Availability Of Palliative Care Services Research Articles

Virtual inpatient continuity visit to reduce readmissions, establish goals of care and engage palliative care: A feasibility pilot.

421 Background: Patients with solid tumors readmitted within 30 days (d) have a median overall survival of less than 90d. Decisions regarding goals of care (GOC), engagement with Palliative Care (PC) and further therapy are often deferred to the outpatient team leading to future readmissions. Methods: A pilot virtual continuity visit (VCV) program was developed using a video platform to arrange meetings with outpatient oncologists, inpatient teams, patients, families and PC providers during a hospital readmission within 30d. The intervention occurred on a single solid tumor oncology service at an academic medical center. Patients were included if discharged from the same hospital within 30d and not readmitted from hospice or SNF. Exclusion criteria included admission for scheduled therapy, curative-intent treatment, or acute side effects of new therapy. Orders were placed at the discretion of the inpatient team. Visits were scheduled only on weekdays. A structured discussion tool was used for prognostic awareness, GOC and availability of PC services. Results: From April 1, 2022 through March 31, 2023, 96 unique patients were eligible for VCVs. This represented 6% admissions to this floor. 15 VCV were completed, 23 were scheduled but not completed, 58 were not scheduled. Reason scheduled visits not completed included: in-person family meeting (7 ), physician unavailable (9), transfer off floor (1), conversation deferred to outpatient visit (4), not clinically necessary (2). Reason visits not scheduled: unable to schedule prior to D/C (37), deferred to outpatient (2) hospice D/C (3), not appropriate (5), in person visit (1). Of the 15 patients who completed VCV, 0% were readmitted within 30d, 100% had documented GOC discussion and 100% had PC engaged in the VCV. Of the 7 patients who had in person visits, 3 of 7 were readmitted, 1 of 7 in person visits had a documented GOC discussion. No PC engagement was present for the in-person meetings. 51/58 patients without scheduled VCV were readmitted, 22 within 30d. Conclusions: VCV are feasible via a video platform with the patient, primary oncologist, inpatient team and PC. The structured discussion provided clear documentation of prognostic awareness, GOC and engagement with PC. No patient who completed a VCV was readmitted.

Role of palliative care in fetal neurological consultations: Guiding through uncertainty and hope.

Fetal neurology is a rapidly evolving and expanding field. Discussions about diagnosis, prognosis, treatment options, and goals of care often begin in the antenatal period. However, there are inherent challenges to fetal counseling of neurological diagnoses due to limitations of fetal imaging, prognostic uncertainty, and variability in neurodevelopmental outcomes. In the midst of uncertainty, families are challenged with preparing a care plan for their baby while simultaneously experiencing profound grief. The paradigms of perinatal palliative care can assist with the grieving process and help frame diagnostic testing and complex decision-making within the context of a family's spiritual, cultural, and social belief system. This ultimately leads to a shared decision-making process and value driven medical care. While perinatal palliative care programs have expanded, many families faced with such diagnoses never meet with a palliative care team prior to delivery. Moreover, there is significant variability in the availability of palliative care services throughout the country. Using an illustrative vignette of a patient with a prenatally diagnosed encephalocele, this review aims to provide a basic framework of perinatal palliative care for fetal neurology diagnoses that emphasizes 1) importance of clear, consistent, and transparent communication among all subspecialists and families, 2) creation of a palliative care birth plan, 3) importance of consistent care providers and longitudinal points of contact prenatally and post-delivery, 4) close communication between the prenatal and post-natal providers to allow for optimal continuity of care, and 5) recognize that information, care plans, and goals of care often evolve over time.

Navigating the challenges of neuro-oncology in Africa: addressing diagnostic and treatment barriers in the region: a correspondence

Navigating the challenges of neuro-oncology in Africa: addressing diagnostic and treatment barriers in the region: a correspondence

Proposal for improving access to palliative care by enhancing primary care services in an upper middle-income country.

