Collaborative Palliative Care Research Articles

Interprofessional collaboration during a specialised mobile palliative care service pilot in the rural area of Lucerne.

Interprofessional collaboration in outpatient palliative care is critical to ensuring good quality of care in the home care sector. We investigated facilitators and barriers (FaBs) of interprofessional collaboration among healthcare professionals who participated in a 6-month pilot of a newly implemented specialised mobile palliative care service (SMPCS) in rural Lucerne. This study used a mixed-methods approach to collect (i) qualitative data on FaBs as perceived by nurses and primary care physicians (PCPs), and (ii) quantitative data across the entire interprofessional collaboration using a validated questionnaire expanded with 10 specific questions about the pilot. Identified facilitators of interprofessional collaboration were (i) use of standardised documents, (ii) clear allocation of responsibilities, (iii) regular exchange and clear communication and (iv) consideration of care coordination. Reported barriers were (i) a deficit of knowledge and experience of palliative care among PCPs and (ii) time constraints. This study provides valuable insights into FaBs of interprofessional collaboration in palliative care. Several recommendations can be drawn for how interprofessional collaboration may be optimised. Awareness of FaBs and their consideration in the implementation phase of new services can strengthen the foundation for a successful interprofessional collaboration.

An App Platform-Facilitated Collaborative Palliative Care Intervention for Outpatients With Interstitial Lung Disease: A Pilot Randomized Trial.

Rationale: Outpatients with interstitial lung disease often experience serious symptoms, yet infrequently receive palliative care. Objective: To determine the feasibility and clinical impact of a mobile application (PCplanner) in an outpatient setting. Methods: We conducted a pilot randomized controlled trial among adults with interstitial lung disease in a single-center academic clinic. Clinical outcomes included change in Needs at the End-of-Life Screening Tool (NEST) scale between baseline and 3 months as well as frequency of advance care planning discussions and referrals to palliative care services. Results: Observed feasibility outcomes were similar to targeted benchmarks including randomization rates (82.1% vs 80%) and retention (84.8% vs 80%). Mean NEST scores between the intervention and control group were 38.9 (SD, 18.9) vs 41.5 (SD, 20.5) at baseline, 34.6 (SD, 18.9) vs 33.6 (SD, 19.4) at 1 month after clinic visit, 40.5 (SD, 21.6) vs 35.3 (SD, 25.0) at 3 months after clinic visit. Changes in NEST scores between baseline and 3 months showed no difference in the primary outcome (P = 0.481, 95% CI [-8.45, 17.62]). Conclusion: Among patients with interstitial lung disease, a mobile app designed to focus patients and clinicians on palliative care principles demonstrated evidence of feasibility. Although changes in self-reported needs were similar between intervention and control groups, more patients in the intervention group updated their advance directives and code status compared to the control group. Clinical Trial Registration: Palliative Care Planner (PCplanner) NCT05095363. https://www.clinicaltrials.gov/study/NCT05095363.

Increasing interprofessional collaboration in community-based palliative care: a pilot study of the CAPACITI education program for primary care providers

ABSTRACT Interprofessional collaboration in palliative care is essential to ensuring high-quality care for seriously ill patients. Education interventions to increase competency in palliative care should incorporate team-building skills to encourage an interprofessional approach. We developed and piloted a virtual educational program named CAPACITI for interprofessional teams to promote a community palliative approach to care. Primary care teams from across Ontario, Canada, participated in CAPACITI which consisted of 10 facilitated sessions that emphasized how to operationalize a palliative care approach as a team. Pre- and post-study questionnaires were completed by each team, including the AITCS-II, a validated instrument that measures interprofessional collaboration. We analyzed individual paired differences in summary scores and in each of three subdomains of the AITCS-II questionnaire: partnership, cooperation, and coordination. Seventeen teams completed the AITCS-II post survey, representing 133 participants. Teams varied demographically and ranged from 5 to 16 members. After CAPACITI, the overall mean AITCS-II summary score among teams increased to 96.0 (SD = 10.0) for a significant paired mean difference increase of 9.4 (p = .03). There were also significant increases in the partnership (p = .01) and in the cooperation subdomains (p = .04). CAPACITI demonstrated the potential for improving collaboration among primary care teams, which can lead to improved provider and patient outcomes in palliative care.

