Community Palliative Care Team Research Articles

The role of pharmacist in community palliative care-a scoping review.

Dynamic and adaptive services that provide timely access to care are pivotal to ensuring patients with palliative needs experience high-quality care. Patients who have palliative care needs may require symptomatic relief with medicines and, therefore, may engage with community pharmacists frequently. However, there is limited evidence for pharmacists' involvement in community palliative care models. Therefore, a scoping review was conducted to identify pharmacists' role in community palliative care. A systematic search strategy was implemented across PubMed, PsychINFO, CINAHL, and Embase databases. Articles were screened by abstract and full text against inclusion and exclusion criteria. Five articles (two from Australia, two from England, and one from Scotland) met the inclusion criteria and described interventions involving pharmacists in community palliative care. This review has identified that the inclusion of trained pharmacists in community palliative care teams can improve the quality of care provided for patients with palliative needs. Pharmacists are able to undertake medication reviews and provide education to patients and other healthcare professionals on the quality use of palliative care medicines. Additionally, the underutilization of community pharmacists in palliative care, the need for further training of pharmacists, and improved community pharmacy access to patient information to deliver community palliative care were identified. Pharmacists can play a vital role in community palliative care to enhance the quality of life of patients. There is a need for greater pharmacist education/training, improved interprofessional communication, improved access to patient information and sustainable funding to strengthen community-based palliative care.

Exploration of Patient and Clinician Experience of Video Consultations in Community Palliative Care

ContextTelehealth video consultations (VCs) were implemented in the community palliative care team (CPCT) in a regional NSW health district, Australia, as a response to restrictions to the COVID-19 pandemic, using patient's device in the absence of a clinician. ObjectivesTo evaluate patient/carer and clinician satisfaction in using VCs for CPC consultations; to explore advantages and challenges of VCs. MethodsSelf-reported online questionnaires to community-dwelling patients under care of the CPCT; seeking patients/carers and clinician perspectives on the VCs from April to September 2020. ResultsOf 126 eSurveys completed, (85 clinicians; 41 patients/carers), 97% patient/carers and 97% clinicians indicated they were satisfied with VC. Overall, 93% clinicians agreed they provided same level of care compared to face-to-face review; 85% patients/carers agreed they received same level of care compared to face-to-face consultations and 98% agreed their issues were addressed. Of eSurvey responses 97% clinicians and 78% patients/carers indicated they would continue to use VCs in practice. Comments indicated dissatisfaction with lack of personal examination; some found technological issues to be barriers. Benefits discovered incidentally were empowering patient independence to live out their end-of-life desires while being treated/supported, improved service delivery, increased staff autonomy and upskilling staff. ConclusionUsers in this study perceived VCs to have a place in CPC consultations. Using patient device enabled patient freedom, improved timeliness of clinical assessment, and communication to complement face-to-face consults, while minimizing infection risk. Unexpected, but valuable benefits were revealed. Workable technology is paramount.

End of life care at home: The role of critical care transfer services.

Most people would rather die at home than in hospital but only 18% of patients do so. Palliative care focuses on the physical, spiritual and psychosocial wellbeing of patients and their families, which should include facilitating transfers home when possible. Patients can have more autonomy over their care and be surrounded by loved ones which can have a significant impact on their quality of life. In this article we describe two cases of home repatriation for palliation. Case 1 describes the transfer of a patient with difficulties and gaps in planning, but with a safe transfer ultimately. Case 2 recounts a more comprehensive planning process emphasising collaboration between teams. Facilitating home-based care aligns with patients' desires for familiar surroundings and emotional support. A secondary benefit is that releasing a bed space allows another patient to receive critical care treatment. Challenges of palliative critical care transfers include needing a highly trained team and thorough planning. Early discussion with the family and community palliative care teams makes this a more feasible option for patients. A multidisciplinary team of hospital and community healthcare professionals working with the patient and their family can facilitate the transfer from intensive care to allow them to die at a place of their choosing. We should aim to fulfil these wishes at the end of life as it can greatly improve the patient's and their family's physical and emotional wellbeing during this difficult time.

‘That just doesn’t feel right at times’ – lone working practices, support and educational needs of newly employed Healthcare Assistants providing 24/7 palliative care in the community: A qualitative interview study

Background: Healthcare assistants working in hospice at home settings have a pivotal role in supporting people dying at home and their family caregivers. Some healthcare assistants are working alone in patients’ homes, which magnifies some of the issues reported for those working closely with other team members. There is a dearth of evidence in terms of education, training and support needs for healthcare assistants when working alone. Aim: To explore the role of newly employed lone working healthcare assistants delivering palliative care in the community, and their support and educational needs. Design: Qualitative exploratory study using semi-structured interviews. Setting/participants: Healthcare assistants (n = 16) employed less than 12 months by a national non-profit hospice and palliative care provider located across the UK. Results: Analysis of interviews identified three main themes: (1) Healthcare assistants have a unique and complex role catering for holistic needs of patients and their family caregivers in the home environment; (2) preparation for the complex role requires focus on experiential learning and specific training to support holistic care provision; (3) lone workers experience loneliness and isolation and identify peer support as a key intervention to support their wellbeing. Conclusions: Given the complexities of their role within community palliative care teams, there are key learning points in relation to healthcare assistant preparation. Education and support networks should be prioritised to reduce isolation and support ongoing learning and development of newly employed healthcare assistants; all of which is vital to ensure safety and quality of care for the growing number of people they support in the community.

