scholarly journals Family Physicians’ Perspectives on Their Role in Palliative Care: A Double Focus Group in Portugal

2021 ◽  
Vol 18 (14) ◽  
pp. 7282
Author(s):  
Carlos Seiça Cardoso ◽  
Filipe Prazeres ◽  
Beatriz Xavier ◽  
Bárbara Gomes
Keyword(s):  
Palliative Care ◽  
Focus Group ◽  
Training Programs ◽  
Family Physicians ◽  
Holistic Approach ◽  
Physical Symptoms ◽  
Care Needs ◽  
Focus Group Study ◽  
Organizational Barriers ◽  
Palliative Care Needs

Background: Aggravated by the COVID-19 pandemic, the provision of palliative care for patients with palliative care needs emerges as a necessity more than ever. Most are managed in primary care by their family physicians (FP). This study aimed to understand the perspectives of specialist and trainee FPs about their role in palliative care. Methods: we conducted a double focus-group study consisting of two separate online focus-groups, one with FP specialists (n = 9) and one with FP trainees (n = 10). Results: FPs already gather two fundamental skills for the provision of palliative care: the capacity to identify patients’ needs beyond physical symptoms and the recognition that the patient belongs to a familiar, psychosocial, and even spiritual environment. They perceive their role in palliative care to be four-fold: early identification of patients with palliative care needs, initial treatment, symptom management, and patient advocacy. Participants recognized the need for palliative care training and provided suggestions for training programs. Conclusion: FPs share a holistic approach and identify multiple roles they can play in palliative care, from screening to care and advocacy. Organizational barriers must be addressed. Short training programs that combine theory, practice, and experiential learning may further the potential for FPs to contribute to palliative care.

scholarly journals Recognition of patients with medically unexplained physical symptoms by family physicians: results of a focus group study

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Madelon den Boeft ◽  
Danielle Huisman ◽  
Johannes C. van der Wouden ◽  
Mattijs E. Numans ◽  
Henriette E. van der Horst ◽  
...  
Keyword(s):  
Focus Group ◽  
Family Physicians ◽  
Physical Symptoms ◽  
Focus Group Study ◽  
Medically Unexplained Physical Symptoms ◽  
Medically Unexplained ◽  
Unexplained Physical Symptoms

Screening for Palliative Care Needs: Pilot Data From German Comprehensive Cancer Centers

2021 ◽  
pp. OP.20.00698
Author(s):  
Carmen Roch ◽  
Maria Heckel ◽  
Birgitt van Oorschot ◽  
Bernd Alt-Epping ◽  
Mitra Tewes
Keyword(s):  
Palliative Care ◽  
Human Resources ◽  
Structural Characteristics ◽  
Physical Symptoms ◽  
Screening Tools ◽  
Current Status ◽  
Care Needs ◽  
Cancer Centers ◽  
Comprehensive Cancer Centers ◽  
Palliative Care Needs

PURPOSE: Guidelines recommend several screening tools to identify patients with complex palliative needs. This diversity and lack of structural recommendations offer a wide scope for implementing screening. Against this background, the current status of implementation at German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid has not yet been investigated. METHODS: e-mail survey of the 17 hospital sites of the 13 CCCs. The questionnaire asked for structural characteristics of the centers as well as preconditions of the screening process. Structurally established screening procedures (one item) and standardized workflows, modes of performance, screening tools (four items), modes of training how to screen, and responsibilities (two items) were assessed. RESULTS: In a 2-month period, 15 hospital sites responded; seven hospital sites conducted a palliative care needs (PCN) screening. Only one hospital site carried out PCN screening in almost all oncology departments, but only with the distress thermometer. Other hospital sites determined palliative needs by assessing physical symptoms using the Integrated Palliative Care Outcome Scale or the Minimal Documentation System, and two hospital sites combined tools to determine both physical and psychological stress. The type of screening varied from paper-pencil–based to tablet computer–based documentation. The main barriers to implementation were identified as a lack of human resources and a lack of structural conditions. CONCLUSION: There is a lack of consensus among palliative care specialists and oncologists in the CCCs supported by the German Cancer Aid in PCN screening as well as of structured guidelines and the professional association. Structural requirements should be adapted to these needs, which include both technical and human resources. A combined psycho-oncologic and palliative care screening might help to formulate best practice recommendations.

scholarly journals Palliative care needs of patients living with end-stage kidney disease not treated with renal replacement therapy: An exploratory qualitative study from Blantyre, Malawi

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Maya J. Bates ◽  
Alex Chitani ◽  
Gavin Dreyer
Keyword(s):  
Palliative Care ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Qualitative Study ◽  
Replacement Therapy ◽  
Physical Symptoms ◽  
End Stage Kidney Disease ◽  
Care Needs ◽  
End Stage ◽  
Palliative Care Needs

