Development and Progress of a Collaborative Learning Model for Quality Improvement in the Field of Palliative Care in India

Quality is central to healthcare and even more so in the field of palliative care. Palliative care approach is centered around discovering facets of care crucial to improving the quality of life of the patient; be it symptom control, emotional concerns, impact on social roles or reviving the sense of spiritual connectedness. Although there are essential and desirable standards for quality of services, the journey taken by a service, toward quality improvement (QI), is often complex and uncharted. It is up to individual service units to strive toward improvement and reach higher levels of quality. Evidence suggests using a structured methodology for successful improvement in healthcare quality, as most problems are complex and multifaceted. This article introduces the concept and application of QI methodology in the field of palliative care in India and provides an overview of the first cohort of QI projects, facilitated through an international collaborative. The sequence of training, the tools, and the key ingredients for success are enumerated.

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Implementing a patient-centred outcome measure in daily routine in a specialist palliative care inpatient hospital unit: An observational study

Palliative Medicine ◽

10.1177/0269216316655349 ◽

2016 ◽

Vol 31 (3) ◽

pp. 275-282 ◽

Cited By ~ 5

Author(s):

Alze Pereira dos Santos Tavares ◽

Carolina Paparelli ◽

Carolina Sassaki Kishimoto ◽

Silvia Avo Cortizo ◽

Karen Ebina ◽

...

Keyword(s):

Palliative Care ◽

Quality Of Care ◽

Missing Data ◽

Outcome Measure ◽

Symptom Control ◽

Daily Practice ◽

Daily Routine ◽

Palliative Care Outcome Scale ◽

Care Outcome

Background: Gathering clinical evidence data on patients’ palliative care needs is paramount to identify changes in outcomes over time and maintaining on-going quality improvement. Implementation of patient-centred outcome measures has been widely recommended. The routine use of these instruments in daily practice is challenging and not widespread. Aim: To implement a patient-centred outcome measure in daily practice and fulfil one quality indicator: improve pain during the 72 h after admission, in at least 75% of patients. Design: An observational prospective study. The Palliative care Outcome Scale was used at admission (T0), third day (T1) and weekly. Setting/participants: Hospital palliative care unit with 17 individual rooms. All patients admitted to the unit were included in the study. Results: Preliminary results ( N = 84) revealed inconsistent and missing data (14%). Symptoms were sub-optimally controlled by T1. Processes changed, and only a team member could apply Palliative care Outcome Scale. Doctors were encouraged to grasp the meaning of Palliative care Outcome Scale results for each patient. The post-pilot included 317 patients. No missing data occurred. There was an improvement in most items between T0 and T1: ‘pain’ and ‘other symptoms’ presented statistical significant differences ( p < 0.05). Conclusion: Implementing a patient-centred outcome measure in a hospital palliative care service is feasible and improves quality of care. Controlling high pain at T0 improved (>80%) by T1. Results became more consistent and symptom control was improved overall. Patients are evaluated based on holistic domains by an interdisciplinary team and we have added a much needed measure to help guide improvement of the quality of care provided.

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Perinatal palliative care

Oxford Textbook of Palliative Care for Children ◽

10.1093/med/9780198821311.003.0029 ◽

2021 ◽

pp. 325-331

Author(s):

Áine Ni Laoire ◽

Daniel Nuzum ◽

Maeve O’Reilly ◽

Marie Twomey ◽

Keelin O’Donoghue ◽

...

Keyword(s):

Palliative Care ◽

Symptom Control ◽

Management Strategies ◽

Models Of Care ◽

Multidisciplinary Teams ◽

Care Approach ◽

Perinatal Palliative Care ◽

Limiting Condition ◽

Multidisciplinary Model ◽

Bereavement Care

Perinatal palliative care (PNPC) is a holistic multidisciplinary model of care for both baby and family in the event of a perinatal diagnosis of a life-limiting condition. It aims to provide optimal symptom control and end-of-life care to the baby as well as specialized support to families from diagnosis through to birth, death, and bereavement. This chapter aims to address the challenging clinical, ethical, and practical issues specific to perinatal palliative care. It describes antenatal life-limiting diagnoses, the role of anticipatory bereavement care, a palliative care approach to pregnancy, and outlines the complex planning and models of care required to optimally provide for the baby, mother, and family throughout. This chapter ultimately aims to provide management strategies to guide multidisciplinary teams (MDT) to deliver high-quality PNPC to the family as a whole.

