Need For Palliative Care Services Research Articles

Primary palliative care in the ICU.

Despite the best efforts of modern health care and critical care providers, many patients in the intensive care unit (ICU) will still die each year. The need for palliative care services in the ICU is common. Although specialty palliative care services provide excellent care and are a tremendous resource, every critical care provider should be able to provide the basics of palliative care themselves through the model of primary palliative care. Although it may be uncomfortable for the critical care provider at first, providing palliative care to our ICU patients can be a very rewarding experience. In this article, I discuss best practices for handling difficult conversations with patients and their families, helping patients and families make difficult decisions regarding the goals of care, and managing symptoms at the end of life.

Occupations and occupational therapy practice with Chinese older adults living with life-limiting illnesses in Singapore: A focus group study.

While Singapore is rapidly ageing and the need for palliative care services is projected to rise, there has been limited exploration of the occupations of Chinese older adults with life-limiting conditions. This study is the third in a series of three studies aimed to address this issue. This study also sought to discuss future directions for occupational therapy practice with Chinese older adults living with life-limiting illnesses in Singapore. The study adopted a qualitative exploratory design using focus groups. Participants were recruited using convenience and snowball sampling. Inclusion criteria were occupational therapists who had attained full registration status with the Allied Health Professionals Council in Singapore, had two or more years of practice as an occupational therapist, and had a current or recent palliative care caseload. Three focus groups with 16 participants were conducted, and three themes were constructed from the data through reflexive thematic analysis. Reflections on culture and occupations is about the impact of a collectivist culture on occupations, such as tensions new caregivers experience between keeping clients safe and respecting clients' choices. It also highlights that there will always be individual differences within any cultural group. Challenges of occupational therapy practice in palliative care describe the need for therapists to be comfortable with rest and ethical tensions participants faced with billing for sessions that mainly involved time spent conversing with clients and when clients and caregivers' goals differed. Finally, Moving forward is about the importance of having mentors and the learning needs of occupational therapists in palliative care. Occupational therapists experienced in providing services to palliative care clients in Singapore emphasised the collectivist nature of Singaporean Chinese families and contributed more information to its possible impact on occupations and occupational therapy practice and made suggestions for future practice.

Caregivers’ Perceptions of Do Not Resuscitate Orders: A Qualitative Study in Rural Southwestern Kenya

The need for palliative care services has increased with the rise of patients with terminal illnesses. Unfortunately, there is a need for more research in palliative care, especially on end-of-life care. Conversations during that period present an ethical and cultural challenge in both collectivistic and individualistic societies. Worldwide, the laws regulating Do Not Resuscitate orders differ from country to country. The perceptions also vary from society to society. Studies have shown the need to involve families in this era of rising advocacy for patient-centered care. Caregivers have an essential role in decision-making and are involved in end-of-life decisions. This study aimed to describe caregivers' perceptions of Do Not Resuscitate orders. The study used a qualitative approach and phenomenological research design. It involved eighteen caregivers of patients receiving palliative care. The sampling procedure was non-probability purposive. Data was collected using in-depth interviews and analyzed using thematic analysis. Overall, two themes emerged from the findings. The first theme was a lack of awareness of the Do Not Resuscitate orders and the resuscitation techniques, and the second theme was subjective perceptions based on caregivers' beliefs and emotional responses. Caregivers need counseling, preparation, and education on Do Not Resuscitate orders and resuscitation methods to improve Do Not Resuscitate discussions. Healthcare providers need to be empowered to hold those discussions.

