Pulmonary referrals to specialist palliative medicine: a survey

2021 ◽  
pp. bmjspcare-2021-003386
Author(s):  
Michael Bonares ◽  
Kenneth Mah ◽  
David Christiansen ◽  
John Granton ◽  
Andrea Weiss ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Chronic Respiratory Disease ◽  
Life Care ◽  
Care Needs ◽  
Patients With Cancer ◽  
Referral Criteria ◽  
Referral Practices ◽  
Palliative Care Needs

ObjectivesPatients with chronic respiratory disease have significant palliative care needs, but low utilisation of specialist palliative care (SPC) services. Decreased access to SPC results in unmet palliative care needs among this patient population. We sought to determine the referral practices to SPC among respirologists in Canada.MethodsRespirologists across Canada were invited to participate in a survey about their referral practices to SPC. Associations between referral practices and demographic, professional and attitudinal factors were analysed using regression analyses.ResultsThe response rate was 64.7% (438/677). Fifty-nine per cent of respondents believed that their patients have negative perceptions of palliative care and 39% were more likely to refer to SPC earlier if it was renamed supportive care. While only 2.7% never referred to SPC, referral was late in 52.6% of referring physicians. Lower frequency of referral was associated with equating palliative care to end-of-life care (p<0.001), male sex of respirologist (p=0.019), not knowing referral criteria of SPC services (p=0.015) and agreement that SPC services prioritise patients with cancer (p=0.025); higher referral frequency was associated with satisfaction with SPC services (p=0.001). Late referral was associated with equating palliative care to end-of-life care (p<0.001) and agreement that SPC services prioritise patients with cancer (p=0.013).ConclusionsPossible barriers to respirologists’ timely SPC referral include misperceptions about palliative care, lack of awareness of referral criteria and the belief that SPC services prioritise patients with cancer. Future studies should confirm these barriers and evaluate the effectiveness of strategies to overcome them.

An Admiral Nursing and hospice partnership in end-of-life care: Innovative practice

Dementia ◽  
2018 ◽  
Vol 19 (7) ◽  
pp. 2484-2493
Author(s):  
Karen Harrison Dening ◽  
Jaqueline Crowther ◽  
Sadaf Adnan
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Stage ◽  
Life Care ◽  
Care Providers ◽  
Care Needs ◽  
People With Dementia ◽  
Health And Social Care ◽  
Palliative Care Needs

Addressing palliative care needs of people with dementia appropriately, identifying the end-of-life stage, meeting the needs of family carers as well as supporting the preferences and wishes of the person with the diagnosis can all present challenges to generalist health and social care providers. In partnership with Dementia UK and Kirkwood Hospice in West Yorkshire embarked upon a two-year pilot to introduce the first end-of-life care Admiral Nurse to their Specialist Community Palliative Care Team to identify and support people with dementia who required palliative and end-of-life care. This paper describes and discusses this innovative partnership and outcomes from year one evaluation and sets out future plans.

Palliative Care and End-of-Life Care

2019 ◽  
pp. 201-210
Author(s):  
Carole Bouleuc ◽  
Christine Langenaeken
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Skills Training ◽  
Prognostic Scores ◽  
Life Care ◽  
Prognostic Assessment ◽  
Referral Criteria ◽  
The Individual ◽  
Staffing Requirements

Abstract: Quality palliative care requires the integration of palliative care into standard oncological care, an educated workforce, and access to essential drugs. Referral criteria for specialist palliative care include time- and needs-based criteria. Prognostic scores have been constructed to assist in prognostic assessment but remain inaccurate in the individual patient. Patient–clinician communication is essential; guidelines for effective communication have been developed, and communication skills training and early exposure are important. Advanced care planning is of paramount importance for patients and families, since it can reduce aggressiveness of end-of-life care. Barriers to the development of palliative care need to be addressed; a resource-stratified practice guideline has been developed making recommendations for model of care, staffing requirements, roles, and training needs of members. Quality indicators have been developed as well, and these focus mainly on outcome indicators. The movement to legalize assisted dying has met with much controversy, yet this may also be an opportunity for communication, transparency, and accountability.

