The Palliative Care and Covid-19 Pandemic

During this phase of the COVID-19 pandemic, healthcare systems and healthcare personnel are overwhelmed and are already prepared to treat an influx of patients affected. The corona virus poses an uncertain period of intense acute care crisis where hundreds of thousands of people theoretically could get infected, some fatally, and ten thousands could die. This article addresses the normal palliative care issues — Life quality, comprehensive care planning, Patient discernment preferences, treatment of pain and symptoms, and encouragement for caregivers over prolonged trajectories — seem small and weak in contrast. The use of the particular Palliative care skills and abilities needs to be part of the programme. To agree that death is imminent for any human being should be right for the health system. Extending the dying process in days, weeks, or months against the person’s wish is pointless; it will only prolong the physical and emotional agonies. Individual must be at peace at the end of the life and give as much dignity and comfort as possible, but intensive care units cannot give them the comfort or dignity they deserve. It basically means that all COVID- treating nurses will have expertise in the basics of palliative care, as well as access to opioids for symptoms management like breathlessness.

Download Full-text

Access to palliative care in Canada

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.913 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Tracy Johnson ◽

Clare Cheng ◽

Christina Lawand ◽

Maureen Kelly

Keyword(s):

Palliative Care ◽

Intensive Care ◽

Home Care ◽

Health System ◽

Acute Care ◽

Long Term Care ◽

Emergency Department Visits ◽

Data Availability ◽

Term Care

IntroductionMany Canadians prefer to remain in the community at end-of-life, and to die at home. To do so, early and integrated palliative care (PC) is needed to provide individuals with care and support services across care settings. Measuring access to PC can help to evaluate progress over time. Objectives and ApproachThis presentation will show findings from our study on whether Canadian decedents had access to PC in the last year of life. Data from physician billings, drug claims, home care, long-term care and acute care were linked to identify decedents and PC service use. These data were also used to examine how PC may affect, or be affected by other interactions with the health system, including inpatient alternate level care days, admissions from long-term care, emergency department visits and stays in intensive care units. Gaps in data availability and quality will also be highlighted. ResultsAbout 70% of decedents were identified using administrative health data, although there were variations across jurisdictions due to differences in data availability and quality (9%-81%). For decedents identified across care settings, few received PC in the community in their last year of life, ranging from 4% in long-term care to 12% in home care. More decedents were identified as palliative in acute care (44%) but only one-third received PC in another setting despite multiple interactions with the health system in the last year of life. Those who had integrated, community-based PC were less likely to have a stay in an intensive care unit, and more likely to die in the community. However, few Canadian decedents had access to this type of care. Conclusion/ImplicationsData linkage identified opportunities for earlier integration of PC and improved care transitions. However, lack of common definitions of PC across sectors and jurisdictions, limitations in data availability and issues in PC coding were identified. Improvements in PC data are required to evaluate progress for the future.

Download Full-text

Barriers of Palliative Care in Neonatal Intensive Care Units

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909115616597 ◽

2016 ◽

Vol 34 (3) ◽

pp. 205-211 ◽

Cited By ~ 10

Author(s):

Mansooreh Azzizadeh Forouzi ◽

Marjan Banazadeh ◽

Jila Soltan Ahmadi ◽

Farideh Razban

Keyword(s):

Palliative Care ◽

Organizational Culture ◽

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Attitude Scale ◽

Neonatal Intensive Care Units ◽

Cross Sectional ◽

Neonatal Nurses ◽

Eol Care

Objective: Neonatal nurses face numerous barriers in providing end-of-life (EOL) care for neonates and their families. Addressing neonatal nurses’ attitudes could provide insight into barriers that impede neonatal palliative care (NPC). This study thus conducted to examine neonatal nurses’ attitude toward barriers in providing NPC in Southeast Iran. Method: In this cross-sectional study, a translated modified version of Neonatal Palliative Care Attitude Scale was used to examine attitudes of 70 nurses toward barriers of palliative care in 3 neonatal intensive care units in Southeast Iran. Results: Findings indicated that overall 42.63% of nurses were strongly agreed or agreed with the proposed barriers in NPC. Among all categories, the highest and the lowest scores belonged to the categories of “insufficient resources” (3.42 ± 0.65) and “inappropriate personal and social attitudes” (2.33 ± 0.48), respectively. Neonatal nurses who had less education and study regarding NPC reported the presence of more barriers to NPC in the categories of “inappropriate organizational culture” and/or “inadequate nursing proficiency.” Also, younger nurses had more positive attitudes toward the category of inappropriate organizational culture as being a barrier to provision of NPC (4.62). Conclusion: The findings suggest that developing a context-based instrument is required to represent the barrier more precisely. Neonatal palliative care can be improved by establishing a special environment to focus on infants’ EOL care. This establishment requires standard palliative care guidelines and adequate NPC-trained nurses.

Download Full-text

Health system characteristics of quality care delivery: A comparative case study examination of palliative care for cancer patients in four regions in Ontario, Canada

Palliative Medicine ◽

10.1177/0269216311416697 ◽

2011 ◽

Vol 26 (4) ◽

pp. 322-335 ◽

Cited By ~ 17

Author(s):

Jonathan Sussman ◽

Lisa Barbera ◽

Daryl Bainbridge ◽

Doris Howell ◽

Jinghao Yang ◽

...

Keyword(s):

Palliative Care ◽

Health System ◽

Acute Care ◽

Pattern Analysis ◽

Care Delivery ◽

Quality Care ◽

Structural Features ◽

Comparative Case Study ◽

Care Utilization

Background: A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described. Aim: The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths. Design: A comparative case study evaluation was conducted of ‘palliative care’ in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed. Results: 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services. Conclusions: The four palliative care regional ‘systems’ examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems.

Download Full-text