‘The palliative care ambulance’: A qualitative study of patient and caregiver perspectives of an ambulance service

Background: The need for home-based palliative care is accelerating internationally. At the same time, health systems face increased complexity, funding constraints and global shortages in the healthcare workforce. As such, ambulance services are increasingly tasked with providing palliative care. Where paramedics with additional training in palliative care have been integrated into models of care, evaluations have been largely positive. Studies of patient and family carer experiences of paramedic involvement, however, are limited. Aim: To explore patient and family caregiver experiences of paramedics’ contribution to palliative care at home. Design: Qualitative interview study. We analysed data within a social constructionist epistemology using reflexive thematic analysis. Setting/participants: Participants receiving specialist palliative care in the community of a metropolitan city of Australia who requested an ambulance between January and August 2018, inclusive. Results: Participants considered paramedics with expertise and experience in palliative care as an extension of the specialist community palliative care team and held them in high regard. Participants highlighted the importance of: critical palliative care at home and a timely, responsive approach; person-centred paramedics; as well as safety and security. Conclusion: Patients and carers feel safe and secure when they know that highly responsive skilled professional support is available when an unexpected problem or sudden change arises, especially out-of-hours, and that support is delivered in an empathic and person-centred manner.

Palliative Education and Care for the Homeless (PEACH): A Model of Outreach Palliative Care for Structurally Vulnerable Populations.

The Palliative Education and Care for the Homeless (PEACH) program comprises a community palliative care team serving some of the most complex clients in the healthcare system. Formal partnerships bring together physician, nursing, psychosocial and homecare, health and housing navigation supports. PEACH has served over 1,000 clients, leading field-defining research, medical education and public advocacy. The PEACH program demonstrates that innovation through deep interorganizational and intersectoral integration can drive value-based impact for the most complex clients, providing instructive lessons for public health system reform well beyond the margins faced by people who are unhoused. This paper describes how PEACH's unique model, critical community partnerships and research have been necessary for it to become a leader in community-based palliative care for structurally vulnerable people.

209 THE ADVANCED NURSE PRACTITIONER CANDIDATE: PALLIATIVE CARE IN END-STAGE DEMENTIA UTILISING A CARE COORDINATED APPROACH IN THE COMMUNITY SETTING

Abstract Background Palliative care in the context of dementia is a relatively new concept. Over recent years, there has been an increased emphasis on extending palliative care for those with dementia worldwide, supported by the 2014 white paper from the European Association of Palliative Care (EAPC) defining optimal palliative care for people with dementia. Individualized care coordination for older adults in the community improves high quality care and sets the scene for this care-coordinated approach initiative led by the Advanced Nurse Practitioner candidate (ANPc) Methods Developing a robust pathway of care in partnership with community palliative care service will enhance the support given to achieve optimal and quality driven palliative and end of life care outcomes. The pathways achieved involve a three-step integrated pathway structure. Step one involves care intervention by the ANPc, step 2 a care coordinated approach with the ANPc and Community Palliative Care Team (CPCT) and step 3 CPCT with collaborative interactions with the ANPc. Inclusion criteria include patients with end stage dementia who have reached a FAST scale of seven or over. All patients accepted onto this pathway must reside within the healthcare area set out and experience at least one or more symptoms resulting from their dementia. Results Results to date have shown how this pathway has achieved significant care interventions meeting the need of people living with dementia at end stages of their journey in the community setting. Additionally, families have indicated the overall satisfaction of the service and with significant reductions in Carer stress. Conclusion Research indicates that individualized care coordination in the community is crucial to optimise quality care interventions, which this pathway achieves.

Exploring the experiences of a community palliative care team as services were adapted to meet the demand of the COVID-19 pandemic.

During COVID-19, it was critical that services adapted to meet the high demands of the pandemic. This qualitative study explores the experiences of several staff members of the community palliative care team, as they adapted the delivery of their services to such pressures. Semi-structured interviews via a virtual platform were conducted and four themes were identified: service development, communication, inter-professional relationships and support mechanisms. The participants supported the change in service delivery and use of technology to triage patients. The participants also reported improved collaboration and patient care-coordination, and enhanced support mechanisms used by the team helped sustain resilience and wellbeing. Although challenging, the team embraced the changes and described improved collaboration and coordination of patient care.

The impact of specialist community palliative care teams on acute hospital admission rates in adult patients requiring end of life care: A systematic review.

The aim of this systematic review was to determine the impact that specialist community palliative care teams (SCPCT) have on acute hospital admission rates in adult palliative care (PC) patients who require End of Life Care (EOLC). Using systematic review methodology, eight studies were obtained from thorough searching of CINAHL, Medline and Embase databases. The review question was formulated using the PICO mnemonic - Population, Intervention, Comparison and Outcome. PRISMA guidelines were used to conduct the review and record the database searches. Data were extracted using a pre-designed extraction tool and all included studies were quality appraised using the checklist. The results are presented as a narrative review. For the purposes of this review SCPCT is a minimum of one specialist doctor and one specialist nurse. The eight selected studies reported that when SCPCT's cared for patients requiring EOLC there was a reduction in the admission rates to acute hospital settings in comparison to those who received standard care only. Some studies showed this reduction to be as high as 33% and 34% in the last year of life. With regards to secondary outcomes the studies that evaluated the impact of SCPCT's on emergency department usage and hospital death rates all found that SCPCT's had a positive influence in both areas. With regards to emergency department usage, one study reported the most significant reduction of 51% for patients who had SCPCT compared with those who had not. With regards to hospital death rates, the most significant results found that 39% of patients receiving SCPCT died in hospital compared to 74.8% who did not receive SCPCT. This review demonstrates that SCPCT's have a positive impact in reducing acute hospital admissions in adult patients requiring EOLC, however, these results may not be conclusive. Palliative care is a complex intervention with a very diverse population. It is vital therefore that further research and investigation, accounting for the confounding factors that may affect the accuracy of the results, is undertaken.

Patients with Congestive Cardiac Failure Referred to Specialist Palliative Care.