Background: The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is increasing rapidly but the palliative care needs of patients living with ESKD are not well described. Resource limitations at both health system and patient level act as major barriers to patients receiving renal replacement therapy (RRT) in the form of dialysis. We undertook an exploratory qualitative study to describe the palliative care needs of patients with ESKD who were not receiving RRT, at a government teaching hospital in Blantyre, Malawi.Methods: A qualitative, explorative and descriptive design was used. Study participants were adults aged > 18 years with an estimated glomerular filtration rate < 15 ml/min on two separate occasions, three months apart, who either chose not to have or were not deemed suitable for RRT. Data were collected by means of semi-structured interviews.Results: In October and November 2013, interviews were conducted with 10 adults (7 women with median age of 60.5 years). All were hypertensive and four were on treatment for HIV. Four themes emerged from the data: changes in functional status because of physical symptoms, financial challenges impacting hospital care, loss of role within the family and the importance of spiritual and cultural beliefs.Conclusion: This study reports on four thematic areas which warrant further quantitative and qualitative studies both in Malawi and other low-resource settings, where a growing number of patients with ESKD unable to access RRT will require palliative care in the coming years.

Palliative care in the emergency department

2015 ◽  
Author(s):  
Paul L. DeSandre ◽  
Karen May
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Rapid Assessment ◽  
Physical Symptoms ◽  
Care Needs ◽  
Advanced Illness ◽  
Complex Needs ◽  
Life Threatening ◽  
Access To Medical Care ◽  
Palliative Care Needs

The emergency department provides immediate access to medical care for patients and families in crisis. As the proportion of elderly in our populations increases, complications related to advanced illness will likely drive increasing numbers of patients with palliative care needs into emergency departments. In addition to immediately life-threatening situations, severe physical symptoms, psychological distress, social upheaval, or even an unrecognized spiritual crisis near death can overwhelm patients or their caregivers, who come to the emergency department hoping for relief from their suffering. Emergency clinicians must rapidly assess these complex needs while negotiating interventions with effective and efficient communications. This chapter addresses several of these essential clinician skills for effective primary palliative care in the emergency department. These include rapid assessment of patients with palliative care needs, titration of opioids for pain emergencies, efficiently establishing goals of care, skilful and empathic death disclosure, and a structured approach to involving family presence during cardiopulmonary resuscitation.

Early identification of palliative care needs by family physicians: A qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients

2014 ◽  
Vol 28 (6) ◽  
pp. 480-490 ◽  
Author(s):  
Kim Beernaert ◽  
Luc Deliens ◽  
Aline De Vleminck ◽  
Dirk Devroey ◽  
Koen Pardon ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Early Identification ◽  
Family Physicians ◽  
Barriers And Facilitators ◽  
Care Needs ◽  
Palliative Care Needs

Palliative Care Needs of People Living in a Newly Established Informal Settlement

2018 ◽  
Vol 20 (2) ◽  
Author(s):  
Martjie De Villiers ◽  
Johanna Elizabeth Maree ◽  
Corrien Van Belkum
Keyword(s):  
Palliative Care ◽  
Informal Settlement ◽  
Palliative Care Service ◽  
Physical Symptoms ◽  
The Body ◽  
Care Needs ◽  
Care Clinic ◽  
Medical Diagnoses ◽  
Common Diagnosis ◽  
Palliative Care Needs

Evidence-based guidance for the delivery of palliative care in Africa is rare. Identifying the palliative care needs of this community could contribute evidence to guide the services provided, and could add to the body of knowledge of palliative care in Africa. Using a retrospective chart review research method, the researchers aimed to describe the palliative care needs of people using a nurse-led palliative care service situated in a newly established, underserved, informal settlement in Tshwane, Gauteng, South Africa. A quantitative inductive content analysis method was used to analyse the data. The sample realised at 48 (n = 48). The ages of patients ranged from 21 to 78 with the median age 47. Nearly half (45.9%) of the patients were functionally illiterate. The records reflected 85 different medical diagnoses and some patients suffered more than one illness. The most common diagnosis was HIV/AIDS (54.2%). Furthermore, records revealed 379 health problems, ranging from 1 to 17 per patient, with an average of 8.1. Most problems were physical symptoms (50.3%; n = 195), while 38.8 per cent (n = 147) were psychosocial problems and 9.8 per cent (n = 37) were spiritual problems. The need for pain relief (89.6%; n = 43) was the greatest, followed by the need for emotional support. Patients suffering from various medical diagnoses used the services of the palliative care clinic. Patients’ care needs revolved around relief from total pain. Therefore, nurses should become aware of the suffering of palliative patients living in resource-poor communities, and through meticulous assessment, identify their main care needs.

scholarly journals Family physicians supporting patients with palliative care needs within the Patient Medical Home in the community: An Appreciative Inquiry qualitative study