Mapping Evidence in Teaching Palliative Care in Undergraduate Curriculum of Healthcare Professionals Qualification: A Systematic Scoping Review Protocol.

Clinical Practice Guidelines recommend interprofessional collaboration in palliative care. However, healthcare profession educators lack clear curricular guidance, particularly for undergraduate programs, to adequately train future professionals for effective participation in such teams. This systematic scoping review protocol aims to address this gap by: (i) mapping evidence on key characteristics of teaching palliative and end-of-life (EOL) care to undergraduate healthcare and social care students, and (ii) identifying the nature and effectiveness of educational interventions for improving palliative care education in the undergraduate curriculum. The protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol Extension for Scoping Reviews (PRISMA-P-ScR) guidelines, while the proposed systematic scoping review study will be conducted based on methods and steps identified by Arksey and O'Malley and experts in the field. We will conduct systematic searches across five EBSCOhost databases using relevant search terms. Additionally, a limited grey literature search will be conducted on the first 100 results of Google Scholar and Open-Grey. The selection process will follow PRISMA-Extension for Scoping Reviews. Two independent reviewers will screen titles and abstracts for eligibility. Data extraction will be done on standardized forms in duplicate with cross-checking by a third reviewer. Braun and Clarke's thematic analysis approach, combining thematic and directed content analysis, will be employed for analysis. Intervention effectiveness will be narratively summarized based on the TIDieR checklist. Meta-analysis will be considered if applicable and data is homogeneous. Palliative care education (PCE) is a crucial element of undergraduate health professions education. This study's findings may aid educators in fostering optimal learning among healthcare students, who can then positively influence community health outcomes. The protocol was submitted for ethical clearance to the University of KwaZulu-Natal's Biomedical Research Ethics Committee and granted exemption from ethics review (00024289). We will disseminate findings through scientific journal publication and by sharing a summary with relevant institutions and attendees at health promotion and interprofessional education conferences.

Interprofessional Collaboration in Palliative Care—The Need for an Advanced Practice Nurse: An Ethnographic Study

ObjectivesThe literature highlights the importance of an interprofessional approach in palliative care to improve the quality of care, favoring an effective use of resources. Members of the interprofessional team include all professionals involved in patient care; in some contexts, the advanced practice nurse (APN) has a clearly defined role. This study aimed to define the possible role of the APN within the interprofessional palliative care team in our context. Data SourcesA focused ethnographic approach was taken involving participant observation and semistructured interviews. ConclusionFrom the participant observations, interaction of the participants, discussion content, and styles of meeting management were described. From the thematic analysis of the interviews, 15 themes emerged, grouped into four macro-themes: interprofessional collaboration, the interprofessional meeting, nurse's role, and developments. Implications for Nursing PracticeThe study has identified current nursing practice within the interprofessional palliative care team and areas where interprofessional collaboration can be improved. These are both organizational (role definition and team meeting management) and professional (development of nursing culture, expanded nursing role, and introduction of the APN within the team). Nurses must develop advanced skills to ensure more effective care for patients and caregivers. The introduction of an APN could be appropriate to address this need.

Kidney Transplant Clinicians’ Perceptions of Palliative Care for Patients With Failing Allografts in the US: A Mixed Methods Study