Primary care doctors play an important role in providing palliative care as they are often the first point of contact for most healthcare needs in the community. This mixed-method study aims to 1) determine the accessibility of palliative care services in Malaysia, an upper middle-income country with universal health coverage, 2) explore the knowledge, challenges and opportunities faced by primary care doctors in providing palliative care and 3) identify if minimum standards for palliative care service are clearly defined, available and achieved in primary care facilities. Data on availability of palliative care services will be sourced from governmental and non-governmental databases and reports. Accessibility will be examined by estimating the distance, travel time and cost to the nearest facility offering palliative care services from various locations throughout Malaysia. In-depth interviews will be conducted with primary care doctors to explore their knowledge, challenges and opportunities in providing palliative care. Alongside, a survey will be conducted to evaluate whether components of palliative care services are available in primary care facilities using the Minimum Standard Tool for Palliative Care from India, which covers all the domains recommended by the World Health Organization. All findings will be inductively analysed and integrated, followed by a strengths, weaknesses, opportunities and threats analysis and a threats, opportunities, weaknesses and strength analysis with relevant stakeholders. The mapping study will provide empirical data on availability and accessibility of palliative care services in Malaysia. The qualitative inquiry will provide insights on the experiences and concerns of primary care physicians in providing palliative care in the community settings. The survey meanwhile will provide real-world data on availability of basic palliative care service components in the primary care facilities. Findings will facilitate development of framework and policies aiming to optimise provision of sustainable palliative care services at the primary care level in local settings.

Expectations and barriers to the utilization of specialist palliative care services among persons living with cancer in Ghana: an exploratory qualitative study.

The need for palliative care among patients living with cancer is increasing globally. This need is far greater in resource-constrained settings like Ghana where there is a high unmet need for palliative care services. Consequently, there are lapses in the current palliative care regime, thus, resulting in suboptimal utilization. The study aims to explore patients living with cancer's expectations of palliative care services and examine the barriers that impede palliative care utilization. Descriptive exploratory qualitative design. A total of 15 patients living with cancer and receiving treatment in a tertiary health facility were purposively sampled to participate in this study. Semi-structured interviews were conducted. The data were transcribed and inductively analysed following Collaizi's qualitative analysis framework. From the analysis, the findings were grouped under two main categories: perceived expectations and barriers to utilizing palliative care. The participants expected to receive meaningful communication about their condition and prognosis; they also expected to be actively involved in palliative care decision-making. Regarding the barriers, the following themes emerged: financial constraints, unfavourable health appointment schedules, problems with the distance to the health facility, poor referral and follow-up from oncology specialists and being unaware of the availability of palliative care services. In conclusion, there is a need to actively involve patients and their families in all decision-making along the continuum of palliative care service delivery. The study underscores the need for Ghana to implement an integration of palliative care services in primary healthcare facilities to avert the challenges that distance to tertiary healthcare facilities poses to palliative care utilization. Service providers must implement awareness programmes to enable patients to better comprehend palliative care services.

Current public perception of, and barriers to, palliative care in China: a mixed-methods study

Cancer is a major cause of death in China, accounting for 2·56 million deaths in the country in 2018 alone. Yet, on that year, only 28 600 patients (1·1%) at the end of life received palliative care. Existing studies in palliative care have mainly been done in medical environments. The aim of this study was to focus instead on the general public and to identify the public's perceptions of, and demand for, various palliative care services, as well as barriers to palliative care in China. A convergent mixed-methods design was used to facilitate an understanding of the Chinese public's knowledge of palliative care services and the demand for palliative care. An interdisciplinary team of scholars and practitioners worked collaboratively to develop a contextually and culturally relevant questionnaire for the public in China (named KNPCP-1) to explore these issues. Quantitative and qualitative evaluation phases in the development of KNPCP-1 ensured its high validity. We did cross-over comparison analyses of the findings from the quantitative survey (conducted using KNPCP-1). Stata version 17.2 and NVivo version 12.6.1 were used for data analysis. 6120 people completed the qualitative surveys, and 19 survey respondents and 20 medical staff were also interviewed. No significant difference in knowledge of palliative care and general need for various palliative care services was found between men and women. A greater demand for palliative care services was found among rural respondents than among their urban counterparts. Convergent analysis indicates that factors or mechanisms associated with the low availability of palliative care services include scarce knowledge about palliative care, a cultural taboo around death, factors related to patient-clinician conflict, and the pressure on adult children to fulfil their filial duty of care for elderly parents. Several factors contribute to the low availability of palliative care services in China despite recent governmental awareness campaigns. Innovative and culturally sensitive approaches are needed to promote palliative care services in relation to the factors synthesised from the analysis. Ministry of Education of China, Youth Project of Humanities and Social Sciences (project number 20XJC840001); China Postdoctoral Science Foundation (project number 2021M691521); and 2020 Young Teacher Development Project of the Chinese Universities Scientific Fund (project number 230600001002020030).

