scholarly journals The Impact Of COVID-19 On Out-Of-Hours Adult Hospice Care: An Online Survey

2021 ◽  
Author(s):  
Felicity Hasson ◽  
Paul Slater ◽  
Anne Fee ◽  
Tracey McConnell ◽  
Sheila Payne ◽  
...  
Keyword(s):  
Palliative Care ◽  
United Kingdom ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Community Based ◽  
Out Of Hours ◽  
Care Services ◽  
The United Kingdom ◽  
Palliative Care Services ◽  
The Impact

Abstract BackgroundGlobally COVID-19 has had a profound impact on the provision of healthcare, including palliative care. However, there is little evidence about the impact of COVID-19 on delivery of out-of-hours specialist palliative care services in the United Kingdom. The aim of the study is to investigate the impact of the COVID-19 pandemic on the delivery of out-of-hours community-based palliative care services.Methods A national online census survey of managers of adult hospices in the United Kingdom was undertaken. Survey were emailed to managers of adult hospices (n=150) who provided out-of-hours community palliative care services. Fifteen questions related specifically to the impact of COVID-19 and data were analysed thematically.ResultsEighty-one responses to the survey were returned (54% response rate); 59 were complete of which 47 contained COVID-19 data. Findings indicated that COVID-19 impacted on out-of-hours community-based palliative care. To meet increased patient need, hospices reconfigured services; redeployed staff; and introduced new policies and procedures to minimize virus transmission. Lack of integration between charitably and state funded palliative care providers was reported. The interconnected issues of the use and availability of Personal Protective Equipment (n=21) and infection control screening (n=12) resulted in changes in nursing practices due to fear of contagion for patients, carers and staff. Conclusions Survey findings suggest that due to increased demand for community palliative care services, hospices had to rapidly adapt and reconfigure services. Even though this response to the pandemic led to some service improvements, in the main, out-of-hours service reconfiguration resulted in challenges for hospices, including workforce issues, and availability of resources such as Personal Protective Equipment. These challenges were exacerbated by lack of integration with wider healthcare services. More research is required to fully understand the implications of such changes on the quality of care provided.

In our own words …

2018 ◽  
Author(s):  
Ros Scott
Keyword(s):  
United States ◽  
Palliative Care ◽  
United Kingdom ◽  
United States Of America ◽  
Care Services ◽  
The United Kingdom ◽  
Palliative Care Services ◽  
Hospice And Palliative Care ◽  
Original Story ◽  
The Impact

This chapter explores the experience of volunteers in hospice and palliative care their own words. Frequently we hear about the work of volunteers from paid staff, from research, but not always from the volunteers themselves in their own words. In this chapter we have tried to explore what happens in the unique place that volunteers have within hospice and palliative care services; somewhere between staff, patients, and families. The stories in this chapter have all come directly from volunteers from Italy, Australia, Romania, India, United States of America (USA), and the United Kingdom (UK) in their own words. Translation, where required, has tried to remain true to the original story and all volunteers have agreed the translation to ensure that it has not changed the essence of the story. Volunteers have described their roles, what volunteering means to them, and the impact that it has on their lives.

Volunteering in hospice and palliative care in the United Kingdom

2018 ◽  
Author(s):  
Ros Scott
Keyword(s):  
Palliative Care ◽  
United Kingdom ◽  
Care Services ◽  
The United Kingdom ◽  
Strategic Direction ◽  
Palliative Care Services ◽  
History Of ◽  
The Uk ◽  
Hospice And Palliative Care ◽  
Changing Role

This chapter explores the history of volunteers in the founding and development of United Kingdom (UK) hospice services. It considers the changing role and influences of volunteering on services at different stages of development. Evidence suggests that voluntary sector hospice and palliative care services are dependent on volunteers for the range and quality of services delivered. Within such services, volunteer trustees carry significant responsibility for the strategic direction of the organiszation. Others are engaged in diverse roles ranging from the direct support of patient and families to public education and fundraising. The scope of these different roles is explored before considering the range of management models and approaches to training. This chapter also considers the direct and indirect impact on volunteering of changing palliative care, societal, political, and legislative contexts. It concludes by exploring how and why the sector is changing in the UK and considering the growing autonomy of volunteers within the sector.

