scholarly journals Advance directives of patients: process of implementation by palliative care teams

2020 ◽  
Vol 73 (suppl 6) ◽  
Author(s):  
Aline Carniato Dalle Nogario ◽  
Edison Luiz Devos Barlem ◽  
Jamila Geri Tomaschewski-Barlem ◽  
Rosemary Silva da Silveira ◽  
Silvana Bastos Cogo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Directives ◽  
Patient Autonomy ◽  
Implementation Process ◽  
Descriptive Study ◽  
Natural Process ◽  
Southern Brazil ◽  
Palliative Care Teams ◽  
Human Finitude

ABSTRACT Objectives: to investigate the process of implementing advance directives in palliative care teams in southern Brazil. Methods: an exploratory-descriptive study with a qualitative approach conducted with 51 professionals from seven palliative care teams from December 2018 to April 2019. Data were collected through semi-structured online interviews and submitted to discursive textual analysis. Results: the implementation process starts on approach of the advance directives with patients, so that their wishes and desires are the guiding axis for planning care and conduct. Final Considerations: the palliative philosophy is important with regard to advance directives, due to the preparation of these professionals in the search for dignity, quality of life and respect for patient autonomy, in addition to reducing suffering and offering dignified death, based on the understanding of human finitude as a natural process that belongs to life.

Retrospective review of end-of-life care in the last month of life in older patients with multiple myeloma: what collaboration between haematologists and palliative care teams?

2020 ◽  
pp. bmjspcare-2020-002293
Author(s):  
Thomas Chalopin ◽  
Nicolas Vallet ◽  
Lotfi Benboubker ◽  
Marlène Ochmann ◽  
Emmanuel Gyan ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Palliative Care ◽  
End Of Life ◽  
Older Patients ◽  
High Rate ◽  
Palliative Care Teams ◽  
Care Family ◽  
Eol Care

ObjectivesPatients with haematological malignancies (HM) receive more aggressive treatments near the end-of-life (EOL) than patients with solid tumours. Palliative care (PC) needs are less widely acknowledged in patients with multiple myeloma (MM) than in other HM. The main objective of our study was to describe EOL care and PC referral in a population of older patients with MM.MethodsWe retrospectively included deceased inpatients and outpatients with an MM previously diagnosed at the age of 70 and over in two tertiary centres in France. We reported EOL characteristics regarding treatments considered to be aggressive—antimyeloma therapies, hospitalisations, blood product transfusions, intensive care units (ICUs) or emergency admissions—and PC referral.ResultsWe included 119 patients. In their last month of life, 75 (63%) were hospitalised for fever, pain, asthenia, anaemia or bleeding, 49 (41%) were admitted in the emergency department and 12 (10%) in ICU, 76 (64%) still received antimyeloma therapy and 45 (38%) had at least two transfusions. Only 24 (20%) received PC intervention for pain, global care, family support, anxiety, social care or confusion. Median follow-up until death was 20 days.ConclusionsOur study found a high rate of hospitalisations and antimyeloma therapies in the last month of life. The PC referral rate was low, often once specific treatments were stopped. Our results suggest the need for more effective collaboration between PC teams and haematologists in order to respond to the specific needs of these patients and to improve their quality of care at EOL.

scholarly journals Do Palliative Care Teams in Nursing Homes Improve the Quality of End-of-Life Care for Nursing Home Residents?

2019 ◽  
Author(s):  
Helena Temkin-Greener Helena Temkin-Greener ◽  
Dana Mukamel ◽  
Susan Ladwig ◽  
Thomas , Caprio ◽  
Sally Norton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Life Care ◽  
Palliative Care Teams

scholarly journals Perception of health professionals about neonatal palliative care

2019 ◽  
Vol 72 (6) ◽  
pp. 1707-1714
Author(s):  
Ernestina Maria Batoca Silva ◽  
Maria José Machado Silva ◽  
Daniel Marques Silva
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Neonatal Intensive Care ◽  
Ethical Decisions ◽  
Palliative Care Teams ◽  
Pain And Suffering ◽  
Probabilistic Sample ◽  
Perception Of Health ◽  
Relational Difficulties