Palliative specialty care availability for adults in community oncology practices.

e24110 Background: The American Society of Clinical Oncology recommends integration of palliative care in patients with advanced cancer. Studies have shown the availability of palliative care services, especially in outpatient settings, varies widely across practice sites; factors associated with outpatient palliative care clinic availability remain unknown. Our study describes the presence and characteristics of palliative care resources in community oncology practices. Methods: Analyses used data from the 2015 Cancer Care Delivery Research (CCDR) Landscape Assessment of National Cancer Institute Community Oncology Research Program (NCORP) practices (funding support provided by 2UG1CA189824). Oncology practices were surveyed regarding availability of specialty providers and supportive services, including palliative care, as reported by designated CCDR leads. Descriptive statistics describe availability of providers and services, and logistic regression models identify practice characteristics associated with supportive/palliative care specialist availability. Results: 216 non-pediatric exclusive NCORP practice groups were included in analyses. Characteristics are shown in Table. A majority of practices had palliative care specialists (76%), oncology certified nurses (95%), and advance practice providers (80%); 45% had nurse navigators for oncology. 76% of practices had inpatient palliative care consultation services, but only 36% had a dedicated outpatient palliative care clinic. Multivariable analyses demonstrated practices with Medicaid and/or uninsured patient volumes > 25% (Odds Ratio (OR) = 2.5, p = 0.020), more oncology providers (OR = 1.02, p = 0.025), survivorship clinic availability (OR = 2.5, p = 0.005), and who participated in the Quality Oncology Practice Initiative (QOPI) (OR = 2.0, p = 0.039) were significantly more likely to have an outpatient palliative care clinic. Conclusions: Most community oncology practices reported having palliative care specialists, although only a third had a dedicated outpatient palliative care clinic. Newly discovered factors associated with increased odds of having an outpatient palliative care clinic can inform future efforts to expand the availability of outpatient palliative care clinics within community oncology practices.[Table: see text]

Palliative care in Uganda: quantitative descriptive study of key palliative care indicators 2018-2020

BackgroundThe first and most recent nationwide audit of palliative care services in Uganda was conducted in 2009. Since then, Uganda has made great strides in palliative care development, including policy, education, and services implementation. This study provides an overview of the availability of palliative care services in the country and the challenges and gaps in Uganda prior to the global COVID-19 pandemic. This lays the foundation for better understanding the challenges and changes needed to support palliative care development and access in the wake of the pandemic.MethodsWe conducted a descriptive quantitative study of secondary data on nationwide morphine distribution, collated a list of accredited facilities, and analyzed key palliative care indicators collected through the mHealth surveillance project present at a subset of accredited facilities. Descriptive statistical analysis involved non-parametric tests using SPSS, mapping geographical distribution of available palliative care services using Geographic Information Systems software, and identification of challenges from the subset of accredited facilities.ResultsThere were 226 accredited palliative care facilities across Uganda’s 135 districts in 2020. Thirty districts lacked any accredited palliative care facility. The estimated population coverage was 88.5%. The majority (68.1%) of accredited facilities were public, and private facilities received slightly more pain-relieving morphine. There was an alternating trend in the volumes of morphine delivered to public and private facilities. More than a third of the patients were diagnosed with non-communicable diseases, highlighting their significance alongside cancer and HIV/AIDS as conditions requiring palliative care. Palliative care accredited facilities offered six types of services: outreach, home visits, psychosocial, legal, bereavement, and spiritual support, but only for an average of 7 months a year due to lack of facilitation and transportation.ConclusionPalliative care in Uganda developed in quality, volume, and geographic coverage since 2009. The shift in palliative care patients’ primary diagnosis from HIV/AIDS to non-communicable diseases marks an important epidemiologic transition. Although accredited facilities are present in most administrative districts, more research is needed to evaluate the actual accessibility of these services. The existing services, both private and public, are limited by the amount of pain-relieving morphine, financial and transport resources. More quality data collected on key palliative care indicators is needed into geographical accessibility of palliative care services, morphine availability trends, and patient diagnoses in order to improve the provision of palliative care in Uganda.