The modern context of palliative care

2018 ◽  
Author(s):  
Sheila Payne ◽  
Sara Morris
Keyword(s):  
Palliative Care ◽  
United Kingdom ◽  
Health Care Systems ◽  
Organizational Boundaries ◽  
Care Services ◽  
The United Kingdom ◽  
Health And Social Care ◽  
Palliative Care Services ◽  
Care Systems ◽  
Hospice And Palliative Care

Evidence suggests that in the past support services for patients and family carers of terminally ill people have often been unavailable or inadequate in addressing their needs. This chapter will briefly summarize the context of hospice and palliative care services. The chapter argues that definitions of palliative care are culturally and temporally dependent, exemplified by the changing terminology used in the United Kingdom. One of the challenges facing service deliverers is the necessity to work collaboratively across health and social care services, and statutory and voluntary sector organizational boundaries. The funding and organizational positioning of hospice and palliative care services are often contingent upon health care systems and resources. All roles require careful recruitment, dedicated training, and consistent support to provide effective contributions from volunteers. The chapter ends by providing a short description of three studies investigating the role of volunteers undertaken in the United Kingdom.

scholarly journals The challenges of caring for people dying from COVID-19: a multinational, observational study of palliative and hospice services (CovPall)

2020 ◽  
Author(s):  
AO Oluyase ◽  
M Hocaoglu ◽  
R Cripps ◽  
M Maddocks ◽  
C Walshe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Personal Protective Equipment ◽  
End Of Life Care ◽  
Protective Equipment ◽  
Life Care ◽  
Systematic Data ◽  
Care Services ◽  
Palliative Care Services ◽  
Care Response

AbstractBackgroundSystematic data on the care of people dying with COVID-19 are scarce. We studied the response of and challenges for palliative care services during the COVID-19 pandemic.MethodsWe surveyed palliative care and hospice services, contacted via relevant organisations. Multivariable logistic regression identified associations with key challenges. Content analysis explored free text.Findings458 services responded; 277 UK, 85 rest of Europe, 95 rest of the world (1 country unreported); 81% cared for patients with suspected or confirmed COVID-19, 77% had staff with suspected or confirmed COVID-19; 48% reported shortages of Personal Protective Equipment (PPE), 40% staff shortages, 24% medicines shortages, 14% shortages of other equipment. Services provided direct care and education in symptom management and communication; 91% changed how they worked. Care often shifted to increased community and hospital care, with fewer admissions to inpatient palliative care units. Factors associated with increased odds of PPE shortages were: charity rather than public management (OR 3·07, 95% CI 1·81-5·20), inpatient palliative care unit rather than other setting (OR 2·34, 95% CI 1·46-3·75). Being outside the UK was associated with lower odds of staff shortages (OR 0·44, 95% CI 0·26-0·76). Staff described increased workload, concerns for their colleagues who were ill, whilst expending time struggling to get essential equipment and medicines, perceiving they were not a front-line service.InterpretationAcross all settings palliative care services were often overwhelmed, yet felt ignored in the COVID-19 response. Palliative care needs better integration with health care systems when planning and responding to future epidemics/pandemics.FundingMRC grant number MR/V012908/1, Cicely Saunders International and NIHR ARC South London.Research in contextEvidence before this studySystematic data on the response of palliative care services during COVID-19 are lacking. A search of PubMed on 27 August 2020 (start date: 01 December 2019) using keywords (palliative care OR end of life care OR hospice) and (COVID-19 OR coronavirus) and (multinational OR international) identified no studies that reported multinational or international data; there were 79 articles, mostly opinion pieces, single centre case studies or reports. A search for systematic reviews about palliative care and hospice services during pandemics of PubMed, with the same time periods and the keywords (palliative care OR end of life care OR hospice) and (COVID-19 OR coronavirus OR SARS-CoV-2) and (systematic review OR meta-analysis), identified one systematic review by Etkind et al, which underpinned this research and shares two senior authors (Higginson, Sleeman). Of 3094 articles identified, 10 studies, all observational, considered the palliative care response in pandemics. Studies were from single units or countries: West Africa, Taiwan, Hong Kong, Singapore, the U.S. (a simulation), and Italy (the only one considering COVID-19). The review concluded hospice and palliative care services are essential in the response to COVID-19 but systematic data are urgently needed to inform how to improve care for those who are likely to die, and/or have severe symptoms.Added value of this studyWe found a high response by palliative care services during the COVID-19 pandemic. Services cared for a surge in patients dying from and with severe symptoms due to COVID-19 in three main categories: patients with underlying conditions and/or multimorbid disease not previously known to palliative care (70% of services), patients already known to palliative care services (47% of services), and patients, previously healthy, now dying from COVID-19 (37% of services). More than three quarters of services reported having staff with suspected or confirmed COVID-19. We found high levels of shortages of Personal Protective Equipment (PPE), staff, medicines and other equipment, with different effects according to service management, care settings and world regions. Mitigating these challenges was extremely time consuming, limiting the palliative care response.Implications of all the available evidenceDespite actively supporting dying patients, those with severe symptoms, their families/carers, and supporting other clinicians, palliative care professionals felt ignored by national health systems during the COVID-19 pandemic. Palliative care services need equipment, medicines and adequate staff to contribute fully to the pandemic response. Their crucial role must be better recognised and integrated, including into infection disease management, with improved workforce planning and management, so that patients and families can be better supported.