Put on the sidelines of palliative care: a qualitative study of important barriers to GPs’ participation in palliative care and guideline implementation in Norway

Background Demographic changes, the evolvement of modern medicine and new treatments for severe diseases, increase the need for palliative care services. Palliative care includes all patients with life-limiting conditions, irrespective of diagnosis. In Norway, palliative care rests on a decentralised model where patient care can be delivered close to the patient’s home, and the Norwegian guideline for palliative care describes a model of care resting on extensive collaboration. Previous research suggests that this guideline is not well implemented among general practitioners (GPs). In this study, we aim to investigate barriers to GPs’ participation in palliative care and implementation of the guideline. Methods We interviewed 25 GPs in four focus groups guided by a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Data were analysed qualitatively with reflexive thematic analysis. Results We identified four main themes as barriers to GPs’ participation in palliative care and to implementation of the guideline: (1) different established local cultures and practices of palliative care, (2) discontinuity of the GP–patient relationship, (3) unclear clinical handover and information gaps and (4) a mismatch between the guideline and everyday general practice. Conclusion Significant structural and individual barriers to GPs’ participation in palliative care exist, which hamper the implementation of the guideline. GPs should be involved as stakeholders when guidelines involving them are created. Introduction of new professionals in primary care needs to be actively managed to avoid inappropriate collaborative practices. Continuity of the GP–patient relationship must be maintained throughout severe illness and at end-of-life.

Survey of NCI-designated cancer centers on the utilization of palliative care in patients with pancreatic cancer.

248 Background: Pancreatic cancer, known as one of the deadliest cancers, has a high demand for palliative care. However, there remains a considerable amount of uncertainty regarding the nature of palliative care treatment to this specific patient demographic across the United States. This study aims to assess the utilization of palliative care in pancreatic cancer patients and explore the variations in timing and emphasis of palliative care involvement. Methods: We conducted a survey assessing utilization of palliative care in pancreatic cancer patients. We targeted palliative care directors at all 65 National Cancer Institute (NCI) cancer centers. The physicians were invited to voluntarily participate in the study. Responses were collected by email between May 30, 2023, and June 22, 2023. 1) Does your palliative care and/or oncology team have a policy to get involved with every pancreatic cancer patient (yes or no)? 2) When palliative care is involved with pancreatic cancer patients, in what setting are you typically/primarily first asked to be involved (early in the patient’s treatment journey, focusing more to assist with symptom management, or later in the patient’s treatment journey, focusing more on end-of-life discussions such as explaining hospice)? Results: We received responses from palliative care leaders at 65 NCI-designated palliative care centers, and thus 100% of the targeted population sample. Out of these centers, 64 indicated that there was no established policy for palliative care involvement with every pancreatic cancer patient. Among the respondents, 38 centers started intervention early, primarily focusing on symptom management, while 15 centers started palliative care late in the treatment process, with a focus on end-of-life discussions. Additionally, 12 centers reported that they first intervene both early and late when treating pancreatic cancer. Conclusions: The utilization of palliative care services improves various outcome measures. Pancreatic cancer has one of the lowest survival rates and is associated with significant morbidity. Our findings suggest an increasing recognition among medical centers of the need for palliative care services for pancreatic cancer patients. However, there is variation in the timing and emphasis of palliative care involvement, suggesting a need for further exploration in this area. Notably, there is a growing trend to integrate palliative care at an early stage. Future research should explore barriers to accessing palliative care, distinguish between inpatient and outpatient services, and compare outcomes of early versus late palliative care intervention. By addressing these areas, healthcare providers can enhance the quality of care and improve outcomes for pancreatic cancer patients.

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.

Estimating the Impact of Inpatient Palliative Care Consultations on Health Care Costs in a Low- and Middle-Income Country.