Utilization of palliative care services in patients who died from stage IV non-small cell lung cancer (NSCLC): A retrospective study from a tertiary care center in rural Maine.

95 Background: It is known that palliative care involvement in metastatic NSCLC cancer patients has been shown to improve quality of life in previous studies. The aim of our study was to analyze the utilization of palliative care services among patients who died from NSCLC and the setting in which these patients first received palliative care. Methods: This is a retrospective chart review analysis of patients with stage IV NSCLC who were diagnosed at Eastern Maine Medical center and the affiliated cancer center who died between January 2016 and December 2018. We collected demographic data, date and stage of diagnosis, location of palliative referral, location of first palliative care contact with the patient, time between diagnosis and death, utilization of hospice services and time between the initial palliative care consult and death. Results: 255 patients with stage IV NSCLC died between 2016 and 2018. Mean age was 65.5 years. Women were 49% and men were 51%. Majority (60%) of patients had good performance status with ECOG score between 0-1 at presentation. All 255 patients were referred to palliative care. The location of initial palliative care referral following diagnosis was 40% from the hospital, 32% from the oncology clinic and 28% from the outpatient specialist or PCP office. Overall, 174 patients (68%) were seen by palliative care and 81 (32%) were not seen. Of the patients seen 119 (68%) had their initial palliative evaluation in the hospital, and 55 (32%) in the clinic. Majority (55%) had more than one follow-up visit. Consults initiated in the inpatient setting were more likely to be seen by palliative care than in the outpatient setting (p 0.0009). Time between diagnosis to palliative care consult was less than one month in 39%, 1-2 months in 25%, 2-6 months in 21%, and more than 6 months in 14% patients. Patients seen by palliative care had a more likelihood to end up on hospice (p 0.09). The majority of patients seen by palliative care (53%) died within a month of initial consultation. Conclusions: All patients in our study population were referred to palliative care with 100% provider compliance. Among these, 68% were seen by palliative care. Interestingly, inpatient referrals were more likely to be seen by palliative care than the outpatient referrals. We think this is likely related to ease of access to palliative care team in the hospital as well as some of the patients being at terminal stages of their disease. About 33% of patients died within a month of their initial diagnosis, likely giving palliative care team a shorter window of opportunity to be seen in the outpatient setting. Prioritizing referrals of stage IV NSCLC patients might decrease the wait time after initial referral and increase the availability of palliative care services to these patients.

Perceptions of Palliative Care: Voices From Rural South Dakota.

This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery. Six focus groups were conducted over two months. Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants. Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged: Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results: Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents.

To Study the Barriers in Palliative Care to Nonmalignant Cases in COVID-19 Crisis in a Tertiary Health-Care Center.

Introduction:COVID-19, the new pandemic faced by the world, is a novel betacoronavirus causing severe respiratory coronavirus syndrome. Elderly patients, people with underlying chronic illnesses, cancer patients, and those who are immunocompromised are at higher risk and account for higher mortality rate. Unfortunately, there is no approved medication for treatment, till date, thereby supporting triage management and difficult decision-making. Thus, there should be a substantial increase in the palliative care in times of pandemic. There should be an increase in the availability of palliative care services in different care settings. Due to a surge in the number of cases of COVID-19, it has been reported on how palliative care is being delayed, discontinued, or deprioritized.Aim:The aim of this study is to evaluate the barriers occurring in providing the palliative care to the patients with nonmalignant illness.Methodology:A questionnaire was designed after studying previous work over palliative care and pandemic crisis and was distributed among the physicians, surgeons, and the residents; a total of 95 health-care workers were involved. The survey was done through mails. The response then was evaluated and analyzed.Results:As seen by the responses we got from the health-care workers, the main issue is the nonavailability of the personal protective equipment during this pandemic. Keeping the current scenario in mind, regarding COVID-19, the patients are at fear of coming to the hospital at first place, and even if they come then the fear of being alone haunts them. One of the biggest fears of the patient is dying alone, without being in contact with their loved ones.Conclusion:Palliative care should be an essential part of any health-care service in any humanitarian crisis, including the COVID-19 pandemic. Thus, effort should be made to remove the barriers and provide palliative care to the patient.

