Concept Of Palliative Care Research Articles

Concept-dependent and -independent care effects of site-specific care concepts using "pain" as an example

Structures of palliative care, cross-sectoral transitions and care pathways of patients with palliative care needs were investigated at two sites. The systematic comparison of similarities and differences using the topic of 'pain' as an example is intended to provide information on the extent to which these are related to site-specific palliative care concepts (integrated and cooperative). The study follows amixed-methods design. In addition to adocument analysis of anonymised patient records (n = 774), expert interviews (n = 20), as well as interviews with patients, relatives (n = 60) and focus groups (n = 12), were conducted. The systematic comparative analysis provides evidence for concept-independent commonalities (e.g. sociodemographic distribution, aggravated pain treatment) as well as concept-dependent differences (e.g. care pathways, facilitated continuous symptom control through integrated care structures) in the context of integrated or cooperative palliative care. Commonalities and differences with regard to the topic of pain, as focused on here, and its organisational management become tangible as effects of the respective organisational structure (=concept-dependent) as well as concept-independent external influencing factors.

Importance of palliative care in oncology: a qualitative study

The objective is to know the perception of nursing professionals about the importance of palliative care in the hospital oncology sector. This is a descriptive-exploratory study of a qualitative nature, with nursing professionals from an oncology sector. Data collection was carried out through a questionnaire prepared on the Google Forms platform with previously structured questions. For data analysis, Braun and Clarke's thematic analysis was used. Eleven nursing professionals participated in the study, most of whom were female nursing technicians. From the data analysis, three themes emerged, namely: Concept of palliative care; Importance of palliative care in the hospital environment; Importance of approaching palliative care during academic training and continuing education. Research participants perceive the importance of introducing palliative care during their training and within the hospital environment. Reporting that the hospital environment is where most patients with life-threatening diseases are found, requiring a palliative care approach in this environment.

Knowledge, attitude toward palliative care and associated factors among clinical nurses in Vietnam.

137 Background: Nurses who offer palliative care must be knowledgeable about several aspects of caring for advanced cancer patient. The concept of palliative care is not widely discussed in Vietnam, and there needs to be more data regarding the knowledge and attitude of the nurses. This study’s objectives were to (1) Describe the knowledge and attitudes about palliative care of nurses and (2) Identify related factors with knowledge and attitudes about palliative care among those nurses. Methods: A cross-sectional study was conducted among 118 nurses working in a University Hospital. The Palliative Care Quiz for Nursing (PCQN) and The Frommelt Attitude Towards Care of the Dying Scale (FATCOD) were used to measure the participants' knowledge and attitude toward Palliative care. The 34-item of PCQN used a ‘true/ false/don’t know’ format with possible scores ranging from 0 to 34. The FATCOD consists of 30 items, Positive items were scored from 1 (strongly disagree) to 5 (strongly agree). Possible scores ranged from 30 to 150. The Statistical Package for Social Sciences (SPSS) version 21 was used to analyze the data. The level of significance for all analyses was set at less than 0.05. Results: There were 118 nurses completed the questionnaire. Most participants were female (69.5%) and younger than 25 years (84.7%). Nearly two-thirds of nurses had graduate and postgraduate degrees (67.8%) and 62% of nurses had more than five years of working experience. 24% of nurses have received palliative care training, and 96% of nurses wanted to learn palliative care, 85% of nurses reported that palliative care is necessary for their work. Most of them (78%) had moderate palliative care knowledge; only 31% of the nurses had a positive attitude toward palliative care. A significant relationship was found between working experience and a positive attitude toward palliative care (p < 0.05). Conclusions: Nurses’ knowledge and attitude about palliative care were not high. Clinical nurses need more education to develop their palliative care knowledge and skills. Palliative care should be added to the curriculum for undergraduate students.

Advance Care Planning in Taiwan

Taiwan has been promoting the concept of palliative care since 1983. In the 2021 global quality of death index, Taiwan ranked third. Regarding the development of patient autonomy, there are two phases. The first phase was the passage of the Hospice Palliative Care Act in 2000, which respects the personal choices of terminally ill patients, including the decision to refuse cardiopulmonary resuscitation and to withhold or withdraw life-sustaining treatment. The second phase was the passage of the Patient Right to Autonomy Act in 2015, which expanded the scope of application beyond terminally ill patients to include four other severe and irreversible conditions, while providing clearer explanations on life-sustaining treatment and artificial nutrition. Taiwan's legislation regarding the respect for patient autonomy has become increasingly comprehensive. However, there is still room for improvement in its practical implementation.

Patient Safety in Palliative Care at the End of Life from the Perspective of Complex Thinking.

Actions for patient safety at the end of life must be aligned with the principles of palliative care, such as promoting comfort and quality of life. Faced with this complex process, health professionals need to seek the central relationships of the concepts of safety and palliative care to the end of life, in line with the wishes and expectations of the person and family members/caregivers, as well as with available resources and the capacity of services but, above all, reinforcing the importance of a non-reductionist care approach, which encompasses the various aspects inherent to humans. Hence, we present a new vision of patient safety in palliative care at the end of life based on the complex thinking of Edgar Morin, scientific evidence, and health policies in the global context. We discuss the deficiencies and disjunctions in thought and practice of palliative care at the end of life and patient safety, as well as the challenges for the conjunction of these complex themes, to finally present potential ways to apply complex thinking in the safe care of the patient at the end of life. The problematization of different aspects for the interposition of knowledge about patient safety in palliative care at the end of life portrays the existence of intersubjective connections and the multidimensionality that permeate the guidelines, actions and relationships that sustain the disciplines.