Background: The escalating cost of health care has important implications on national economies and public health. Palliative care (PC) consultations have been shown to reduce health costs while improving the quality of life. Aim: To assess the impact of PC consultations on hospital costs in a low- and middle-income country. Methods: We analyzed billing data of patients who received a PC consultation at our tertiary care hospital over a one-year period. Controls were patients with a serious illness who had at least one admission during the study period. Analysis was conducted for patients discharged alive and those who died during their hospitalization. The primary outcome was cost of hospitalization. Readmission rates, length of stay (LOS), and number of emergency department (ED) visits after discharge were secondary outcomes. Results: Daily hospital costs were 10% lower for patients who received a PC consult (n = 346) compared with controls (n = 698). This difference was more pronounced among patients who died during their hospitalization and when the consult was conducted earlier in the hospital course. LOS (4.92 vs. 4.68, p < 0.0001), readmissions (24.78% vs. 36.41%, p < 0.001), and ED visits after discharge were lower in the PC group compared with the control group (relative risk [RR] = 2.46). Conclusions: We used readily available hospital billing data to demonstrate the cost benefits of inpatient PC consultations. This simple approach can provide powerful data to justify the need for PC services.

186  Published discussion of palliative care for patients with long term neurological conditions

IntroductionThere is a growing recognition of the need for palliative care services for people with long-term neurological conditions (LTNC). However, in order to provide optimal treatment, there is a need for discussion and teaching within the relevant specialties, and research needs to provide evidence to inform provision of best medical practice.MethodsWe use number of abstracts from neurological, geriatric and palliative care conferences as a marker of the level of discourse at a clinical and academic levels. We searched ABN, BGS (British Geriatric Society), and APM (Association for Palliative Medicine) conference abstracts from 2014–2019 for neuro- logical and palliative search terms as appropriate.ResultsWe searched 3,750 abstracts over 21 conferences using the pre-specified search terms. Overall, only 2.19% out of these abstracts related to palliative issues in LTNC (ABN 21/1612 (1.3%), BGS 12/1017 (1.1%), APM 48/1121 (4.4%)) α2 p=3.2x10–8. ‘Dementia’ and ‘Parkinson’s’ were the most commonly identified LNTCs in BGS abstracts (each 4/12), with MND (14/48) and ‘dementia’ (10/48) dominating the APM abstracts.DiscussionThere is a dearth of published research and discussion at academic meetings related to the palliative needs of patients with LTNC. We believe these are necessary to inform best medical practice, and to establish policies and guidelines to serve this vulnerable group, or to inform the ongoing national debate.richard.n.rees@ucl.ac.uk

A Scoping Review on the Experience of Participating in Dignity Therapy for Adults at the End of Life.

Background: As the proportion of aging population is increasing, so is the need for palliative care services. The end of life is marked by suffering and currently it is not well addressed in palliative care. Dignity therapy (DT) is one of the most popular therapies aimed at reducing suffering at the life and yet the quantitative evidence supporting its effectiveness is mixed. Also, no study has looked extensively at the qualitative literature. Objective: To describe the experience of participating in DT for adults in end of life. Design: A scoping review was conducted on the experience of DT among adults at their end of life. We searched electronic databases between 2002 and 2020. Two reviewers independently screened, extracted, and coded the data. They were analyzed using a thematic framework approach. Results: Twelve articles were included in the final analysis and were published between 2010 and 2019. The articles originated from the United States (3), Canada (3), Poland (2), Australia (2), the United Kingdom (2), Italy (1), and Germany (1). Two main categories of themes emerged from our analysis: themes mentioned during the DT intervention and themes following the DT intervention. The primary themes found during the DT intervention are discussions relating to the end of life, reflection on life, and creating a life narrative. The themes found following the DT intervention are that it opened a reflection on the past, that this was a helpful intervention, and that it was difficult, but important. Conclusions: Few qualitative studies assessed the experience of participating in DT following the intervention. This gap in the literature could explain the difficulties we currently have in understanding the effects of DT. Future studies should aim to assess how the effects of DT are perceived by patients after the intervention.

Palliative Care Masterclass for Nurses in Central-Eastern Europe: An International Collaboration.

Given the increased need for palliative care services globally, the education of nurses has become paramount. In response, a group of nurses from Romania and the United States developed diverse nursing educational programs to meet the palliative care educational needs of nurses in Central-Eastern European countries. The purpose of this article is to describe a palliative nursing masterclass that was offered virtually to 59 participants, primarily nurses but also other health care professionals, from 11 Central-Eastern European countries.