Congestive cardiac failure is a chronic, progressive condition with a significant symptom burden. There is limited data available regarding the palliative care requirements of the heart failure population. To characterise patients with a primary diagnosis of congestive cardiac failure referred to a specialist palliative care (SPC) service in Ireland. A retrospective chart review of patients with congestive cardiac failure admitted to the specialist palliative care unit or reviewed by the community palliative care team over 2 years was carried out, utilising a data collection template. 57 patient charts were included. 54% (n = 31) were female. Mean age was 81 [60 - 97] years. GP's referred 42% (n = 24), Cardiologists 39% (n = 22) and other hospital consultants 19% (n = 11). The commonest symptom reported was dyspnoea (n = 47). Time from referral to death ranged from less than one month (n =22) to greater than one year (n = 3). 14 patients were discharged from the service due to lack of SPC needs. Place of death was distributed between home, hospice, nursing home and acute hospital. Patients with congestive cardiac failure experience high symptom burden. More than 50% of patients that died while receiving SPC input had been referred less than 1 month prior, while almost a quarter of all referrals resulted in patient discharge. This highlights the importance of further education regarding indication for specialist palliative care referral and the benefits of early referral in this patient cohort when appropriate.

Study recruitment factors in advanced cancer: the Prognosis in Palliative care Study II (PiPS2) - a multicentre, prospective, observational cohort project

ObjectivesThe Prognosis in Palliative care Study II (PiPS2) was a large multicentre observational study validating prognostic tools in patients with advanced cancer. Many palliative care studies fail to reach their...

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

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.

Development and Management of Networks of Care at the End of Life (the REDCUIDA Intervention): Protocol for a Nonrandomized Controlled Trial.

BackgroundEnd-of-life needs can be only partly met by formalized health and palliative care resources. This creates the opportunity for the social support network of family and community to play a crucial role in this stage of life. Compassionate communities can be the missing piece to a complete care model at the end of life.ObjectiveThe main objective of this study is to evaluate the REDCUIDA (Redes de Cuidados or Network of Care) intervention for the development and management of networks of care around people with advanced disease or at the end of life.MethodsThe study is a 2-year nonrandomized controlled trial using 2 parallel groups. For the intervention group, we will combine palliative care treatment with a community promoter intervention, compared with a control group without intervention. Participants will be patients under a community palliative care team’s supervision with and without intervention. The community promotor will deliver the intervention in 7 sessions at 2 levels: the patient and family level will identify unmet needs, and the community level will activate resources to develop social networks to satisfy patient and family needs. A sample size of 320 patients per group per 100,000 inhabitants will offer adequate information and will give the study 80% power to detect a 20% increase in unmet needs, decrease families’ burden, improve families’ satisfaction, and decrease the use of health system resources, the primary end point. Results will be based on patients’ baseline and final analysis (after 7 weeks of the intervention). We will carry out descriptive analyses of variables related to patients’ needs and of people involved in the social network. We will analyze pre- and postintervention data for each group, including measures of central tendency, confidence intervals for the 95% average, contingency tables, and a linear regression. For continuous variables, we will use Student t test to compare independent samples with normal distribution and Mann-Whitney U test for nonnormal distributions. For discrete variables, we will use Mann-Whitney U test. For dichotomous variables we will use Pearson chi-square test. All tests will be carried out with a significance level alpha=.05.ResultsEthical approval for this study was given by the Clinical Research Committee of Andalusian Health Service, Spain (CI 1020-N-17), in June 2018. The community promoter has been identified, received an expert community-based palliative care course, and will start making contacts in the community and the palliative care teams involved in the research project.ConclusionsThe results of this study will provide evidence of the benefit of the REDCUIDA protocol on the development and assessment of networks of compassionate communities at the end of life. It will provide information about clinical and emotional improvements, satisfaction, proxy burden, and health care resource consumption regarding patients in palliative care.Registered Report IdentifierRR1-10.2196/10515

Nurse practitioners' completion of Physician Orders for Scope of Treatment forms in West Virginia: A secondary analysis of 12 months of data from the state registry.

Advanced care planning documents, such as the Physician Orders for Life-Sustaining Treatment (POLST), require authorized medical provider signatures; only recently have nurse practitioners (NPs) been authorized to sign these forms. Recent legislation in West Virginia (WV) granting NPs signatory authority on POLST forms and the creation of a statewide registry provides an opportunity to examine the completion rates. The aim of this study was to investigate how recent legislation allowing NPs signatory authority for POLST forms has affected POLST completion. Data were obtained from the WV statewide registry of POST forms completed by all authorized personnel. Forms submitted by NPs were compared with those completed by physicians on patient demographics, setting, resuscitation status, level of medical intervention, and errors. Variables were cross-tabulated by provider type to determine whether and how NP POST completion differed from that of physicians. Forty-five NPs submitted 430 POST forms to the WV registry, which constituted 14.4% of the POST forms received. Ten NPs in community and hospital specialist palliative care teams submitted more than two thirds of these 430 forms. Nurse practitioner-completed POST forms were more likely to order do not resuscitate and comfort measures than POST forms ordered by physicians (both p < .001) and to be without errors (p < .001). Nurse practitioners practicing in specialist palliative care roles in communities and hospitals have embraced the use of POST and followed through on complete and accurate completion of the forms. With this signatory authority, primary and specialist NPs have the potential to improve end-of-life care.

Can specially trained community care workers effectively support patients and their families in the home setting at the end of life?

Surveys indicate that many Australians would prefer to die at home, but relatively few do. Recognising that patients and their families may not have the support they need to enable end-of-life care at home, a consortium of care providers developed, and received funding to trial, the Palliative Care Home Support Program (PCHSP) across seven health districts in New South Wales, Australia. The programme aimed to supplement end-of-life care in the home provided by existing multidisciplinary community palliative care teams, with specialist supportive community care workers (CCWs). An evaluation of the service was undertaken, focussing on the self-reported impact of the service on family carers (FCs), with triangulation of findings from community palliative care teams and CCWs. Service evaluation data were obtained through postal surveys and/or qualitative interviews with FCs, community palliative care teams and CCWs. FCs also reported the experience of their loved one based on 10 items drawn from the Quality of Death and Dying Questionnaire (QODD). Thematic analysis of surveys and interviews found that the support provided by CCWs was valued by FCs for: enabling choice (i.e. to realise end-of-life care in the home); providing practical assistance ("hands-on"); and for emotional support and reassurance. This was corroborated by community palliative care teams and CCWs. Responses by FCs on the QODD items indicated that in the last week of life, effective control of symptoms was occurring and quality of life was being maintained. This study suggests that satisfactory outcomes for patients and their families who wish to have end-of-life care in the home can be enabled with the additional support of specially trained CCWs. A notable benefit of the PCHSP model, which provided specific palliative care vocational training to an existing community care workforce, was a relatively rapid increase in the palliative care workforce across the state.