2021 ◽  
Author(s):  
Amy Tan ◽  
Ronald Spice ◽  
Aynharan Sinnarajah
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Focus Groups ◽  
Appreciative Inquiry ◽  
Family Physicians ◽  
Care Providers ◽  
Care Needs ◽  
Palliative Home Care ◽  
Essential Components ◽  
Palliative Care Needs

ABSTRACTObjectivesCanadians want to live and die in their home communities. Unfortunately, Canada has the highest proportion of deaths in acute care facilities as compared to other developed nations. This study aims to identify the essential components required to best support patients and families with palliative care needs in their communities to inform system changes and empower family physicians (FPs) in providing community-based palliative care for patients.DesignAppreciative Inquiry (AI) methodology with individual interviews. Interview transcripts were analyzed iteratively for emerging themes and used to develop “possibility statements” to frame discussion in subsequent focus groups. A conceptual framework emerged to describe the “destiny” state as per AI methods.SettingFamily physicians, palliative home care providers, patients and bereaved caregivers were recruited in the urban and surrounding rural health authority zones of Calgary, Canada.Participants9 females and 9 males FPs (range of practice years 2-42) in interviews; 8 bereaved caregivers, 1 patient, 26 Palliative Home Care team members in focus groups. Interviews and focus groups were recorded digitally and transcribed with consent.ResultsThe identified themes that transcended all three groups created the foundation for the conceptual framework. Enhanced communication and fostering team relationships between all care providers with the focus on the patient and caregivers was the cornerstone concept. The family physician/patient relationship must be protected and encouraged by all care providers, while more system flexibility is needed to respond more effectively to patients. These concepts must exist in the context that patients and caregivers need more education regarding the benefits of palliative care, while increasing public discourse about mortality.ConclusionsKey areas were identified for how the patient’s team can work together effectively to improve the patient and caregiver palliative care journey in the community with the cornerstone element of building on the trusting FP-patient longitudinal relationship.Strengths and limitations of this studyThis study uses Appreciative Inquiry qualitative methods to identify the essential components required to best support patients and families with palliative care needs in their communities.Multiple perspectives recruited including: community-based family physicians, palliative home care clinicians, patients, and bereaved caregivers.Analysis was focused on the family physicians’ interviews to derive “possibility statements” and used to frame the focus groups with the other groups of participants.Generalisability may be limited due to the lack of diversity in participants recruited for the patients and bereaved caregivers in terms of ethnicity, age, and gender.Patients and caregivers may have been reluctant to volunteer for this study as it involved discussing palliative care.

scholarly journals Family physicians supporting patients with palliative care needs within the patient medical home in the community: an appreciative inquiry study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e048667
Author(s):  
Amy Tan ◽  
Ronald Spice ◽  
Aynharan Sinnarajah
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Focus Groups ◽  
Conceptual Framework ◽  
Appreciative Inquiry ◽  
Family Physicians ◽  
Care Providers ◽  
Care Needs ◽  
Palliative Home Care ◽  
Palliative Care Needs

ObjectivesCanadians want to live and die in their home communities. Unfortunately, Canada has the highest proportion of deaths in acute care facilities as compared with other developed nations. This study aims to identify the essential components required to best support patients and families with palliative care needs in their communities to inform system changes and empower family physicians (FPs) in providing community-based palliative care for patients.DesignAppreciative inquiry (AI) methodology with individual interviews. Interview transcripts were analysed iteratively for emerging themes and used to develop ‘possibility statements’ to frame discussion in subsequent focus groups. A conceptual framework emerged to describe the ‘destiny’ state as per AI methods.SettingFPs, palliative home care providers, patients and bereaved caregivers were recruited in the urban and surrounding rural health authority zones of Calgary, AB, Canada.Participants9 females and 9 males FPs (range of practice years 2–42) in interviews; 8 bereaved caregivers, 1 patient, 26 palliative home care team members in focus groups. Interviews and focus groups were recorded digitally and transcribed with consent.ResultsThe identified themes that transcended all three groups created the foundation for the conceptual framework. Enhanced communication and fostering team relationships between all care providers with the focus on the patient and caregivers was the cornerstone concept. The FP/patient relationship must be protected and encouraged by all care providers, while more system flexibility is needed to respond more effectively to patients. These concepts must exist in the context that patients and caregivers need more education regarding the benefits of palliative care, while increasing public discourse about mortality.ConclusionsKey areas were identified for how the patient’s team can work together effectively to improve the patient and caregiver palliative care journey in the community with the cornerstone element of building on the trusting FP–patient longitudinal relationship.

scholarly journals What makes palliative care needs “complex”? A multisite sequential explanatory mixed methods study of patients referred for specialist palliative care

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anne M. Finucane ◽  
Connie Swenson ◽  
John I. MacArtney ◽  
Rachel Perry ◽  
Hazel Lamberton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Healthcare Professionals ◽  
Psychological Needs ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Care Needs ◽  
Complex Needs ◽  
Sequential Explanatory ◽  
Palliative Care Needs

Abstract Background Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service. Methods Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly. Conclusions Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.

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