scholarly journals ReCAP: Attitudes, Beliefs, and Awareness of Graduate Medical Education Trainees Regarding Palliative Care at a Comprehensive Cancer Center

2016 ◽  
Vol 12 (2) ◽  
pp. 149-150 ◽  
Author(s):  
Angelique Wong ◽  
Akhila Reddy ◽  
Janet L. Williams ◽  
Jimin Wu ◽  
Diane Liu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Graduate Medical Education ◽  
Surgical Oncology ◽  
Comprehensive Cancer Center ◽  
Graduate Medical ◽  
Care Services ◽  
Palliative Care Services ◽  
Care Training ◽  
The Impact

QUESTION ASKED: What are graduate medical education trainees’ attitudes and beliefs regarding palliative care, what is their awareness of the availability and role of palliative care services, and does previous exposure to a palliative care rotation facilitate a better awareness of palliative care? SUMMARY ANSWER: A vast majority of oncology trainees perceived palliative care services to be beneficial for patient care (92%) and were supportive of mandatory palliative care training (74%). Surgical oncology trainees and trainees with no previous palliative care exposure were significantly less likely to consult palliative care and had significantly less awareness of palliative care. METHODS: We conducted an institutional review board–approved online survey to determine awareness of palliative care among graduate medical trainees at MD Anderson. One hundred seventy oncology trainees who completed at least 9 months of training in medical, surgical, gynecologic, and radiation oncology fellowship and residency program during the 2013 academic year completed an online questionnaire. Descriptive, univariate, and multivariate analyses were performed. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Although there was a substantial response rate (78%), the results may not be generalizable as the survey was conducted at a single institution. Also, the frequency of palliative care referrals is self-reported. REAL-LIFE IMPLICATIONS: Our findings suggest that exposure to palliative care training may lead to increased awareness of palliative care among oncologists, and thus, increased overall and early referrals to palliative care. Surgical oncology trainees may benefit from increased exposure to palliative care rotations. More research is needed to characterize the impact of training on referral patterns to palliative care. In the meantime, efforts should be made to include formal palliative care rotations in oncology training. [Table: see text]

scholarly journals Clinician views of patient decisional conflict when deciding between dialysis and conservative management: Qualitative findings from the PAlliative Care in chronic Kidney diSease (PACKS) study