ABSTRACT Objective: To identify the perception of health professionals about neonatal palliative care. Method: A phenomenological qualitative study, a non-probabilistic sample, of 15 health professionals from a neonatal intensive care unit in northern Portugal. Content analysis was performed. Results: Despite their lack of training in palliative care, the health professionals showed concern for the dignity, quality of life and comfort of the newborn and family. They expressed emotional and relational difficulties in following the trajectories of serious illness and death and in the ethical decisions regarding the end-of-life. Conclusion: It is emphasized that professionals are sensitive to pain and suffering and reveal dedicated and committed in the care of the newborn and family. They are available to train and embrace the current challenges posed by the constitution of pediatric palliative care teams and to help achieve an organizational culture that advances in such care.

Retrospective assessment of quality of cancer care in last 6 months of life.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 234-234
Author(s):  
Brian Cassel ◽  
Nevena Skoro ◽  
Kathleen Kerr ◽  
Lisa Shickle ◽  
Patrick J. Coyne ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Cancer Care ◽  
Specialist Palliative Care ◽  
Retrospective Assessment ◽  
Palliative Care Teams ◽  
Social Security Death Index ◽  
National Quality ◽  
National Organizations

234 Background: National organizations such as the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum (NQF) have developed metrics that assess the quality of cancer care. These metrics include consensus standards by the NQF for management of symptoms and end-of-life-care. Cancer centers need feasible methods for self-evaluating their performance on such metrics. Methods: Claims for our cancer patients were matched to Social Security Death Index data to determine date of death.3,128 adult cancer patients died between January 2009 and July 2011 and had at least 1 contact with our center in their last six month of life. All inpatient and outpatient claims data generated in the last six months of life at our hospital were analyzed. Results: 32% of patients had an admission in their last 30 days of life, with 15% dying in the hospital. 19% had at least one 30-day readmission in their last six months of life. 6.7% had chemotherapy in the 2 weeks prior to death, and 11.4% in the last month. 27.5% had some contact with the specialist palliative care (SPC) team. Solid tumor patients with SPC earlier than 1 month until death had fewer in-hospital deaths (15.6%) versus those with later or no SPC (19.5%), p=.041. There was no SPC difference for 30-day mortality, or 14- or 30-day chemotherapy metrics. Conclusions: Hospitals can self-evaluate their own performance on NQF endorsed measures, and CMS outcome measures. These data provide additional impetus for earlier integration of specialist palliative care teams. SPC in the last 1-3 weeks of life did not improve most utilization metrics.[Table: see text]

Establishing Relationships With Specialty Palliative Care for More Complex Patient Needs

2020 ◽  
pp. 67-75
Author(s):  
Kate Schueller ◽  
Joseph D. Rotella
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Palliative Care ◽  
Quality Improvement ◽  
Palliative Care Team ◽  
Patient Needs ◽  
Improve Quality ◽  
Palliative Care Teams ◽  
Whole Person

Interdisciplinary palliative care teams can improve quality of life by addressing the needs and experience of the whole person with chronic kidney disease, including physical, psychological, social, spiritual, cultural, end-of-life, ethical, and practical concerns. Nephrology teams can develop the essential skills to provide primary palliative care for uncomplicated problems, but consultation with a specialty palliative care team is warranted for more severe, complex, or refractory problems. Although specialty palliative care can be delivered in any care setting, it may be a scarce resource outside of a hospital or hospice. Nephrology teams should identify all the specialty palliative care resources available in their community and consider engaging palliative care experts not only in patient care but also in advisory, educational, and quality improvement activities.