A10-C A Palliative Care Home Support Program in New South Wales (NSW), Australia – Design and Evaluation

To ascertain whether a program providing specially trained Community Care Workers (CCWs) is effective in supporting palliative care patients and their families with end-of-life care in the home. The program was delivered in 7 Local Health Districts (LHDs) across metropolitan and regional NSW. A training workshop was developed and delivered to CCWs, and evaluated using post-workshop evaluation questionnaires. Family carers who received CCW support were invited to provide an anonymous evaluation survey on their experience with the program, approximately 3 months after their loved one had died. A purposive sample of CCWs, family carers and clinical staff from Specialist Community Palliative Care Teams (SCPCT) from each LHD were also invited to participate in qualitative telephone interviews about the program. Over 300 patients received this service during the evaluation period. CCWs indicated that the training enhanced their skills, knowledge and confidence in supporting palliative care patients and their families. Most family carers had no previous experience in providing this type of care. Moreover, many had limited networks of support, and some had their own health issues. Over 80% of respondents were happy with their decision to support their loved one to die at home. They reported that CCWs assisted with personal patient care, overnight respite care, advice on patient care, and emotional support. Interviews with SCPCT members suggest that the program was more easily implemented in metropolitan areas. In regional LHDs the challenges were geographical distances, a shortage of skilled staff, and carer reticence to having ‘strangers’ come into their homes. SCPCT members reported that palliative care-trained CCWs were able to effectively support carers. Challenges external to the program were identified in some Districts. These included limited access to palliative care specialists and general practitioner home visits. CCWs were effective in supporting patients and carers with end-of-life care in the home.

Improving palliative care in selected settings in England using quality indicators: a realist evaluation

BackgroundThere is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England.Methods1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service change in selected settings (general practice, community palliative care teams, care homes, hospital wards, in-patient hospices) with a before-and-after evaluation, and 3) realist evaluation of processes and outcomes across settings. Participants in each setting were supported to identify no more than three Quality Indicators to work on over an eight-month period in 2013/2014.ResultsGeneral practices could not be recruited to the study. Care homes were recruited but not retained. Hospital wards were recruited and retained, and using the Quality Indicator (QI) set achieved some of their desired changes. Hospices and community palliative care teams were able to use the QI set to achieve almost all their desired changes, and develop plans for quality improvements. Improvements included: increasing the utility of electronic medical records, writing a manual for end of life care, establishing working relationships with a hospice; standardising information transfer between settings, holding regular multi-disciplinary team meetings, exploration of family carers’ views and experiences; developing referral criteria, and improvement of information transfer at patient discharge to home or to hospital.Realist evaluation suggested that: 1) uptake and use of QIs are determined by organisational orientation towards continuous improvement; 2) the perceived value of a QI package was not powerful enough for GPs and care homes to commit to or sustain involvement; 3) the QI set may have been to narrow in focus, or more specialist than generalist; and 4) the greater the settings’ ‘top-down’ engagement with this change project, the more problematic was its implementation.ConclusionsWhilst use of QIs may facilitate improvements in specialist palliative care services, different QI sets may be needed for generalist care settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0144-1) contains supplementary material, which is available to authorized users.

Abstracts from Center to Advance Palliative Care National Seminar Palliative Care Everywhere: Bridging the Gaps November 12-14, 2015 San Antonio, TX.