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

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

Pilot of a pharmacist‐integrated interprofessional team to optimize prescribing in a telemedicine palliative care clinic

AbstractIntroductionThe rapidly growing number of frail elderly patients is leading to a greater need for palliative care services. Palliative care clinical pharmacy specialists (CPSs) can improve quality of care through comprehensive symptom and medication management. Incorporating pharmacists into palliative care through telemedicine meets complex pharmacotherapy needs of Veterans who have difficulty accessing care due to advanced illness.ObjectivesThe primary objective of this quality improvement project was to pilot a pharmacist‐integrated palliative care team clinic utilizing telemedicine to optimize palliative prescribing for Veterans and to describe CPS outcomes related to pharmacotherapy changes implemented. A secondary outcome was to assess Veteran satisfaction with assessments completed via telephone post visit.MethodsA CPS was integrated into the existing palliative care team beginning December 1, 2019 with video and audio telemedicine clinic appointments offered through May 31, 2020. The CPS completed comprehensive medication regimen reviews, assessed symptoms, and addressed medication‐related concerns during the visit. Recommendations for deprescribing opportunities and symptomatic management were provided to the consulting provider and/or primary treatment team. Recommendations made and those implemented within 30 days of the appointment were documented. Veteran satisfaction assessments were completed via telephone 14‐30 days after the clinic visit.ResultsThe palliative care team integrated a CPS and completed 25 consults via telemedicine technology between December 2019 and May 2020. The pharmacotherapy implementation rate was 60% (119/200) including a deprescribing rate of 57% (72/126), decreasing polypharmacy and potentially resulting in a decrease in adverse drug events. Veterans were on average very satisfied with their visit, with an assessment response rate of 56% (14/25).ConclusionPharmacist involvement with the palliative care team decreased polypharmacy, optimized symptom management, and increased use of telemedicine technology. Veterans were overall satisfied with the care received by the palliative care team via telemedicine technology.

Hong Kong’s Growing Need for Palliative Care Services and the Role of the Nursing Profession

This viewpoint paper explores the growing emphasis and social need for palliative care from a global perspective, juxtaposed against the Hong Kong status quo and its increasing need for such services. It further highlights that the role of nursing within palliative care is central to patients receiving the best quality of care. Hong Kong’s current delivery models are generally insufficient and can be improved by the adoption of five recommended policy changes, which reinforce the position of nurses as vital to creating a better service. These recommendations will enable nurses to take the lead in future palliative care delivery frameworks, enabling more efficient planning of future management of patients’ pain and other symptoms, social, spiritual, or emotional needs that arise during assessment. Its value may extend to other countries and settings.

In This Issue

This issue of the journal commences with an editorial that provides some discussion about the current approaches to Covid and the tensions that exists in that context..... Editorial SettingsCovid-19: A strife of interests for us all and what problem are we attempting to solve? Research Articles Gender Equity in Australian Health Leadership Research Articles Assessing Quality of Healthcare Delivery When Making Choices: National Survey on Health Consumers’ Decision Making Practices Research Articles The Case for a Reciprocal Health Care Agreement between Australia and South Korea Commentary COVID-19 and Working Within Health Care Systems: the future is flexible Review Articles Review of Public Private Partnership in the Health Care in Hong Kong Viewpoint Article Hong Kong’s Growing Need for Palliative Care Services and the Role of the Nursing Profession Commentary Vietnam’s Healthcare System Decentralization: how well does it respond to global health crises such as covid-19 pandemic? Research Articles Publicly Financed Health Insurance Schemes and Horizontal Inequity in Inpatient Service Use in India Research Articles Distress and Quality of Life among Type II Diabetic Patients: Role of physical activity Viewpoint Article Achievements and Challenges of Iran Health System after Islamic Revolution: Structural reforms at the second step Research Articles Strategic Analysis of Community Participation in Primary Health Care in Iran and Presentation of Promotion Strategies Using Internal and External Environment Assessment Techniques Research Articles Utilization of Healthcare Services &amp; Healthcare Expenditure Patterns in the Rural Households of Nepal

Palliative care services for cancer patients in Nepal, a lower-middle-income country.

