
Experience Of Care ◽  
Outcomes Of Care ◽  
Specialist Palliative Care Service ◽  
The Right

Abstract   NACEL is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the final admission in acute and community hospitals in England and Wales. Mental health inpatient providers participated in the first round but excluded from the second round. NACEL round two, undertaken during 2019/20, comprised: Data was collected between June and October 2019. 175 trusts in England and 8 Welsh organisations took part in at least one element of NACEL (97% of eligible organisations). Key findings include Recognising the possibility of imminent death: The possibility that the patient may die was documented in 88% of cases. The median time from recognition of dying to death was 41 hours (36 hours in the first round). Individual plan of care: 71% of patients, where it had been recognised that the patient was dying (Category 1 deaths), had an individualised end of life care plan. Of the patients who did not have an individualised plan of care, in 45% of these cases, the time from recognition of dying to death was more than 24 hours. Families’ and others’ experience of care: 80% of Quality Survey respondents rated the quality of care delivered to the patient as outstanding/excellent/good and 75% rated the care provided to families/others as outstanding/excellent/good. However, one-fifth of responses reported that the families’/others’ needs were not asked about. Individual plan of care: 80% of Quality Survey respondents believed that hospital was the “right” place to die; however, 20% reported there was a lack of peace and privacy. Workforce Most hospitals (99%) have access to a specialist palliative care service. 36% of hospitals have a face-to-face specialist palliative care service (doctor and/or nurse) available 8 hours a day, 7 days a week. NACEL round three will start in 2021.

scholarly journals The association between ethnicity, socioeconomic deprivation and receipt of hospital-based palliative care for people with Covid-19: A dual centre service evaluation

2021 ◽  
pp. 026921632110229
Author(s):  
Sabrina Bajwah ◽  
Polly Edmonds ◽  
Emel Yorganci ◽  
Rosemary Chester ◽  
Kirsty Russell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Ethnic Minority ◽  
Primary Outcome ◽  
Minority Groups ◽  
Care Service ◽  
Palliative Care Service ◽  
Service Evaluation ◽  
Socioeconomic Deprivation ◽  
Black British ◽  
Multivariable Regression

Background: People from ethnic minority groups and deprived socioeconomic backgrounds have worse outcomes from COVID-19. Aim: To examine associations between ethnicity and deprivation with timing of palliative care referral for inpatients with COVID-19. Design: Service evaluation of consecutive patients with COVID-19 referred to palliative care. Sociodemographic (including age, sex, Index of Multiple Deprivation, ethnicity coded as White/non-White) and clinical variables were described. The primary outcome was timing of referral to palliative care. Associations between ethnicity and socioeconomic deprivation with the primary outcome were explored using multivariable regression. Setting/participants: Patients with COVID-19 referred to a hospital palliative care service across two London hospitals February–May 2020. Results: A total of 334 patients were included. 119 (36%) were from a non-White ethnic group; most commonly Black British (77, 23%) and Asian British (26, 8%). A longer time between admission and palliative care referral was associated with male gender (IRR 1.23, 95% CI 1.14–1.34) and lower levels of socioeconomic deprivation (IRR 1.61, 95% CI 1.36–1.90) but not ethnicity (IRR = 0.96, 95% CI 0.87–1.06). Conclusions: This large service evaluation showed no evidence that patients from ethnic minority or more deprived socioeconomic groups had longer time to palliative care referral. Ongoing data monitoring is essential for equitable service delivery.

scholarly journals Use of Alfentanil in Palliative Care

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 240
Author(s):  
José António Ferraz Gonçalves ◽  
Filipa Sousa ◽  
Lucy Alves ◽  
Patrícia Liu ◽  
Sara Coelho
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Retrospective Study ◽  
Pain Relief ◽  
Renal Impairment ◽  
Care Service ◽  
Palliative Care Service ◽  
Median Number ◽  
Second Line ◽  
Induction Of Tolerance

Alfentanil is used for chronic pain relief in palliative care. However, there is a dearth of data on its use. For this reason, a decision was made to review the use of alfentanil in palliative care. Retrospective study was carried out in a palliative care service. The files of patients who received alfentanil as an intravenous or subcutaneous continuous infusion for pain relief, between January 2018 and April 2019. In total, 111 patients received alfentanil out of 113 admissions. Of them, 56 were male, and the median age was 70 years. The median number of days on alfentanil was 6 (range 1 to 129). The most frequent primary reasons for switching to alfentanil was uncontrolled pain in 52 (46%) patients and renal impairment in 24 (21%) patients. The median 24-h initial dose of alfentanil was 4 mg (1–20), and the median final 24-h dose of alfentanil was 5 mg (1–60), (p < 0.001). The initial 24-h median number of rescue doses was 2 (0–8), and the final median number of rescue doses was 1 (0 to 8), (p = 0.025). In 56 patients who were on alfentanil for at least 7 days, the dose decreased in 3 (5%), remained stable in 10 (18%) and increased in 43 (77%). The patient on alfentanil for 129 days maintained the same dose throughout that period. Alfentanil can be a useful second-line opioid. The induction of tolerance does not seem to be particularly rapid with alfentanil.

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