Journal of Palliative MedicineVol. 19, No. 5 AbstractsFree AccessAbstracts from Center to Advance Palliative Care National Seminar Palliative Care Everywhere: Bridging the Gaps November 12–14, 2015 San Antonio, TXPublished Online:3 May 2016https://doi.org/10.1089/jpm.2016.0088AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The topic areas for abstract submission include:Palliative Care Delivery/Operations• Innovative and emerging community-based palliative care models (e.g., home/office/clinic/long-term care)• Innovative hospital-based palliative care models• Integration of palliative care services in cancer centers/dialysis centers, and other special care units• Approaches to palliative care delivery in specific hospital settings (e.g., ICU, ED)• Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty) or in specific settings (ICU, ED)• Innovative pediatric palliative care programs including combined adult/pediatric models• Integrating palliative care services (e.g., across a health system/patient-centered medical home/assisted living/nursing homes)• Successful development of pharmacy roles on a palliative care team• Implementation of standardized interventions such as checklists and screening tools• Successful approaches to conducting an effective needs assessmentPalliative Care Teams• Staffing the interdisciplinary team including staffing benchmarks and maximizing the roles of social workers/chaplains/nursing and medicine• How teams work together to maximize team health and avoid burnout• Demonstrating clinical and financial outcomes for team rolesCommunication• Communication best practices (e.g., teaching goals of care conversations/advance care planning/family meetings)• Implementation of POLST/MOLSTEducation• Methods of training in primary/generalist palliative care• Examples of primary palliative care education approaches to address the workforce shortage• Targeting Education: Pain management and communication skillsData and Outcomes• Using technology to improve efficiency and outcomes• Data demonstrating depth of palliative care integration in ACO/PCMH/bundling and other risk-bearing health care delivery frameworks• Successful use of metrics in community or hospital settingsFinancing and Payer Collaborations• Successful payer/provider collaborations and partnerships• Financing/benefit and payment modelsCoalition and Advocacy• Regional and National Palliative Care Initiatives (e.g., statewide coalitions/political advocacy)Other1. The FM Effect on EoL Decisions for AAs by Medical SurrogatesAbington Hospital, Jefferson HealthAbington, PATeam/Contact Information:Maria Doll Shaw, DNPClinical Nurse Manager, Palliative Care ServiceAbington Hospital, Jefferson Health517 S. Schuylkill AvenueAbington, PA 19403(215) 481-8713mdoll-shaw@abingtonhealth.orgTopics: Communication: Communication best practices (e.g., teaching goals of care conversations/advance care planning/family meetings)Description:A retrospective pilot study of 96 EMRs of incapacitated, hospitalized, AA suffering with life-limiting illnesses whose medical surrogates participated in a PCT-led family meeting to determine decisions for EoL care. Patient median age was 78 years, 72% female; 13.5% had a LW, and 69.2% were upheld by the surrogates. Of the surrogates, 45.8% were the adult daughters. The average LOS was 17 days. For those transitioned to comfort care following the PCT-led family meeting the average LOS was reduced to 10.9 days.Conclusion: PCT-led FMs can be effective interventions for this patient population at EoL. Few in this sample had LWs, but if they did, they were generally upheld by the surrogates; and so they are fairly reliable as a tool to provide the care pathway patients prefer when they are unable to advocate for themselves. The burden of EoL decision making often falls to the adult daughter. Knowing in advance characteristics and priorities of meeting participants can assist PCTs as they prepare for these FMs. Finally, organizations as well as patients can benefit from a decreased LOS in the acute care setting because they transitioned to the comfort-focused care pathway.AA, African American; EoL, end of life; FM, family meeting; LOS, length of hospital stay; LW, living will; PCT, palliative care team.2. Community Palliative Care Reduces Hospital ReadmissionAllina Health Hospice and Palliative CareSt. Paul, MNTeam/Contact Information:Joe Amberg, MDMedical Director Palliative CareAllina Health Hospice and Palliative Care1055 Westgate Drive, Suite 100St. Paul, MN 55114(612) 262-7693Joseph.amberg@allina.comProject Team Members:Pat Peschman, DNP, ManagerJennifer Trygg, Data Analyst, Home Care ServicesTopics: Palliative Care Delivery/Operations: Innovative and emerging community-based palliative care models (e.g., home/office/clinic/long-term care)Description:The Allina Health Community Palliative Care Team has provided service in the Twin Cities, MN, community for 8 years. The team is composed primarily of eight specially trained home health nurses who make home visits, with twice monthly IDT collaboration with MD, social worker, and spiritual care. The team successfully provides expert symptom relief and coordination of care for patients with complex illness who continue life-prolonging treatment, with high rates of referral to hospice when warranted by the patient's condition and goals of care. This year we are collecting data on hospital readmissions, with dramatic reductions measured for patients receiving palliative care. Patients assessed as higher risk and worse prognosis by OASIS screen showed the greatest benefit.Results: For patients with temporary at-risk status with return to normal health, readmission rate is 12.1% with no PC, and 3.7% with PC. For patients at high risk and fragile status, readmission rate is 21% with no PC, and 5.6% with PC. For patients in serious condition and with prognosis less than one year, readmission rate is 33.9% with no PC, and 2.6% with PC. This is the grand total for January to June 2015, and we continue rolling data, which can be updated at the time of poster presentation.3. Inpatient Palliative Care Reduces Hospital ReadmissionsAllina Health Hospice and Palliative CareSt. Paul, MNTeam/Contact Information:Joe Amberg, MDMedical Director Palliative CareAllina Health Hospice and Palliative Care1055 Westgate Drive, Suite 100St. Paul, MN 55114(612) 262-7693Joseph.amberg@allina.comProject Team Members:Jennifer Trygg, Data Analyst, Home Care ServicesTopics: Data and Outcomes: Successful use of metrics in community or hospital settingsDescription:Allina Health Palliative Care staffs inpatient consult teams at four metro hospitals in the Twin Cities, MN, and one regional hospital in Shakopee. The teams are well established, providing expert symptom care, goals of care discussion, and end-of-life care for hospital patients with serious illness, working in close collaboration with hospitalists, intensivists, and other specialists. Three hospital teams (two new in the past year) also provide weekly outpatient clinic consultation and follow-up. One hospital provides training for the University of Minnesota HPM Fellowship. In 2014 the teams provided 4047 consults and 10,453 follow-up visits. For this study we reviewed hospital admissions in 2012 to 2013.Results: We measured number of hospitalizations before and after inpatient palliative care intervention, for 2 years including January 2012 to December 2013. The grand total of measured patients is 7930, with an average of 2.67 hospitalizations before IPPC consult, and 0.82 hospitalizations after IPPC consult. Each of the five hospital teams shows statistically