With the rise in cancer burden, need for palliative care services has increased simultaneously and majority of people requiring services are from low- and middle-income countries where palliative care is in primitive stage. Nepal is also facing similar challenges of dealing with cancer care and end-of-life care. From its initiation in the early 1990s, there has been gradual progress in the development of palliative care with joint effort of government as well as non-governmental organizations. Morphine, a major milestone for pain management, is being manufactured in the country for nearly a decade, yet morphine equivalence mg per capita is far below the global average. Currently, Nepal has been placed under ‘Category 3a’ with isolated care provision and there are a lot of challenges to overcome to improve the existing services. Majority of hospice and palliative care centres are located in the capital city and only a few in the periphery. Scarcity of treatment centres and expertise, limited finances, lack of awareness among patients and health care workers, and difficult terrain are major barriers for optimal care. Proper implementation of national guidelines, human resource development and integration of palliative care to primary healthcare level would be crucial steps for further improvement.

Need for Palliative Care in Patient with Rheumatoid Arthritis: A Cross-sectional Observational Study.

Objectives:Rheumatoid arthritis (RA) is a chronic disorder causing inflammation in the joints and achieving remission is often the primary goal of physicians. We evaluated the suffering from RA and assessed the need for palliative care services in these patients.Materials and Methods:This cross-sectional observational study was done in 100 adult RA cases who attended the outpatient department. The Disease Activity Score 28 (DAS28), Health Assessment Questionnaire Disability Index, depression, anxiety and stress score, Short Form 36 Health Survey and numeric rating scale were assessed. The relationship between DAS28 with the other parameters and scores was assessed using Spearman’s rho correlation coefficient.Results:About 90% of patients in our study were female and majority (50%) had a moderate disease activity. The DAS28 showed a positive correlation with the degree of depression (r = 0.671, P = 0.000), anxiety (r = 0.609, P = 0.000) and stress levels (r = 0.474, P = 0.000). The patients with severe disease had a poor quality of life (QoL) [physical functioning (r = –0.737, P = 0.000); role limitation (r = –0.662, P = 0.000); emotional problem (r = –0.676, P = 0.000); energy/fatigue (r = –0.638, P = 0.000); social functioning (r = –0.658, P = 0.000); emotional well-being (r = –0.605, P = 0.000); general health (r = –0.643, P = 0.000); health change (r = –0.376, P = 0.000) and numerical rating scale score for pain (r = 0.656, P = 0.000)].Conclusion:RA patients with high disease activity suffer from depression, anxiety, stress and poor QoL. Palliative care physicians and rheumatologists must be vested with the power to provide comprehensive care to these patients.

QP3: Development of a PharmD-Integrated Interprofessional Palliative Care Clinic Utilizing Video Telemedicine Technology

Background: The rapidly growing number of frail elderly with chronic, life-threatening comorbidities in the United States is leading to a greater need for palliative care services. The West Palm Be...

Access to Palliative Care Services and Clinical Outcomes of Patients With Solid Malignancy-Associated Myelophthisis in a Resource-Limited Setting.