First steps: Health and social care professionals beginning to address the palliative and end of life care needs of people with diverse gender identities and sexual orientations in Lebanon

Sexualities ◽  
2020 ◽  
pp. 136346072093238
Author(s):  
Claude Chidiac
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Social Stigma ◽  
Life Care ◽  
Care Needs ◽  
Mena Region ◽  
Healthcare Needs ◽  
Health And Social Care ◽  
The Impact

The available evidence demonstrates that lesbian, gay, bisexual, and transgender (LGBT) people face challenges when accessing palliative care services, and receive suboptimal care at the end of life. This is mainly attributed to assumed heterosexuality, lack of knowledge and understanding of LGBT issues and specific healthcare needs, discrimination, homophobia, and transphobia. In Lebanon, legal and institutional support for LGBT individuals is minimal, and palliative care provision remains scarce and fragmented. This compounds the impact of social stigma and marginalisation, and results in unrecognised palliative and end of life care needs for the LGBT individual. This short commentary discusses the development of an LGBT palliative care workshop in Lebanon, which was the first initiative of its kind in the Middle East and North Africa (MENA) region. It also explores how this initiative has led to further developments, and how these efforts can be replicated in other countries in the MENA region.

scholarly journals Qualitative Analysis of Palliative Care for Pediatric Patients With Cancer at Bugando Medical Center: An Evaluation of Barriers to Providing End-of-Life Care in a Resource-Limited Setting

2018 ◽  
pp. 1-10 ◽  
Author(s):  
B. Emily Esmaili ◽  
Kearsley A. Stewart ◽  
Nestory A. Masalu ◽  
Kristin M. Schroeder
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Pediatric Patients ◽  
Developing World ◽  
Participant Observation ◽  
Medical Center ◽  
Life Care ◽  
Patients With Cancer ◽  
Bugando Medical

Purpose Palliative care remains an urgent, neglected need in the developing world. Global disparities in end-of-life care for children, such as those with advanced cancers, result from barriers that are complex and largely unstudied. This study describes these barriers at Bugando Medical Center, one of three consultant hospitals in Tanzania, to identify areas for palliative care development suitable to this context. Methods In-depth interviews were conducted with 20 caregivers of pediatric patients with cancer and 14 hospital staff involved in pediatric end-of-life care. This was combined with 1 month of participant observation through direct clinical care of terminally ill pediatric patients. Results Data from interviews as well as participant observation revealed several barriers to palliative care: financial, infrastructure, knowledge and cultural (including perceptions of pediatric pain), and communication challenges. Although this study focused on barriers, what also emerged were the unique advantages of end-of-life care in this setting, including community cohesiveness and strong faith background. Conclusion This study provides a unique but focused description of barriers to palliative care common in a low-resource setting, extending beyond resource needs. This multidisciplinary qualitative approach combined interviews with participant observation, providing a deeper understanding of the logistical and cultural challenges in this setting. This new understanding will inform the design of more effective—and more appropriate—palliative care policies for young patients with cancer in the developing world.

End-of-life care in cancer and dementia: a nationwide population-based study of palliative care policy changes

2019 ◽  
pp. bmjspcare-2019-001782 ◽  
Author(s):  
Lou-Ching Kuo ◽  
Jung Jae Lee ◽  
Denise Shuk Ting Cheung ◽  
Ping-Jen Chen ◽  
Chia-Chin Lin
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Population Based ◽  
Life Care ◽  
Population Based Study ◽  
Patients With Cancer ◽  
Insurance Programme ◽  
National Health Insurance Programme ◽  
Vasopressor Use