2017 ◽  
Vol 31 (10) ◽  
pp. 921-931 ◽  
Author(s):  
Helen Noble ◽  
Kevin Brazil ◽  
Aine Burns ◽  
Sarah Hallahan ◽  
Charles Normand ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Palliative Care ◽  
United Kingdom ◽  
Kidney Disease ◽  
Conservative Management ◽  
Treatment Options ◽  
Decisional Conflict ◽  
The United Kingdom ◽  
The Impact

Background: Only a paucity of studies have addressed clinician perspectives on patient decisional conflict, in making complex decisions between dialysis and conservative management (renal supportive and palliative care). Aim: To explore clinician views on decisional conflict in patients with end-stage kidney disease. Design: Interpretive, qualitative study. Setting and participants: As part of the wider National Institute for Health Research, PAlliative Care in chronic Kidney diSease study, semi-structured interviews were conducted with clinicians (nephrologists n = 12; 7 female and clinical nurse specialists n = 15; 15 female) across 10 renal centres in the United Kingdom. Interviews took place between April 2015 and October 2016 and a thematic analysis of the interview data was undertaken. Results: Three major themes with associated subthemes were identified. The first, ‘Frequent changing of mind regarding treatment options’, revealed how patients frequently altered their treatment decisions, some refusing to make a decision until deterioration occurred. The second theme, ‘Obligatory beneficence’, included clinicians helping patients to make informed decisions where outcomes were uncertain. In weighing up risks and benefits, and the impact on patients, clinicians sometimes withheld information they thought might cause concern. Finally, ‘Intricacy of the decision’ uncovered clinicians’ views on the momentous and brave decision to be made. They also acknowledged the risks associated with this complex decision in giving prognostic information which might be inaccurate. Limitations: Relies on interpretative description which uncovers constructed truths and does not include interviews with patients. Conclusion: Findings identify decisional conflict in patient decision-making and a tension between the prerequisite for shared decision-making and current clinical practice. Clinicians also face conflict when discussing treatment options due to uncertainty in equipoise between treatments and how much information should be shared. The findings are likely to resonate across countries outside the United Kingdom.

Effectiveness of palliative care services: A population-based study of end-of-life care for cancer patients

2018 ◽  
Vol 32 (8) ◽  
pp. 1344-1352 ◽  
Author(s):  
Rossana De Palma ◽  
Daniela Fortuna ◽  
Sarah E Hegarty ◽  
Daniel Z Louis ◽  
Rita Maria Melotti ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Conditional Logistic Regression ◽  
Emergency Department Visits ◽  
Administrative Databases ◽  
Hospital Death ◽  
Care Services ◽  
Palliative Care Services ◽  
The Impact

Background: Multiple studies demonstrate substantial utilization of acute hospital care and, potentially excessive, intensive medical and surgical treatments at the end-of-life. Aim: To evaluate the relationship between the use of home and facility-based hospice palliative care for patients dying with cancer and service utilization at the end of life. Design: Retrospective, population-level study using administrative databases. The effect of palliative care was analyzed between coarsened exact matched cohorts and evaluated through a conditional logistic regression model. Setting/participants: The study was conducted on the cohort of 34,357 patients, resident in Emilia-Romagna Region, Italy, admitted to hospital with a diagnosis of metastatic or poor-prognosis cancer during the 6 months before death between January 2013 and December 2015. Results: Patients who received palliative care experienced significantly lower rates of all indicators of aggressive care such as hospital admission (odds ratio (OR) = 0.05, 95% confidence interval (CI): 0.04–0.06), emergency department visits (OR = 0.23, 95% CI: 0.21–0.25), intensive care unit stays (OR = 0.29, 95% CI: 0.26–0.32), major operating room procedures (OR = 0.22, 95% CI: 0.21–0.24), and lower in-hospital death (OR = 0.11, 95% CI: 0.10–0.11). This cohort had significantly higher rates of opiate prescriptions (OR = 1.27, 95% CI: 1.21–1.33) ( p < 0.01 for all comparisons). Conclusion: Use of palliative care at the end of life for cancer patients is associated with a reduction of the use of high-cost, intensive services. Future research is necessary to evaluate the impact of increasing use of palliative care services on other health outcomes. Administrative databases linked at the patient level are a useful data source for assessment of care at the end of life.