PALLIATIVE CARE NEEDS ASSESSMENT OF A RURAL AND FRONTIER STATE

Background: Palliative Care (PC) is a valuable tool for improving the lives of people living with chronic illness. However, access to PC is limited in rural areas. The purpose of this study is to describe the current PC needs and barriers to care in a rural state. Methods: An online survey was disseminated through professional organizations, licensing boards, and the University of Wyoming. Rurality of counties was classified using Rural Urban Continuum Codes (RUCC). Descriptive statistics were calculated using SPSS. Results: Responses were received from 336 individuals across 20 of 23 counties (i.e., RUCC range 3 - 9; 1=most metropolitan, 9=most rural). The majority worked in healthcare or social service sectors (n = 265, 78.8%). Approximately one-half (n = 119, 50.6%) of these individuals endorsed providing PC (i.e., typically symptom management, supportive resources, and family support). Over one-half of respondents (n = 173, 51.5%) rated availability of PC services in their communities as “poor” or “somewhat good.” Key barriers to providing PC were lack of patient information and knowledge (n = 215), access to PC specialists (n = 183), and funding and reimbursement (n = 181). Approximately one third of healthcare professionals (n = 78, 32.8%) had received formal training in PC. A majority of healthcare and social service respondents (n = 139, 59.1%) endorsed interest in PC continuing education. Conclusions: This study provides insight into the state of PC across a rural state. Results highlight the need to design accessible education and implement system transformation to improve PC access.

HSR19-080: Situational Analysis and Needs Assessment Regarding the Availability and Extent of Pediatric Palliative Care Services in the Philippines

Background: Around 200,000 pediatric clients are diagnosed with cancer each year globally. Majority (84%) of cancer cases are found in developing countries with 20% average survival rate (Ferlay et al, 2012). Two-thirds of pediatric oncology clients in the Philippines are diagnosed at advanced stages (Lecciones, 2015). Abandonment of treatment is high at 80%. Only about 10%–20% of clients attain long-term survival despite availability of multidisciplinary management. These outcomes reflect the gap in service delivery for pediatric oncology clients (Ferlay et al, 2012). Therefore, to improve accessibility to healthcare, it is necessary to determine the perceived palliative care needs of clients, their caregivers, and healthcare providers. Objective: To identify the availability of palliative care services in the country, identify barriers in service delivery, and determine the palliative care needs of pediatric oncology clients, their caregivers, and healthcare providers. Methods: The descriptive, cross-sectional study design involved a situational analysis by mapping 2 Philippine palliative centers. Focus group discussions (FGD) and interviews with healthcare professionals were conducted to determine the extent of services, geographical coverage, and perceived palliative care needs. The needs assessment tool by WHO (2004) was adopted to identify the palliative care needs of pediatric oncology clients as perceived by caregivers. Results: From a total of 181 primary caregivers, the identified main problems in caring was the economical (95.6%) aspect. Financial support (92%) was the most pressing need. Caregivers would like to learn more about general cancer care (39%) and nutrition counseling (24%). The most common palliative care needs as perceived by caregivers included accessibility to cancer facility (27%), free cancer medications (12.7%), and financial assistance (14.9%). The common barriers in rendering care were financial constraints (66%), behavioral changes (12.7%), and travel limitations (6%). The common themes found during the FGDs and interviews were: (1) inadequate human and structural health resources; (2) need to focus on psychosocial care; (3) addressing economic constraints; and (4) need to increase cancer awareness among caregivers. Conclusion: The findings of the study documented the need for the development of structured programs for pediatric palliative care in the Philippines.

Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey

BackgroundWith high rates of HIV/AIDS and rising burdens of non-communicable diseases, Zambians increasingly need palliative care. While efforts are underway to grow Zambia’s palliative care system, the most recent situational analysis of palliative care in Zambia, conducted in 2008, revealed substantial gaps in availability. MethodsTo provide an updated appraisal of breast and cervical cancer services in Zambia, including palliative care, we conducted a nationwide provincial and tertiary hospital survey. All 9 provincial hospitals and the University Teaching Hospital and Cancer Diseases Hospital in Lusaka Province participated (N = 11). The survey was conducted between August 2014 and January 2015 and administered in-person at each facility. Data regarding the availability of inpatient, outpatient, and community-based palliative care services, palliative medications, and psychosocial supports was obtained at each facility. The reported results are descriptive in nature. ResultsAlthough the need for palliative care services was recognized, many facilities (64%) lack palliative care policies and only 18% offer palliative care in a coordinated program. The majority of services are only available to inpatients and rarely include community-based programs. While all facilities had adequate supplies of acetaminophen, 82% reported unavailability of codeine and 45% reported no access to oral morphine. ConclusionsThis assessment confirms the dearth of palliative care services across Zambia. Less than half of its provincial hospitals offer community- or home-based services and only 55% offer opioid analgesics. Immediate and substantial improvements in policy, drug procurement and distribution, and service expansion are needed to ensure high-quality palliative care is available throughout Zambia.

Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey

Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey

Perceived barriers and facilitators to goals of care discussions in the emergency department: A descriptive analysis of the views of emergency medicine physicians and residents.

Few studies have examined the challenges faced by emergency medicine (EM) physicians in conducting goals of care discussions. This study is the first to describe the perceived barriers and facilitators to these discussions as reported by Canadian EM physicians and residents. A team of EM, palliative care, and internal medicine physicians developed a survey comprising multiple choice, Likert-scale and open-ended questions to explore four domains of goals-of-care discussions: training; communication; environment; and patient beliefs. Surveys were sent to 273 EM staff and residents in six sites, and 130 (48%) responded. Staff physicians conducted goals-of-care discussions several times per month or more, 74.1% (80/108) of the time versus 35% (8/23) of residents. Most agreed that goals-of-care discussions are within their scope of practice (92%), they felt comfortable having these discussions (96%), and they are adequately trained (73%). However, 66% reported difficulty initiating goals-of-care discussions, and 54% believed that admitting services should conduct them. Main barriers were time (46%), lack of a relationship with the patient (25%), patient expectations (23%), no prior discussions (21%), and the inability to reach substitute decision-makers (17%). Fifty-four percent of respondents indicated that the availability of 24-hour palliative care consults would facilitate discussions in the emergency department (ED). Important barriers to discussing goals of care in the ED were identified by respondents, including acuity and lack of prior relationship, highlighting the need for system and environmental interventions, including improved availability of palliative care services in the ED.

Gaps in the Use of Palliative Care in US Hospitals (FR461D)

•Describe the prevalence of patients in US academic medical centers who are appropriate for palliative care referral.•Identify the varying levels of palliative care referrals, consultations, and services among the hospitals that participated in the study.•Discuss the individual, programmatic, and organizational characteristics that result in differing levels of palliative care coverage for patients appropriate for palliative care referral. The approach to care for individuals with serious, life-threatening illness seems to be shifting. However, the extent of unmet need for palliative care in US hospitals remains largely unknown. We conducted a multi-site cross-sectional, retrospective point prevalence analysis to determine the size and characteristics of the population of inpatients at 33 US hospitals who were appropriate for palliative care referral, as well as the percentage of these patients who were referred for and/or received palliative care services. Patients appropriate for palliative care referral were defined as adult (≥18 years) patients with any diagnosis of a poor-prognosis cancer, New York Heart Association Class IV congestive heart failure, or oxygen-dependent chronic obstructive pulmonary disease who had inpatient status in one of 33 hospitals on May 13, 2014. Qualitative assessment involved interviews of palliative care team members and non-palliative care frontline providers. Nearly 19% of inpatients on the point prevalence day were deemed appropriate for palliative care referral. Of these, approximately 39% received a palliative care referral or services. Delivery of palliative care services to these patients varied widely among participating hospitals, ranging from approximately 12% to more than 90%. Factors influencing differences in referral practices included non-standardized perceptions of referral criteria and variation in palliative care service structures. This is the first multi-site study designed to estimate the prevalence of hospitalized patients appropriate for palliative care referral in US hospitals. The findings demonstrate the need to expand the availability of palliative care services, including primary palliative care delivered by frontline providers.