similar results. To address whether these patients were simply being seen at the end of life, further data on patients living 30, 90, 120, and 240 days after discharge are available, all showing similar reductions (e.g., 2.58 versus 1.28 hospitalizations for alive >240 days).4. Palliative Care Reduces Hospital Costs at End of LifeAllina Health Hospice and Palliative CareSt. Paul, MNTeam/Contact Information:Joe Amberg, MDMedical Director Palliative CareAllina Health Hospice and Palliative Care1055 Westgate Drive, Suite 100St. Paul, MN 55114(612) 262-7693Joseph.amberg@allina.comProject Team Members:Lori Motschenbacher, Manager, System Financial AnalysisTopics: Palliative Care Teams: Demonstrating clinical and financial outcomes for team rolesDescription:Study information: Net hospital costs in 2011 were tabulated for patients who died in the hospital, with length of stay of 4 days or greater, and who received palliative care consultation at least 2 days prior to death. Costs were measured for the final 3 hospital days, with data specific to hospital, patient diagnosis, and allocation of costs. A comparison group are patients with the same inclusion criteria, but who did not receive palliative care consultation.Savings per consultNet savingsExpenseTeam sizeAbbott$ 3,702$ 685,000$ 317,0007.3United$ 1,721$ 215,000$ 210,0002.6Mercy$ 1,935$ 122,000$ 104,0003.0Unity$ 1,734$ 110,000$ 124,0001.6TOTAL $ 1,132,000$ 775,000 Results: The table below provides a summary for the four hospitals. The average cost for the final 3 hospital days was always greater for patients with no palliative care, regardless of diagnosis or hospital. There were a total of 475 palliative care consults provided meeting study inclusion criteria, compared with 239 patients who were not seen by palliative care. This study group represents only 13% of total consults seen, and demonstrates cost avoidance that exceeds total program costs.5. Patient and Caregiver Experience with CareAllina HealthMinneapolis, MNTeam/Contact Information:Laura Sutter, MPHResearch CoordinatorAllina Health2925 Chicago Avenue, MR 10039Minneapolis, MN 55407(612) 262-0534laura.sutter@allina.comProject Team Members:Nathan Shippee, MS, PhDTetyana Shippee, MS, PhDKarl Fernstrom, MPHCindy Cain, MA PhDAlissa Jones, MAHeather Britt, MPH, PhDTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:Aim: Assess experience in LifeCourse, a late-life supportive care intervention, using a new experience tool for patients and caregivers.Data and analysis: Intervention sample with baseline and 6-month data included 373 heart failure, cancer, and dementia patients and 434 caregivers. Usual care included 201 patients and 163 caregivers. Experience was assessed quantitatively through quarterly administration of a 30-item tool built to study guiding principles as sub-domains, and overall ratings for care and support. Qualitative data came from patient and caregiver interviews, and was used to better understand patterns.Results: Intervention patients trended toward greater improvements in all sub-domains and overall care and support ratings, compared with those in usual care. Findings were more mixed for caregivers.Conclusions: Experience scores showed more positive trends for LifeCourse than for comparison patients (although without significance in most domains by 6 months.) The patterns were slightly more consistent for patients than caregivers, reflecting potential benefits of LifeCourse and challenges to engaging caregivers. We look to perform longer follow-up and other components of assessment. Care delivery and experience tools oriented toward ongoing relationships and later-life care for complex patients may allow for meaningful assessment and better understanding of goals for integrating and streamlining care.6. Patient and Caregiver Quality of LifeAllina HealthMinneapolis, MNTeam/Contact Information:Laura Sutter, MPHResearch CoordinatorAllina Health2925 Chicago Avenue, MR 10039Minneapolis, MN 55407(612) 262-0534laura.sutter@allina.comProject Team Members:Nathan Shippee, MS, PhDTetyana Shippee, MS, PhDKarl Fernstrom, MPHCindy Cain, MA PhDAlissa Jones, MAHeather Britt, MPH, PhDTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:Question: Does participation in LifeCourse provide better quality of life (QOL) for late-life patients with chronic conditions and their caregivers compared with usual care controls?Data: Intervention sample with baseline and 6-month data included 373 heart failure, cancer, and dementia patients and 434 caregivers. Usual care included 201 patients and 163 caregivers.Measures: QOL was measured quarterly. Patient QOL was measured using the FACIT-PAL, and caregiver QOL was measured using the PROMIS-29. We also collected qualitative interviews.Results: Stability in QOL for LifeCourse patients versus negative change for usual care, and improvements for LifeCourse patients in emotional and palliative care subscales. Interviews provided examples of a positive impact across subscales. Marginal positive scores for caregivers enrolled in LifeCourse compared with usual care controls.Conclusions: LifeCourse helped maintain and even improve some QOL domains. This is notable because late-life patients face declining health and caregivers often have high caregiving burden. LifeCourse assessments of patient and caregiver QOL meet a need for information about patient and family functioning and the role of health care delivery in whole-person care. Whole-person supportive care interventions are a promising approach for patients and caregivers affected by complex chronic illness at the end of life.7. Late Life Care Approach Decreased Utilization and TCOCAllina HealthMinneapolis, MNTeam/Contact Information:Laura Sutter, MPHResearch CoordinatorAllina Health2925 Chicago Avenue, MR 10039Minneapolis, MN 55407(612) 262-0534laura.sutter@allina.comProject Team Members:Karl Fernstrom, MPHRebecca Prenevost, MPH, PhDTC TongHeather Britt, MPH, PhDTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:Aim: Evaluate the effects of LifeCourse, a late-life care approach, on health care utilization and total cost of care in a large health care delivery system.Data: 373 intervention and 201 usual care patients between October 2012 and April 2015. A subset of patients with total cost of care claims data available was selected for cost analysis, with controls selected from the health care system's patient population and matched using propensity scores.Results: LifeCourse patients in their last 6 months of life had half as many inpatient days as usual care controls. No significant difference in the number of ED visits. The proportion of advance directives increased significantly in the follow-up period compared with usual care. LifeCourse patients experienced higher inpatient and community-based palliative care utilization. The proportion of hospice enrollment prior to death was higher in the intervention group than the usual care group, the health care system in general, and the 2013 NHPCO national estimate. Also, average per patient per month total expenditures decreased more in the intervention group.Conclusions: Early signals indicate that using a whole person approach and allowing patients to voice preferences and take part in care decisions may benefit utilization and total cost of care.8. Palliative Care through a Dementia LensAlzheimer's Association, New York City ChapterNew York, NYTeam/Contact Information:Ann Wyatt, MSWAlzheimer's Association, New York City Chapter360 Lexington Avenue, 4th FloorNew York, NY 10017 (646) 744-2963awyatt@alznyc.orgProject Team Members:Tena Alonzo, MANatasha Bryant, MSEdward