Access To Palliative Care Services Research Articles

Palliative care for rural growth and wellbeing: identifying perceived barriers and facilitators in access to palliative care in rural Indiana, USA

With the growing aging population and high prevalence of chronic illnesses, there is an increasing demand for palliative care. In the US state of Indiana, an estimated 6.3 million people are living with one or more chronic illnesses, a large proportion of them reside in rural areas where there is limited access to palliative care leading to major healthcare inequities and disparities. This study aims to identify common barriers and facilitators to access palliative care services in rural areas of Indiana from the perspectives of healthcare providers including clinicians, educators, and community stakeholders. Using a community-based participatory approach, a purposive sample of palliative care providers (n = 15) in rural areas of Indiana was obtained. Penchansky and Thomas (1981) theoretical framework of access was used to guide the study. A semi-structured individual in-depth interview guide was used to collect the data. All the interviews were conducted online, audio-recorded, and transcribed. Barriers to palliative care include: misconceptions about palliative care as an underrecognized specialty; lack of trained palliative care providers; late involvement of inpatient palliative care and community hospice services; inadequate palliative care education and training; financial barriers, attitudes and beliefs around PC; and geographical barriers. Facilitators to palliative care include financial gains supporting palliative care growth, enhanced nurses’ role in identifying patients with palliative care needs and creating awareness and informing the community about palliative care. Robust education and awareness, enhancing advanced practice nurses’ roles, increasing funding and resources are essential to improve the access of palliative care services in the rural communities of Indiana.

Reimagining the inpatient palliative care consult: lessons from COVID-19

As the number of inpatients with advanced age and chronic conditions rises, so too does the need for inpatient palliative care (PC). Despite the strong evidence base for PC, less than 50% of all inpatient PC needs are met by inpatient consults. Over the past several months in epicenters of the COVID-19 pandemic, PC providers have responded to the increased need for PC services through innovative digital programs including telepalliative care programs. In this article, we explore how PC innovations during COVID-19 could transform the PC consult to address workforce shortages and expand access to PC services during and beyond the pandemic. We propose a 3-pronged strategy of bolstering inpatient telepalliative care services, expanding electronic consults, and increasing training and educational tools for providers to help meet the increased need for PC services in the future.

Dying homeless receiving little palliative care, study finds.

Homeless people are dying in unsupported and unacceptable situations with inadequate access to palliative care services, a study has found.

Holistic models for end of life care: Establishing the place of culture

IntroductionThis article presents a holistic model for clinical palliative care and research which expands and improves previous models by fully recognizing the place of culture in illness.MethodsLiterature review and philosophical enquiry.ResultsHolistic models of patient care are essential to the practise of patient-centred care. However, these models have up to now largely neglected the role of culture and the search for meaning in the illness experience, despite evidence of disparities in the access of palliative care services by people from ethnic minority groups. A phenomenological approach to illness highlights three principles: that illness is cultural, that the search for meaning related to the finitude of human life is fundamental to the illness experience, and that illness narratives are culturally conditioned manifestations of the search for meaning in illness. A holistic model for palliative care is presented on the basis of these principles.DiscussionA holistic model that recognizes the place of culture in illness has implications for clinical practice, service development, and training. We propose an agenda for research into cultural and spiritual aspects of care on the basis of the model, including the formulation and evaluation of service models that take into account cultural features of illness and meet patients’ needs for support with finding meaning.

Comparison of Symptom Burden among Patients Referred to Palliative Care with Hematologic Malignancies versus those with Solid Tumors

Patients with hematologic malignancies have reduced and later access to palliative care services (APCS) than do those with solid tumors. It is unclear whether these patients develop a high symptom burden at the end of life that requires special palliative care interventions. The purposes of this retrospective study were to determine whether symptoms are less severe in patients with hematologic than in those with solid malignancies on APCS and whether symptom severity is associated with early APCS. We studied the records of consecutive patients with hematologic and solid malignancies at their first palliative care consultation (PC1). We collected information about demographics, cancer type, date of PC1, and the interval from PC1 to death (PC1-D). We reviewed the charts for the Edmonton Symptoms Assessment System (ESAS) and presence of delirium. We included 250 patients (125 with each type of malignancy). Median pain and drowsiness were 4 (3-5) and 7 (5-10) among hematologic compared to 5 (4-6, p=0.043) and 5 (3-6, p=0.0008) among patients with solid malignancies, respectively. Delirium was detected in 51 of 125 (41%) hematologic versus 20 of 125 (16%) solid (p=0.0001). Median PC1-D was 13 days for hematologic versus 46 days for solid (p=0.0001). There was no correlation between PC1-D and pain (r= -0.117, p=0.4 for hematologic and r=0.09, p=0.37 for solid), dyspnea (r= -0.02, p=0.85 for hematologic and r=0.09, p=0.42 for solid) or the Symptom Distress Score (r= -0.047, p=0.72 for hematologic and r= -0.093, p=0.32 for solid). Hematologic patients had increased delirium and drowsiness and later APCS The overall symptom severity was similar in both groups of patients and did not correlate with early APCS. Future prospective studies are needed to better define APCS patterns in this group.

Predictors of Access to Palliative Care Services among Patients Who Died at a Comprehensive Cancer Center

Palliative care services can decrease physical and psychosocial distress in patients with advanced cancer. However, most patients with cancer die without access to palliative care services (APCS), and patterns of referral are not well understood. The purpose of this study was to determine predictors of patients' access to palliative care. We reviewed patient records from the computerized database at UT M. D. Anderson Cancer Center over 2 (2003 and 2004) to determine differences in characteristics and outcomes between patients with and without APCS. APCS was defined as a palliative care consultation and follow-up or transfer to the palliative care unit. A total of 499 of 1453 (34%) inpatients who died at our cancer center had APCS. There were no significant differences in race, age, or insurance status between the APCS groups. The two major predictors of a low rate of APCS were hematologic malignancies (20% rate of APCS versus 44% for solid tumors, p < 0.0001) and intensive care unit (ICU) admission (15% versus 52% for non-ICU admission, p < 0.0001). Patients with hematologic malignancies who were admitted to the ICU had the lowest APCS rate (10%, p < 0.0001). The median relative cost of care per patient for decedents with APCS was 0.62 compared to non-referred patients (p < 0.0001). APCS was lower among patients with hematologic malignancies and those admitted to the ICU. APCS resulted in a lower cost of care. Mortality in comprehensive cancer centers is quite variable among different primary malignancies. More research is needed to better define patterns of referral.