Palliative care for chronic illness: driving change.

In its 2015 Quality of Death Index report, the Economist Intelligence Unit ranked Canada 11th in overall quality of death and 18th in availability of palliative care services.[1][1] For efforts to develop and promote palliative care, Canada scored 3 out of 5, putting us behind Mongolia and Panama.

Implementation of NCCN Palliative Care Guidelines by member institutions.

Increasingly, evidence suggests the integration of palliative care (PC) with standard oncologic care can yield substantial benefits. As part of an effort to improve the PC of cancer patients, the National Comprehensive Cancer Network (NCCN) has developed clinical practice guidelines for PC that promote access to quality, evidence-based PC. This study sought to characterize current implementation of the guidelines by NCCN member institutions. Institutional representatives appointed to the NCCN Palliative Care Guidelines Panel were asked to complete an online survey in the spring of 2014. The survey focused on availability of PC services, screening and referral practices for PC, PC education, and quality improvement programs. The survey was completed by representatives from 21 of 25 NCCN member institutions (84 %). A majority routinely provides PC services via interdisciplinary teams; 52 % routinely inform patients of the availability, elements, and benefits of PC. The guidelines are most often used to guide clinical practice; only 10 % reported using the guidelines to formally screen for PC needs and/or make referrals to PC specialists. Among the 62 % of institutions that screen any patients using any available criteria, when a patient screens positive for PC needs, a referral to a PC specialist is made less than half the time. Implementation of PC Guidelines is incomplete and various aspects of the guidelines, such as the recommendation to screen all patients for PC needs, are applied inconsistently. Despite this, most institutions provide PC services in a manner consistent with the guidelines. Greater implementation of the guidelines' recommendations is needed.

Nurses' perspectives: hospitalized older patients and end-of-life decision-making.

To explore pressing issues identified by nurses caring for older patients in US NICHE (Nurses Improving Care for the Healthsystem Elders) hospitals, regarding palliative care and end-of-life (EOL) decision-making. Objectives are to (1) identify the most pressing palliative care and EOL decision-making issues and strategies to address them and (2) identify the association of nursing demographics (age, gender, race, education and experience), institutional/unit characteristics and these issues. Critical care nurses have an integral role in supporting older patients and families faced with palliative care and EOL decision-making issues. Despite national imperatives to improve the quality of palliative care, patients continue to experience uncontrolled pain, inadequate communication, disregard of their wishes and life prolonging interventions. These contribute to increased hospitalizations and costs. Understanding the prevalent issues is needed to address patient needs at the end-of-life. It is a mixed method study. A secondary analysis of the NICHE Geriatric Institutional Assessment Profile (GIAP) database (collected 1/08-9/13) was conducted using the sample of Critical Care RNs who provided comments regarding palliative care and EOL decision-making. Qualitative data were analyzed using Dedoose software. Data clusters and patterns of co-occurring codes were explored through an iterative analysis process. Themes were examined across nurse demographics, institutional and unit characteristics. Comments specifically addressing issues regarding EOL decision-making were provided by 393 critical care nurses from 156 hospitals (x‾ age = 42·3 years, 51% BSN degree). Overarching theme was discordance in goals of care (prolonging life versus quality of life), ineffective physician-patient-family communication, lack of time and unrealistic expectations. Nurses' descriptions highlight the need for increased communication, staff education and availability of palliative care services. Palliative care and EOL decision-making will remain a nursing priority as people age and require increased care.