Cisek, PhDMark Heisler, PharmDRobert Hess, PhDMark Kator, CEOJed Levine, MATony Lewis, CEOCarol O. Long, PhDKaren Mitchell, BSNRobyn I. Stone, DrPHAudrey Weiner, CEOAnn Wyatt, MSWTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:Cambia Health Solutions has implemented a health plan-based serious illness services program for the 2.2 million members we serve, with an approach focused on respecting the patient's wishes, from diagnosis to completion of life. This program puts the patient at the center while remaining inclusive of the entire health care community. New health care services, benefits, training, and education have been created to ensure the entire health care system is engaged in putting the patient and their loved ones at the center—supporting the individual and family in their medical, psychosocial, behavioral, and spiritual needs. In addition, we provide necessary support and resources to caregivers and loved ones dealing with the serious illness of a loved one or in need of grief or bereavement counseling. Cambia has focused its efforts in integrating five main areas: benefit expansion, specialized care management, community and member engagement, provider reimbursement and training, and caregiver support. This presentation will provide our framework and implementation of this program, providing a structure for other payers to use in development of palliative care initiatives. We will represent initiatives within and outside of our Accountable Care Organization agreements. Example metrics and baseline statistics will also be presented.9. Cultivating a Culture of Primary Palliative CareBaptist HealthJacksonville, FLTeam/Contact Information:Tasha M. Schoppee, MSNBaptist Health800 Prudential DriveJacksonville, FL, 32207(904) 202-3409Tasha.Schoppee@bmcjax.comTopics: Education: Methods of training in primary/generalist palliative careDescription:Whether in the arena of acute care, the clinic setting, or in the home, comprehensive palliative care requires collaboration among both specialist and generalist clinicians. Developing the infrastructure to support such a cooperative practice requires strategic communications and intentional education across the disciplines. Successful development of such a culture necessitates intentionally targeting, and inviting in, many who have not previously been passionate about palliative care. They must have the opportunity to meet on mutual ground. One hospital system has found establishment of an interprofessional palliative care council to be the environment in which such collaboration can be nurtured. Additionally, there is great value in developing this foundation prior to the building of a formal palliative care program. Therefore, an interdisciplinary council is a powerful tool for both those organizations with mature palliative programs and those who are still in the planning stages.10. An Assessment of Palliative Care Beliefs and KnowledgeBaptist Health of South FloridaMiami, FLTeam/Contact Information:Yvonne PattenBaptist Health of South Florida8900 North Kendall DriveMiami, FL 33176(786) 596-0092yvonnep@baptisthealth.netProject Team Members:Maria M. Ojeda, ARNP, MSN, MPH, DNP, PHDCarolyn L. Lindgren, PhD, RNTopics: Education: Examples of primary palliative care education approaches to address the workforce shortageDescription:This study evaluated the level of perceived competency and knowledge regarding palliative care among health care personnel at a seven-hospital not-for-profit health care system; and determined if there was a significant difference in perceived competency and knowledge, between health care personnel who participated in an intercultural palliative care/end-of-life training program and those who did not.Using a pre-experimental static-group comparison design, a non-randomized sample of health care personnel were administered a demographic questionnaire to assess perceived competence (End-of-Life Professional Caregiver Survey [EPCS]) and a knowledge assessment (Palliative Care Survey [PCS]). The results revealed a significant negative association between perceived competency and knowledge scores, (Spearman's rho = −0.380, n = 330, p = 0.000). Those who did not take the course perceived themselves more competent when compared with those who took the course (Mann-Whitney U = 21,332, z = 4.827, p = 0.000). Participants who took the training course scored significantly higher on knowledge than those who did not (Mann-Whitney U = 10,257.00, z = −3.797, p = 0.000). This study supports the need for ongoing education to increase knowledge of palliative care among health care personnel and further exploration of the underlying reason for the negative association between perceived competency and knowledge.11. Stand By You: An Interprofessional Compassionate ServiceBaptist Health of South FloridaMiami, FLTeam/Contact Information:Rose M. Allen, DNPBaptist Health of South Florida8900 North Kendall DriveMiami, FL 33176(786) 596-0092rosea@baptisthealth.netProject Team Members:Rose Allen, DNP, MSM/HM, RN, CHPNChloe Edinger, BS, MS3Renato Santos, MDiv, BCC, LMHCArlenna Williams, MSW, MBASarita Khanal, ARNP, RNCarol Slinger-Howell, MSN, RN, CNMLTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:This poster will outline the collaborative efforts between Herbert Wertheim College of Medicine and Baptist Health South Florida to develop an interprofessional compassionate volunteer service for patients at the end of life, including the program's integration across the health system and the outcomes.The Stand By You (SBY) Volunteer service was developed in 2012 and initially offered at one of the seven hospitals within the system. It is based on the No One Dies Alone (NODA) program started by Sandra Clarke, CCRN, in 2001, with the goal to provide companionship and support for dying individuals, so they don't die alone. The SBY Volunteer program is a unique service where companionship and support is provided by first- and second-year medical student volunteers. Since 2014, the program has been expanded to include hospital volunteers of nurses, social workers, board members, and other community volunteers, who collaborate with the medical students to provide services at our hospitals within the health system.So far, 99 volunteers have been trained (53 medical students, 22 employees, 24 community volunteers) and 16 patients to date at Baptist Health have received services by these volunteers. Satisfaction of the SBY service is measured by survey feedback from staff and family members, if available.12. Examining Use of Advance Directives in Oncology PatientsBaptist Hospital, Inc.Penscola, FLTeam/Contact Information:Kelly C. Markham, MSWPalliative Care CoordinatorBaptist Hospital, Inc.1000 West Moreno StreetPensacola, FL 32501(850) 469-3739kelly.markham@bhcpns.orgTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:In our cancer center, a retrospective chart review was conducted of stage III and IV lung cancer patients, examining the use of advance directives. The results revealed that only 57% of those patients had completed an advance directive. In almost one-quarter of cases, the chart was silent about documented directives. This prompted our team to seek more information about lack of advance care planning among our patients with this serious illness. Several possibilities were discussed: lack of initiation of discussion by physician and/or staff, patient resistance, or other reasons. To assess these barriers, a survey was compiled to inquire about roadblocks. Currently, it is being used in our radiation oncology clinic. At this time, 26 patients have completed