Clinical interventions, economic impact, and palliative care

2015 ◽  
pp. 1048-1055
Author(s):  
Patrick J. Coyne ◽  
Thomas J. Smith ◽  
Laurel J. Lyckholm
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Management Strategies ◽  
Cost Savings ◽  
Palliative Care Teams ◽  
Futile Care ◽  
Seriously Ill Patients ◽  
Care Costs ◽  
Seriously Ill

Economic outcomes are increasingly important for all types of healthcare, including palliative care. There are substantial opportunities for improvement by using disease management strategies and care pathways. Directed, ethically motivated interventions about futile care appear to produce significant cost savings. The use of advance directives or hospice care may be good medical care, but have not been shown to produce major economic benefit. Integrated palliative care teams have been shown to reduce hospital and end-of-life care costs for seriously ill patients. For treatment to be justified, there must be some demonstrable improvement in disease-free or overall survival, toxicity, quality of life, or cost effectiveness.

scholarly journals Development of a cognitive-existential intervention to decrease compassion fatigue in formal caregivers

2020 ◽  
Vol 37 (2) ◽  
pp. 239-251 ◽  
Author(s):  
Paula Hidalgo-Andrade ◽  
Silvia Martínez-Rodríguez
Keyword(s):  
Palliative Care ◽  
Compassion Fatigue ◽  
Interpersonal Relationships ◽  
Latin American ◽  
Vital Role ◽  
Theoretical Development ◽  
Specific Content ◽  
Formal Caregivers ◽  
Palliative Care Teams

Palliative care aims to improve the quality of life of patients with chronic and advanced illnesses and their families. This requires a multidisciplinary approach from formal caregivers. Though caring for others could be rewarding and this satisfaction relates to higher work engagement and resiliency, formal caregivers of palliative care patients may develop compassion fatigue due to the nature of their work. This fatigue affects caregivers, their interpersonal relationships, and the quality of care they provide. Supporting formal caregivers and improving communication plays a vital role. Considering the efficacy of the existential interventions in other populations, and the lack of testing of these interventions on formal caregivers of palliative care teams, this article aims to describe the design and development of an eight-session cognitive-existential group-based psychoeducational intervention to reduce compassion fatigue and to promote self-care and satisfaction of formal caregivers of palliative care patients in a Latin American context. The intervention used Frankl’s Logotherapy and Ellis’ rational emotive therapy as the theoretical framework and included the necessities of formal caregivers in this specific setting. As a result, this article presents the theoretical development of the intervention and its structure, as well as the objectives and specific content of each session. Empirical research, reported elsewhere, has proven its long-term effectiveness in reducing the compassion fatigue of this population. This makes it a replicable intervention with promising results. Future studies need to continue its evaluation and include professionals in other settings outside palliative care.

scholarly journals Implementation of early will directives: facilities and difficulties experienced by palliative care teams

2020 ◽  
Vol 41 ◽  
Author(s):  
Aline Carniato Dalle Nogario ◽  
Edison Luiz Devos Barlem ◽  
Jamila Geri Tomaschewski-Barlem ◽  
Rosemary Silva da Silveira ◽  
Silvana Bastos Cogo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Implementation Process ◽  
Palliative Care Team ◽  
Legal Issues ◽  
Care Team ◽  
Rio Grande Do Sul ◽  
Palliative Care Teams ◽  
The Family ◽  
The Subject ◽  
Difficult Situations

ABSTRACT Objective: To know the facilities and difficulties the palliative care team professionals experience in the implementation process of advance healthcare directives. Method: Exploratory-descriptive study with a qualitative approach, involving 51 professionals from seven palliative care teams in the state of Rio Grande do Sul, Brazil. The data were collected between December 2018 and April 2019 and discursive textual analysis was applied. Results: The facilities found were: the approach by the palliative care team; listening and respecting patients' wishes; effective communication between professionals, patients, and family members and resolution of difficult situations. The difficulties reported were: legal issues; the lack of knowledge of professionals about the subject; the lack of institutional protocols; the difficulty in talking about death and the family barrier. Conclusion: Despite the perceived facilities and difficulties, palliative care professionals intend to work based on the patients' desires and will, aiming to offer dignity in the dying process.

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