Kidney transplant patients with failing allografts have a physical and psychological symptom burden as well as high morbidity and mortality. Palliative care is underutilized in this vulnerable population. We described kidney transplant clinicians' perceptions of palliative care to delineate their perceived barriers to and facilitators of providing palliative care to this population. National explanatory sequential mixed methods study including an online survey and semistructured interviews. Kidney transplant clinicians in the United States surveyed and interviewed from October 2021 to March2022. Descriptive summary of survey responses, thematic analysis of qualitative interviews, and mixed methods integration of data. A total of 149 clinicians completed the survey, and 19 completed the subsequent interviews. Over 90% of respondents agreed that palliative care can be helpful for patients with a failing kidney allograft. However, 46% of respondents disagreed that all patients with failing allografts benefit from palliative care, and two-thirds thought that patients would not want serious illness conversations. More than 90% of clinicians expressed concern that transplant patients and caregivers would feel scared or anxious if offered palliative care. The interviews identified three main themes: (1) transplant clinicians' unique sense of personal and professional responsibility was a barrier to palliative care engagement, (2) clinicians' uncertainty regarding the timing of palliative care collaboration would lead to delayed referral, and (3) clinicians felt challenged by factors related to patients' cultural backgrounds and identities, such as language differences. Many comments reflected an unfamiliarity with the broad scope of palliative care beyond end-of-life care. Potential selection bias. Our study suggests that multiple barriers related to patients, clinicians, health systems, and health policies may pose challenges to the delivery of palliative care for patients with failing kidney transplants. This study illustrates the urgent need for ongoing efforts to optimize palliative care delivery models dedicated to kidney transplant patients, their families, and the clinicians who serve them. Kidney transplant patients experience physical and psychological suffering in the context of their illnesses that may be amenable to palliative care. However, palliative care is often underutilized in this population. In this mixed-methods study, we surveyed 149 clinicians across the United States, and 19 of them completed semistructured interviews. Our study results demonstrate that several patient, clinician, system, and policy factors need to be addressed to improve palliative care delivery to this vulnerable population.

Refining the referral criteria of persons who have been burned to palliative care: A modified Delphi approach

A paucity of evidence is available to guide integration of specialist palliative care into burn care. This study’s purpose was to develop consensus on referral criteria using a modified Delphi process. Content experts were defined as burn or palliative care providers in locations where the teams have collaborative history; published at least one manuscript or presented nationally on burn and palliative care collaboration; or nomination as having equivalent expertise. N = 202 eligible persons were identified; n = 43 participated in Iteration 1 and Iteration 3 retained 79%. Iteration 1 invited participants to rank published referral criteria on a 9-point Likert-style scale. Consensus was defined as an interquartile range ≤ 2. Consensus items with median scores ≤ 3 were dropped from further consideration. Consensus items with median scores ≥ 7 were considered to be important and excluded in Iteration 2. Iteration 2 which presented non-consensus items with their associated median (interquartile range) and the participant’s own ranking from Iteration 1. Iteration 3 presented three models; participants ranked in order of preference and suggested revisions. Consensus was achieved on a final set of criteria for specialist palliative care for persons who sustain burn injuries. Future research should prospectively evaluate the criteria against meaningful outcomes.

FRI-339 - Disparities in hospital outcomes among patients with end- stage liver disease with palliative care collaboration: a nationwide cohort analysis (2016–2020)

FRI-339 - Disparities in hospital outcomes among patients with end- stage liver disease with palliative care collaboration: a nationwide cohort analysis (2016–2020)

Perspectives on Collaborative Palliative Care Delivery for Home Health Patients

Perspectives on Collaborative Palliative Care Delivery for Home Health Patients

Rehabilitation and Long-Term Care Facilities Desire Increased Palliative Care Collaboration (FR214D)

Rehabilitation and Long-Term Care Facilities Desire Increased Palliative Care Collaboration (FR214D)

The Value of Home-Based Palliative Care Collaboration with Home Healthcare.

Afonne Eze, APRN, FNP-c, ACHPN, is a Nurse Practitioner, Palliative Care, MJHS Hospice & Palliative Care, New York, New York. The author declares no conflicts of interest. Address for correspondence: Afonne Eze, APRN, FNP-c, 39 Broadway Ste. #200, New York, NY 10006 ([email protected])

Transforming Nurse Self-Care Through Integration of Spirituality: Lessons From an International Collaboration in Palliative Care.

With growing evidence of compassion fatigue and burnout in health care, it is time for a deeper look at the vital practice of self-care among professionals providing palliative care. The purpose of this study was to provide insights into ways empowerment, caring for self, environment, and building relationships impact well-being among palliative care professionals. Interpretative descriptive methods framed focus group interviews, conducted during a conference on palliative care integrative health practices held in Thailand. An interprofessional research team used inductive reasoning processes to analyze the interviews. Three themes emerged from the four focus groups (N = 22): Buddhist Beliefs and Practices, Community-mindedness, and Empowerment. Aspects of spirituality were consistently woven into self-care practices. Findings suggest that self-care can be reimagined to include highly personal and unique expressions of spirituality. Health care communities are called to integrate ritual in culturally congruent ways, thus supporting health care professionals to find new sources of meaning, enrichment, and empowerment.