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Improving the waiting times within a hospice breathlessness service

BMJ Open Quality ◽

10.1136/bmjoq-2018-000582 ◽

2019 ◽

Vol 8 (2) ◽

pp. e000582

Author(s):

Caroline Sime ◽

Stuart Milligan ◽

Kevin Donal Rooney

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Waiting Time ◽

Current System ◽

Waiting Times ◽

Well Being ◽

Common Symptom ◽

Specialist Palliative Care ◽

Published Evidence

BackgroundBreathlessness, a common symptom in advanced disease, is a distressing, complex symptom that can profoundly affect the quality of one’s life. Evidence suggests that specialist palliative care breathlessness intervention services can improve physical well-being, personal coping strategies and quality of life. In the UK, the use of quality improvement methods is well documented in the National Health Service. However, within the independent hospice sector there is a lack of published evidence of using such methods to improve service provision.AimThe aim of this project was to reduce the waiting time from referral to service commencement for a hospice breathlessness service by 40%—from a median of 19.5 to 11.5 working days.MethodsUsing a quality planning and systems thinking approach staff identified barriers and blockages in the current system and undertook plan-do-study-act cycles to test change ideas. The ideas tested included offering home visits to patients on long-term oxygen, using weekly team ‘huddles’, streamlining the internal referral process and reallocating staff resources.ResultsUsing quality improvement methods enabled staff to proactively engage in positive changes to improve the service provided to people living with chronic breathlessness. Offering alternatives to morning appointments; using staff time more efficiently and introducing accurate data collection enabled staff to monitor waiting times in real time. The reduction achieved in the median waiting time from referral to service commencement exceeded the project aim.ConclusionsThis project demonstrates that quality improvement methodologies can be successfully used in a hospice setting to improve waiting times and meet the specific needs of people receiving specialist palliative care.

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Integration of palliative care into the neuro-oncology practice: patterns in the United States

Neuro-Oncology Practice ◽

10.1093/nop/npt004 ◽

2014 ◽

Vol 1 (1) ◽

pp. 3-7 ◽

Cited By ~ 11

Author(s):

Tobias Walbert

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Brain Tumor ◽

End Of Life ◽

Symptom Control ◽

Tumor Patients ◽

Life Phase ◽

Improve Symptom ◽

Oncology Practice

Abstract Background Between 80%–85 percent of all adult brain tumors are high-grade gliomas (HGGs). Despite aggressive treatment with surgical resection, radiotherapy and chemotherapy, the survival of patients with HGG is limited. Brain tumor patients develop unique symptoms and needs throughout their disease trajectory, and the majority lose the ability to communicate during the end-of-life phase. Palliative care (PC) is a proactive and systematic approach to manage issues that are important to patients and families affected by serious illness. The goal is to improve quality of life and symptom control and thereby reduce suffering. Most PC interventions take place during the end-of-life phase; however, newer data suggest that early PC interventions might improve symptom control and quality of life. Methods A literature review focusing on PC, hospice care, and end-of-life care was performed with the aim to describe the integration of PC into neuro-oncology practice. Results Recently there has been increased interest in the effects of PC and brain tumor patients. The origins, methodology, and conceptual models of delivering PC and how it might be applied to the field of neuro-oncology were reviewed. Patterns of referral and utilization in neuro-oncology are described based on the findings of a recent survey. Conclusions Despite a very high symptom burden, many HGG patients do not receive the same level of PC and have fewer interactions with PC services than other cancer populations. Early PC interventions and structured advance-care planning might improve symptom control and quality of life for brain tumor patients.

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Quality Improvement Yields Quality of Life: A Palliative Care Tissue Donation Collaborative (SA508C)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2017.12.183 ◽

2018 ◽

Vol 55 (2) ◽

pp. 642-643

Author(s):

Karen Blackstone ◽

Anissa Rahman ◽

Margaret Gloria ◽

Elizabeth Cobbs

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Quality Improvement ◽

Tissue Donation

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Upside down solutions: palliative care and COVID-19

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002385 ◽

2020 ◽

pp. bmjspcare-2020-002385 ◽

Cited By ~ 1

Author(s):

Daniel Knights ◽

Felicity Knights ◽

Iain Lawrie

Keyword(s):

Palliative Care ◽

Symptom Control ◽

Well Being ◽

Models Of Care ◽

Resource Limited ◽

Relief Of Suffering ◽

Complex Decision Making ◽

Complex Decision ◽

Effective Use

The current COVID-19 pandemic is unprecedented and requires innovation beyond existing approaches to contribute to global health and well-being. This is essential to support the care of people at the end of their lives or who are critically ill from COVID-19 or other life-limiting illnesses. Palliative care (PC) is centred on effective symptom control, promotion of quality of life, complex decision-making, and holistic care of physical, psychological, social and spiritual health. It is ideally placed to both provide and contribute to care for patients, families, communities and colleagues during the pandemic. Where recovery is uncertain, emphasis should be on care and relief of suffering, as well as survival. Where healthcare resources and facilities come under intense pressure, lessons can be learnt from models of care in other settings around the world. This article explores how the field can contribute by ensuring that PC principles and practices are woven into everyday healthcare practice. We explore alternative ways of providing care under such pressure and discuss three areas of learning from resource-limited settings: (1) integration of palliative medicine into everyday practice, (2) simplification of biomedical management plus multidisciplinary teamwork and (3) effective use of volunteers.