the survey. Initial responses indicate that most patients “just never got around to doing it.” The survey will continue to be utilized to obtain more information about barriers. Results of this survey, when concluded, will direct our cancer center's efforts to increase the understanding and completion of advance directives among our patients. Information already gained during these two projects has led us to expand to plan a system-wide needs assessment about the advance care planning process in our organization. This will be initiated in the spring of 2016.13. CARE: A Model for Doctor-Surrogate Decision MakingBatson Children's HospitalUniversity of Mississippi Medical CenterJackson, MSTeam/Contact Information:Charles Christian Paine, II, MDBatson Children's HospitalUniversity of Mississippi Medical Center402 Hemlock DriveFlowood, MS 39232(601) 842-0930cpaine@umc.eduTopics: Communication best practices (e.g., teaching goals of care conversations/advance care planning/family meetings)Description:Much has been written about the importance of the “Doctor-Patient” relationship and the obligations it demands. A majority of attention has been paid to the various steps, checklists, and algorithms that providers must follow to insure that they allow patients an autonomous voice. Interestingly, although the importance of values such as trust, compassion, and respect are mentioned as vital to this relationship, less attention is given to how to instill and maintain these in practice. Further, although emotion is mentioned as a component of many of these models, it is mostly referenced as merely a reaction to be allowed and affirmed. Finally, the role of family or surrogates in the decision-making relationship is often missed. The CARE Method is an analytical tool to help providers, patients, and families better understand each other's motivations and attitudes. The method examines the means and content of communication, the affect or mood of those communications, the context and reasoning of each party, and the effect and conclusions of each interaction. In this way, one can achieve a better understanding of the emotional roots of a decision and thus have a positive effect on building and sustaining a therapeutic doctor-patient-surrogate relationship.14. Enhancing Care at End of Life through Transition to HospiceBaylor All Saints Medical Center at Fort WorthArlington, TXTeam/Contact Information:Sommer Smith, MSWDirector, Comprehensive Care Management, Supportive and Palliative CarerBaylor All Saints Medical Center at Fort Worth6805 Glen Eagle DriveArlington, TX 76001sommerp@baylorhealth.eduProject Team Members:Shawnta Pittman-Hobbs, MDSommer Smith, LMSW, ACMEllen Pitcher, RN, MSN, MBA NEA-BC FACHELeslie PhillipsKimberly Montgomery, MSN, ACNS-BC, CCRN-CMCDanielle Reed, LMSW, ACHP-SWChuck Wallace, MDiv, MA, BCCTerry Boyd, RRT, RCPApril Jones, BSN, RN, CCTNDiana Stone, MSN, RNTopics: Palliative Care Delivery/Operations: Innovative hospital-based palliative care modelsDescription:Patients who were at the end of life and required planned withdrawal of treatment often had withdrawal take place in the ICU and not in the optimal environment for grieving or allowing them access to the specialized knowledge and support services provided by hospice at end of life. The importance of this need is emphasized in a study in the Journal of Clinical Oncology (Wright, 2010) stating that among caregivers, 21% of those whose loved ones died in the ICU or hospital developed PTSD 6 months later compared with 4.4% of those whose loved ones died at home with hospice. Baylor All Saints Medical Center (BASMC) developed a process for critical care patients to transfer to a more home-like environment of the VITAS Hospice Inpatient Unit (located on the BASMC campus) for withdrawal of life-sustaining treatments. ICU nursing staff was provided with education about the benefits to hospice and processes were put into place that allowed for nursing to be a part of their patient's transfer to hospice. Improvements resulted in an increase of nursing staff understanding of hospice benefits and baseline of 0% of patients/families agreeing to transfer to hospice for planned withdrawal of life-sustaining treatment to 70%+ agreeing.15. ESAS to Improve Symptomatology Management/CommunicationBaylor St. Luke's Medical CenterHouston, TXTeam/Contact Information:Eyitayo O. OdeniyiAdvanced Practice Clinician, Palliative Care ProgramBaylor St. Luke's Medical Center8835 Aspen Meadow DriveHouston, TX 77071(832) 355-5158eodeniyi@stlukeshealth.orgTopics: Palliative Care Delivery/Operations: Implementation of standardized interventions such as checklists and screening toolsDescription:As the cost of health care continues to rise and the American public clamors for improved safety and quality of health care, the Center for Medicare and Medicaid Services has linked patient's evaluation of providers with reimbursement for services. Specific expectations and benchmark scores outlined, and if unmet, providers will be financially penalized. Therefore, hospitals across the nation are implementing efforts to improve patient and family satisfaction.The aim of this project is to answer the following questions. (1) Does the use of the Edmonton Symptom Assessment System improve registered nurses' knowledge of symptom assessment and management of patients with advanced and chronic diseases in an acute care hospital? (2) Will the implementation of the ESAS improve patients' and families' perception of communication with health care practitioners?16. Living with Dying in the PICU: A Nursing PerspectiveBloomsburg UniversityBloomsburg, PATeam/Contact Information:Debbie Stayer, PhDAssistant ProfessorBloomsburg University7 Cotswold StreetDanville, PA 17821(570) 275-9454dstayer@bloomu.eduTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery in specific hospital settings (e.g., ICU, ED)Description:The purpose of this study was to explore the experiences of pediatric ICU nurses who provide palliative care to children with life-threatening or life-limiting il

病院薬剤師が情報通信技術を用いて地域緩和ケアチームを後方支援することで在宅緩和ケアを行った一症例

We experienced the case of a woman with colorectal cancer in the end period being treated by a community palliative care team and hospital pharmacists, using a medical social networking service (SNS). The patient was experiencing somnolence, disturbance of consciousness and convulsion-like attacks at discharge. Based on information on the patient exchanged through SNS, we judged that she was receiving an excess dose of narcotic analgesics, and after suggesting a reduction in the dose of oxycodone, her level of consciousness and attack symptoms improved, and she experienced a painless condition. By using information sharing systems to support community palliative care teams, including community pharmacists, hospital pharmacists can contribute to the development of effective community medicine.

Are nurse prescribers issuing prescriptions in palliative care?

Prescribing in palliative care was an ‘early candidate’ area for the extension of nurse prescribing authority, but has failed to meet expectations. The low number of nurse prescribers working in palliative care, and the impact of the lack of this kind of professional, has received little attention. This paper gives details of an ‘in-depth service evaluation project’ relating to the prescribing activity of specialist palliative care nurse independent prescribers (SPCNIPs) in one community palliative care team to ascertain the volume of their prescribing activity as well identifications of the outcomes and influences to their prescribing activity.