Interprofessional Collaboration Competencies of Nursing Students, Nurse Practitioner Students, and Paramedics in a Simulated Palliative Home Care Setting: A Pilot Study

Background: Post-secondary institutions do not adequately prepare future professionals to provide quality palliative care. Furthermore, the competencies necessary for interprofessional collaborative practice in home-based palliative care are poorly described in the scientific literature. A palliative care simulation involving standardized patients and paramedics would be a strategy to educate nursing students and nurse practitioner students who have little opportunity to experience interprofessional collaborative palliative care in the home.

Quality Improvement in Itself Changes Your Thinking: Lessons From Disseminating Quality Improvement Methods Through a Multisite International Collaborative Palliative Care Project in India.

Seven major palliative care (PC) centers in India were mentored through the Palliative Care-Promoting Assessment and Improvement of the Cancer Experience (PC-PAICE) by US and Australian academic institutions to implement a quality improvement (QI) project to improve the accessibility and quality of PC at their respective centers. The objective was to evaluate the experiences of teams in implementing QI methods across diverse geographical settings in India. A quota sampling approach was used to elicit perspectives of local stakeholders at each site. The Consolidated Framework for Implementation Research informed development of a semistructured interview guide. Analysis leveraged deductive and inductive approaches. We interviewed 44 participants (eight organizational leaders, 12 clinical leaders, and 24 team members) at seven sites and identified five themes. (1) Implementing QI methods enabled QI teams to think analytically to solve a complex problem and to identify resources. (2) Developing a problem statement by identifying specific gaps in patient care fostered team collaboration toward a common goal. (3) Making use of QI tools (eg, A3 process) systematically provided a new, straightforward QI toolkit and improved QI teams' conceptual understanding. (4) Enhancing stakeholder engagement allowed shared understanding of QI team members' roles and processes and shaped interventions tailored to the local context. (5) Designing less subjective processes for patient care such as assessment scales to identify patient's symptomatic needs positively changed work practices and culture. Engaging and empowering multiple stakeholders to use QI methods facilitated the expansion and improvement of PC and cancer services in India. PC-PAICE demonstrated an efficient, effective way to apply QI methods in an international context. The impact of PC-PAICE is being magnified by developing a cadre of Indian QI leaders.

Regional collaborative home-based palliative care and health care outcomes among adults with heart failure.

BackgroundInnovative models of collaborative palliative care are urgently needed to meet gaps in end-of-life care among people with heart failure. We sought to determine whether regionally organized, collaborative, home-based palliative care that involves cardiologists, primary care providers and palliative care specialists, and that uses shared decision-making to promote goal- and need-concordant care for patients with heart failure, was associated with a greater likelihood of patients dying at home than in hospital.MethodsWe conducted a population-based matched cohort study of adults who died with chronic heart failure across 2 large health regions in Ontario, Canada, between 2013 and 2019. The primary outcome was location of death. Secondary outcomes included rates of health care use, including unplanned visits to the emergency department, hospital admissions, hospital lengths of stay, admissions to the intensive care unit, number of visits with primary care physicians or cardiologists, number of home visits by palliative care physicians or nurse practitioners, and number of days spent at home.ResultsPatients who received regionally organized, collaborative, home-based palliative care (n = 245) had a 48% lower associated risk of dying in hospital (relative risk 52%, 95% confidence interval 44%–66%) compared with the matched cohort (n = 1172) who received usual care, with 101 (41.2%) and 917 (78.2%) patients, respectively, dying in hospital (number needed to treat = 3). Additional associated benefits of the collaborative approach included higher rates of clinician home visits, longer time to first hospital admission, shorter hospital stays and more days spent at home.InterpretationAdoption of a model of regionally organized, collaborative, home-based palliative care that uses shared decision-making may improve end-of-life outcomes for people with chronic heart failure.

Multi-level classroom learning prepares nurses for future collaboration in palliative care: an educational initiative.