ObjectivesThe National Health Insurance programme started providing coverage for inpatient care in palliative care (PC) units of acute care hospitals in 2000; however, initially, only PC provided to patients with terminal cancer was covered. A PC policy that enabled PC reimbursement for patients with dementia was implemented in 2009. However, the association of this PC policy with end-of-life care remains unclear. The study aims to compare the association of the PC policy with end-of-life care between patients with dementia and patients with cancer during the last 6 months of their lives.MethodsWe analysed the claims data of 7396 patients dying with dementia (PDD) and 24 319 patients dying with cancer (PDC) during 1997–2013.ResultsAmong PDC, while the percentage of receiving PC increased from 3.6% in 1999 to 14.2% by the end of 2000 (adjusted OR (aOR)=4.07, 95% CI 2.70 to 6.13) and from 20.9% in 2010 to 41.0% in 2013 (aOR=1.40, 95% CI 1.33 to 1.47), vasopressor use decreased from 71.6% in 1999 to 35.5% in 2001 (aOR=0.90, 95% CI 0.82 to 0.98). Among PDD, PC use increased from 0.2% in 2009 to 4.9% in 2013 (aOR=2.05, 95% CI 1.60 to 2.63) and cardiopulmonary resuscitation use decreased from 17.6% in 2009 to 10.0% in 2013 (aOR=0.83, 95% CI 0.76 to 0.90).ConclusionsImplementation of the PC policy in Taiwan was associated with improved PC utilisation among patients with cancer and dementia, which may reduce unnecessary medical care procedures.

Patterns of palliative care utilization and end of life care in adult patients with cancer who died as inpatients at Mayo Clinic.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e21681-e21681
Author(s):  
Collin Thomas Zimmerman ◽  
Shivani S. Shinde ◽  
Pashtoon Murtaza Kasi ◽  
Mark Robert Litzow ◽  
Jeanne M. Huddleston
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Mayo Clinic ◽  
End Of Life Care ◽  
Adult Patients ◽  
Care Utilization ◽  
Life Care ◽  
Patients With Cancer

scholarly journals Inappropriate end-of-life cancer care in a generalist and specialist palliative care model: a nationwide retrospective population-based observational study

2020 ◽  
pp. bmjspcare-2020-002302
Author(s):  
Manon S Boddaert ◽  
Chantal Pereira ◽  
Jeroen Adema ◽  
Kris C P Vissers ◽  
Yvette M van der Linden ◽  
...  
Keyword(s):  
Palliative Care ◽  
Observational Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Population Based ◽  
Exposure Group ◽  
Life Care ◽  
Patients With Cancer ◽  
Timely Access ◽  
The Impact

ObjectivesTo evaluate the impact of provision and timing of palliative care (PC) on potentially inappropriate end-of-life care to patients with cancer in a mixed generalist—specialist PC model.MethodA retrospective population-based observational study using a national administrative health insurance database. All 43 067 adults in the Netherlands, who were diagnosed with or treated for cancer during the year preceding their death in 2017, were included. Main exposure was either generalist or specialist PC initiated >30 days before death (n=16 967). Outcomes were measured over the last 30 days of life, using quality indicators for potentially inappropriate end-of-life care.ResultsIn total, 14 504 patients (34%) experienced potentially inappropriate end-of-life care; 2732 were provided with PC >30 days before death (exposure group) and 11 772 received no PC or ≤30 days before death (non-exposure group) (16% vs 45%, p<0.001). Most patients received generalist PC (88%). Patients provided with PC >30 days before death were 5 times less likely to experience potentially inappropriate end-of-life care (adjusted OR (AOR) 0.20; (95% CI 0.15 to 0.26)) than those with no PC or PC in the last 30 days. Both early (>90 days) and late (>30 and≤90 days) PC initiation had lower odds for potentially inappropriate end-of-life care (AOR 0.23 and 0.19, respectively).ConclusionTimely access to PC in a mixed generalist—specialist PC model significantly decreases the likelihood of potentially inappropriate end-of-life care for patients with cancer. Generalist PC can play a substantial role.

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