Myelophthisis (MPT) has been associated with a dreadful prognosis. Patients' access to palliative care (PC) and factors influencing its clinical outcomes are poorly described. Our aim was to analyze the impact of patient- and disease-specific characteristics on survival of patients with MPT and describe their use of PC in a resource-limited setting. Retrospective study including patients with solid tumor MPT, diagnosed between 1996 and 2018. Seventy patients (median 58 years) were included. 58% were synchronously diagnosed with MPT at time of primary tumor diagnosis. Most common oncologic diagnoses were prostate (25.7%), gastrointestinal (20%), and breast (18.6%) neoplasms. Median overall survival (OS) was 1.9 months. Primaries other than prostate, breast, and lung (HR 1.37, 95% CI 1.15 - 1.8; p = 0.02) and transfusion requirements (HR 2.8, 95% CI 1.01 - 7.9; p = 0.04) were independently associated with decreased OS. Administration of multiple systemic therapeutic interventions (HR 0.15, 95% CI 0.06 - 0.39; p = 0.01) was the sole factor improving OS. Assessment by PC was pursued in 51.4% of patients. The median number of consults per patient was two, with no difference in assessment rate or consult number across different primaries (P = 0.96). Four cases of palliative sedation were reported, all performed by the primary care team. MPT is highly heterogeneous and risk stratification to optimize the use of therapeutic interventions in unison with palliative interventions is needed to maximize efforts toward improving patient quality of life. There is an alarming need of PC services in the multidisciplinary management of patients within developing regions.

Is there an unmet medical need for palliative care services in Germany? Incidence, prevalence, and 1-year all-cause mortality of palliative care sensitive conditions: real-world evidence based on German claims data

AimTo characterize palliative care patients, to estimate the incidence, prevalence, and 1-year all-cause mortality in patients in Germany who received palliative care treatment.Subject and methodsThe study analyzed the InGef Research Database, which covers 4 million people insured in German statutory health insurance companies. Specific outpatient and inpatient reimbursement codes were used to capture cases with palliative conditions. The prevalence was ascertained for the year 2015. The incidence was calculated for patients without documented palliative care services in the year before the observation period. The Kaplan–Meier method was used to analyze the 1-year all-cause mortality.ResultsThe incidence rate of palliative conditions was 41.3 and 34.9 per 10,000 persons in women and men, respectively. The prevalence per 10,000 persons was 61.3 in women and 51.1 in men. The 1-year all-cause mortality among patients receiving their first palliative care treatment was 67.5%. Mortality was lower in patients receiving general outpatient palliative care treatment (AAPV; 60.8%) compared to patients receiving specialized outpatient palliative care treatment (SAPV; 86.1%) or inpatient palliative care treatment (90.6%). Within the first 30 days, mortality was particularly high (~43.0%).ConclusionsIn Germany, more than 400,000 patients per year receive palliative care treatment, which is lower compared to estimates of the number of persons with a potential need for palliative care. This gap was observed particularly in younger to middle-aged individuals. The findings indicate a demand for methodologically sound studies to investigate the public health burden and to quantify the unmet need for palliative care in Germany.

How many people need palliative care for cancer and non-cancer diseases in a middle-income country? Analysis of mortality data

Introduction: Aging of the population and the accompanying increase in prevalence of chronic illnesses mean that more people will need palliative care. This need has not been extensively quantified in middle-income countries to policy planning and expanding health care. Objective: Provide an estimate of the need of palliative care services in Colombia and compare these needs with the current available offer. Methods: Cross-sectional study based on mortality statistics for Colombia for the period 2012 to 2016. We calculated agespecific and sex-specific numbers of deaths and mortality rates from death certificates for defined chronic illnesses to estimate the prevalence of palliative care need in Colombia, and contrasted this information with the current offer according to the Colombian Observatory of Palliative Care. Results: The numbers of deaths requiring palliative care increased from 107,065 in 2012 to 128,670 in 2016 (61.2% of total deaths). The causes of these deaths vary by age group, with a clearly more important proportion of heart and cerebrovascular diseases and dementia in advances ages, and HIV/AIDS in young ages. In all age groups, malignant neoplasms are an important part of the causes of deaths of those requiring palliative care (31.3% of all deaths in 2016). Contrasting this needs, in most areas there is no or very limited offer of palliative care services. Conclusion: A real palliative care policy,including a vast increase in training opportunities in the field and regulation allowing a wide range of health practitioners to be involved in palliative care, is necessary in Colombia to improve the palliative care offer.