Palliative care (PC) education should be an important part of both the graduate and undergraduate nursing curriculum. Nursing's philosophy of holistic care, which aims to improve the quality of life of patients and families, aligns with the primary objective of PC, positioning nurses to take the lead in expanding and improving PC delivery to all patients with a life-threatening diagnosis. The best way to facilitate this level of care is when staff nurses and advanced practice nurses work collaboratively. To establish a new standard for nursing education that emphasises intradisciplinary care. To fill the gap in PC education for nursing students, a dedicated elective PC class was developed for undergraduate and graduate students at a large midwestern University in the United States. Through an interactive approach to learning, both groups were able to experience and more fully understand how they would work collaboratively with each other to provide high-quality PC. Intradisciplinary PC education is an opportunity for students to learn the precepts of PC in an environment that will mirror their post-graduation practice environment.

Clinicians' Perceptions of Collaborative Palliative Care Delivery in Chronic Kidney Disease.

Guidelines recommend palliative care for patients with chronic kidney disease (CKD), who experience a high pain and symptom burden, and receive intensive treatments that often do not align with their values. A lack of scalable specialty palliative care services has prompted calls for attention to primary palliative care, delivered in primary care and nephrology settings. The objectives of this study were to 1) describe expectations for care to meet the palliative care needs of people living with CKD, and limitations to meeting those expectations in the current model, and 2) identify potential interventions to meet patients' palliative care needs. We conducted semi-structured interviews with clinicians from primary care, nephrology, and palliative care to assess 1) reasonable expectations for meeting palliative needs, 2) barriers to integrating primary palliative care, and 3) potential intervention points. Clinicians discussed their expectations for high-quality communication (e.g., discussing disease understanding, assessing goals of care) and better integration of palliative care services. Clinicians expressed barriers to delivering that care, including poor inter-clinician communication. To address barriers, clinicians outlined potential intervention points, such as building collaborative models of care, and structural triggers to identify patients who may be appropriate for palliative care. Interventions to address gaps in palliative care delivery for people living with CKD should incorporate systematic identification of patients with palliative care needs and structural mechanisms to meeting those needs via specialty and primary palliative care.

Exploring Health Care Providers' Experiences of Providing Collaborative Palliative Care for Patients With Advanced Heart Failure At Home: A Qualitative Study.

BackgroundThe HeartFull Collaborative is a regionally organized model of care which involves specialist palliative care and cardiology health care providers (HCPs) in a collaborative, home‐based palliative care approach for patients with advanced heart failure (AHF). We evaluated HCP perspectives of barriers and facilitators to providing coordinated palliative care for patients with AHF at home.Methods and ResultsWe conducted a qualitative study with 17 HCPs (11 palliative care and 6 cardiology) who were involved in the HeartFull Collaborative from April 2013 to March 2020. Individual, semi‐structured interviews were held with each practitioner from November 2019 to March 2020. We used an interpretivist and inductive thematic analysis approach. We identified facilitators at 2 levels: (1) individual HCP level (on‐going professional education to expand competency) and (2) interpersonal level (shared care between specialties, effective communication within the care team). Ongoing barriers were identified at 2 levels: (1) individual HCP level (e.g. apprehension of cardiology practitioners to introduce palliative care) and (2) system level (e.g. lack of availability of personal support worker hours).ConclusionsOur results suggest that a collaborative shared model of care delivery between palliative care and cardiology improves knowledge exchange, collaboration and communication between specialties, and leads to more comprehensive patient care. Addressing ongoing barriers will help improve care delivery. Findings emphasize the acceptability of the program from a provider perspective, which is encouraging for future implementation. Further research is needed to improve prognostication, assess patient and caregiver perspectives regarding this model of care, and assess the economic feasibility and impact of this model of care.

Effect of a Collaborative Palliative Care Intervention vs Usual Care on Quality of Life of Patients with Symptomatic Heart and Lung Diseases: A Randomized Clinical Trial (CO202A)

Effect of a Collaborative Palliative Care Intervention vs Usual Care on Quality of Life of Patients with Symptomatic Heart and Lung Diseases: A Randomized Clinical Trial (CO202A)

Exploring Health Care Providers’ Experiences of Providing Collaborative Palliative Care for Patients with Advanced Heart Failure at Home: A Qualitative Study (GP726)

Exploring Health Care Providers’ Experiences of Providing Collaborative Palliative Care for Patients with Advanced Heart Failure at Home: A Qualitative Study (GP726)