The impact of routine Edmonton symptom assessment system use on receiving palliative care services: results of a population-based retrospective-matched cohort analysis

2020 ◽  
pp. bmjspcare-2020-002220
Author(s):  
Lisa Barbera ◽  
Rinku Sutradhar ◽  
Craig C Earle ◽  
Doris Howell ◽  
Nicole Mittman ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Analysis ◽  
Symptom Assessment ◽  
Assessment System ◽  
Matched Cohort ◽  
Edmonton Symptom Assessment System ◽  
Care Services ◽  
Patient Reported ◽  
Palliative Care Services ◽  
The Impact

BackgroundIn 2007, Cancer Care Ontario began standardised symptom assessment as part of routine care using the Edmonton Symptom Assessment System (ESAS).AimThe purpose of this study was to evaluate the impact of ESAS on receipt of palliative care when compared with a matched group of unexposed patients.DesignA retrospective-matched cohort study examined the impact of ESAS screening on initiation of palliative care services provided by physicians or homecare nurses. The study included adult patients diagnosed with cancer between 2007 and 2015. Exposure was defined as completing ≥1 ESAS during the study period. Using 4 hard and 14 propensity score-matched variables, patients with cancer exposed to ESAS were matched 1:1 to those who were not. Matched patients were followed from first ESAS until initiation of palliative care, death or end of study.ResultsThe final cohort consisted of 204 688 matched patients with no prior palliative care consult. The pairs were well matched. The cumulative incidence of receiving palliative care within the first 5 years was higher among those exposed to ESAS compared with those who were not (27.9% (95% CI: 27.5% to 28.2%) versus 27.9% (95% CI: 27.5% to 28.2%)), when death is considered as a competing event. In the adjusted cause-specific Cox proportional hazards model, ESAS assessment was associated with a 6% increase in palliative care services (HR: 1.06, 95% CI: 1.04 to 1.08).ConclusionWe have demonstrated that patients exposed to ESAS were more likely to receive palliative care services compared with patients who were not exposed. This observation provides real-world data of the impact of routine assessment with a patient-reported outcome.

Competition and Containment in Health Care

2000 ◽  
Vol 30 (2) ◽  
pp. 257-284 ◽  
Author(s):  
Ben Griffith
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Cost Effectiveness ◽  
Transaction Costs ◽  
Health Care Services ◽  
Internal Markets ◽  
Care Services ◽  
The United Kingdom ◽  
Additional Funding ◽  
The Impact

In the United Kingdom and elsewhere, the preconditions for well-functioning internal markets (in relation to market structure, transaction costs, and information) may not exist in health care. Similar doubts exist about the impact of internal markets on cost-effectiveness. While the quantity of health care has increased, the effects on quality are ambiguous and costs have not been successfully restrained. With respect to equity of health care, fears have been raised that sections of the population may be discriminated against. In the United Kingdom, resources have been shifted away from deprived areas and toward the more affluent. Health care services are once again being reformed, by New Labour in the United Kingdom and similar administrations elsewhere. The rhetoric of competition has given way to talk of partnership. The imposition of new forms of rationing has been reshaped, not abandoned. Additional funding is required, along with an effective commitment to the pursuit of equity and quality in health care.

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