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Management of Malignant Bowel Obstruction Associated With GI Cancers

Journal of Oncology Practice ◽

10.1200/jop.2017.022210 ◽

2017 ◽

Vol 13 (7) ◽

pp. 426-434 ◽

Cited By ~ 10

Author(s):

Aaron J. Franke ◽

Atif Iqbal ◽

Jason S. Starr ◽

Rajesh M. Nair ◽

Thomas J. George

Keyword(s):

Palliative Care ◽

Peritoneal Carcinomatosis ◽

Bowel Obstruction ◽

Abdominal Cavity ◽

Symptom Control ◽

Disease Process ◽

Terminal Phase ◽

Malignant Bowel Obstruction ◽

Gi Cancers

For many patients with GI malignancies, the seeding of the abdominal cavity with tumor cells, called peritoneal carcinomatosis, is a common mode of metastases and disease progression. Prognosis for patients with this aspect of their disease remains poor, with high disease-related morbidity and complications. Uniform and proven practices that provide optimal palliative care and quality of life for these patients are needed. The objective of this review is to critically assess the current literature regarding palliative strategies in the management of peritoneal carcinomatosis and associated symptoms in patients with advanced GI cancers. Despite encouraging results in the select population where cytoreductive surgery and intraperitoneal chemotherapy are indicated, the majority of patients who develop peritoneal carcinomatosis in the setting of GI cancers have poor prognosis, with malignant bowel obstruction representing a common terminal phase of their disease process. For all patients with peritoneal carcinomatosis, aggressive symptom control and early multimodality palliative care as further outlined should be sought.

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Ensuring quality of services in HIV prevention research settings: findings from a multi-center quality improvement pilot in East Africa

AIDS Care ◽

10.1080/09540120903012569 ◽

2009 ◽

Vol 22 (1) ◽

pp. 119-125 ◽

Cited By ~ 4

Author(s):

Prince Ngongo Bahati ◽

William Kidega ◽

Hilda Ogutu ◽

Jane Odada ◽

Bonnie Bender ◽

...

Keyword(s):

Quality Improvement ◽

Hiv Prevention ◽

East Africa ◽

Quality Of Services ◽

Prevention Research

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Quality improvement outcomes in an academic practice participating in ASCO’s Quality Oncology Practice Initiative (QOPI).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.206 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 206-206

Author(s):

Mary Anne Fenton

Keyword(s):

Palliative Care ◽

Quality Control ◽

Quality Improvement ◽

Primary Care Physicians ◽

Symptom Control ◽

Well Being ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Academic Practice ◽

Improvement Interventions

206 Background: The ASCO QOPI is an instrument for community and academic practices to assess quality and adherence to guidelines in areas of treatment planning and goals, chemotherapy consent documentation, smoking cessation, symptom control, palliative care, and disease specific measures. Following data submission QOPI summary reports for the submitting practice and QOPI aggregate are available for review and comparison. Methods: The academic practice of Rhode Island Hospital Comprehensive Cancer Center has participated in QOPI since the fall of 2008. QOPI measure summary reports for our practice and comparison to the Academic Aggregate are reviewed by our physicians after each round of chart abstraction, measures are identified for improvement. Interventions include education on practice improvement and development of policy and procedures for implementation by our Quality Control Officer in compliance with hospital policies. Results: Presented is a summary of quality improvement interventions implemented. Additional areas of quality improvement have been identified based on QOPI data, and improvement plans are ongoing including treatment summaries for patient and primary care physicians, tools to assess patient emotional well being, documentation of family history and referral for genetic assessment. Conclusions: QOPI provides a platform for collection, analysis and comparison of quality measures. For the measures of formulating a pain plan the intervention was a reminder to document the plan. For the measure hospice enrollment, a reflection on our hospice enrollment has lead to an increase in referral to palliative care. The ASCO QOPI program is a tool for quality improvement, our Quality Control Officer was essential in implementation of our improvement projects. [Table: see text]

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Reliability and validity of the EORTC QLQ-C30 in palliative care cancer patients

Open Medicine ◽

10.2478/s11536-009-0032-7 ◽

2009 ◽

Vol 4 (3) ◽

pp. 348-357 ◽

Cited By ~ 10

Author(s):

Hubert Jocham ◽

Theo Dassen ◽

Guy Widdershoven ◽

Ruud Halfens

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Cancer Patients ◽

Symptom Control ◽

Reliability And Validity ◽

European Organization ◽

Wide Range ◽

Eortc Qlq C30 ◽

Eortc Qlq

AbstractPalliative care aims at improving the patient’s quality of life. The assessment of this quality of life (QoL) is crucial for the evaluation of palliative care outcome. Many patients require hospital admissions for symptom control during their cancer journey and most of them die in hospitals, although they would like to stay at home until the end of their lives. In 1986, the European Organization for Research and Treatment (EORTC) initiated a research programme to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. This questionnaire measures cancer patients’ physical, psychological and social functions and was used in a wide range of clinical cancer trials with large numbers of research groups and also in various other non-trial studies. The aim of this study was to evaluate the psychometric properties, especially the reliability, validity and applicability of the EORTC QLQ-C30 in a German sample of terminally ill cancer patients receiving palliative care in different settings. The questionnaire was well accepted in the present patient population. Scale reliability was good (pre-treatment 0.80) especially for the functional scale. The results support the reliability and validity of the QLQ-C30 (version 3.0) as a measure of the health-related quality of life in German cancer patients receiving palliative care treatment.

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