Development of Cancer Palliative Care in Turkey.

Palliative care is an important component of integrated, person-centered health care. It can be provided alone or in combination with the patient's medical treatment, not only by the palliative care team but also by the healthcare team caring for the patient. The concept of palliative care was developed in 2010 along with the establishment of the National Cancer Control Program in Turkey, and today there are many palliative care units, especially in metropolitan hospitals, that provide comprehensive palliative care. One-third of patients who come to the palliative care unit for treatment of pain, malnutrition, and respiratory problems are cancer patients. The care needs of all patients presenting to the palliative care unit are assessed, and a multidisciplinary team plans comprehensive palliative care for patients. Theoretical and practical patient care training is provided by palliative care nurses for family members or caregivers. Considering the burden of cancer as well as the increasing life expectancy at birth, it can be stated that the actual need for palliative care in Turkey will be much greater in the near future.

Preparing Future Doctors for Palliative and End of Life Care in Kenya: Cross-sectional Survey

Purpose: The main aim of this study was to assess how prepared are Kenyan doctors in delivering palliative and end of life care to chronic and life-threatening conditions.
 Methodology: Cross-sectional survey was used to assess doctor’s palliative and end of life practices. Multi-center (three-mission referral and teaching hospitals in Kenya): Tenwek, Kijabe, and Chogoria were used to collect data from 96 medical practioners. Medical doctors with at least 6 months managing patients with chronic conditions (cancer, HIV/AIDS and other life-threatening conditions) were recruited into the study. The quantitative data was analysed using an independent t-test. All ethical considerations were addressed.
 Findings: Majority of doctors interviewed were generalists who had managed chronic diseases. Majority had basic concepts of palliative care and end of life care. Those who had received prior training in palliative care were better in performance’s score on knowledge questions regarding palliative care and end of life. Medical doctors were knowledgeable on psychological distress and opioids effects domains as compared to delirium and dyspnea domains. Among those who were knowledgeable in palliative care and end of life care were doctors trained outside Kenya, those who were senior with more experiences (>10 years), over 40 years and had further training after their undergraduate
 Unique Contribution to Theory, Practice and Policy: This study seeks to develop training tailored to Kenyan doctors and Physicians on end-of-life care practices in selected counties then roll-out to the rest of the counties in the country in collaboration with Ministry of Health Kenya and also provide opportunities for doctors to develop palliative and end-of-life care skills especially for resident and junior doctors. This study will also form basis for policy development on palliative and end-of-life care practices in Kenya, which currently is non-existent. End-of-life care Policy would aid in clinical application of good practices surrounding palliative and end-of-life care which should be implemented in Kenya. This study advocates inclusion of end-of-life care training modules in a standardized curriculum for undergraduate as part of training and preparing future Kenyan doctors. Further, this study can be considered as current Physician’s approach to end-of-life care practices in Kenya which then can be a basis to develop guidelines and standards addressing end-of-life which is fraught with ethical and medical dilemmas carried by healthcare professionals.

Особливості психотерапевтичного супроводу в структурі паліативної допомоги хворим, які страждають на злоякісні новоутворення

Palliative medicine is aimed at achieving the best possible in a particular situation the level of quality of life of the patient. Purpose - to investigate that the grief reaction is one of the strongest and most painful human experiences. Materials and methods. There were 120 cancer patients observed. The reaction of grief consists of 4 stages: shock and protest - numbness, disbelief and acute dysphoria; absorption - acute longing, search and anger; disorganization - a sense of despair and acceptance of loss and decision. Results. The initial reaction of grief - shock, emotional numbness and disbelief. The excitement is most pronounced within about two weeks, followed by symptoms of depression, which reach its peak 4-6 weeks. Eventually, the former intense pain of severe loss begins to subside. In addition to the reaction of grief, there is a pathological, which is divided into suppressed (inhibited), delayed (delayed) and chronic. The role of the psychotherapist at this stage is to provide psychological support and assistance to both the patient and his environment to cope with this situation. Conclusions. The principle of the concept of palliative care is the need to ensure the psychological comfort of the patient. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Integrating Surgical Palliative Care Into the Full Spectrum of Medical Education.

We describe our institutional approach to incorporating surgical palliative care education into the Undergraduate Medical Education, Graduate Medical Education and Continuing Medical Education spaces as a model to help guide similarly interested educators. We had a well-established Ethics and Professionalism Curriculum, but an educational needs assessment revealed that both the residents and faculty felt that additional training in palliative care principles was crucial. We describe our full spectrum palliative care curriculum, which begins with the medical students on their surgical clerkship and continues with a 4week surgical palliative care rotation for categorical general surgery PGY-1 residents, as well as a Mastering Tough Conversations course over several months at the end of the first year. Surgical Critical Care rotations, Intensive Care Unit debriefs after major complications, deaths, and other high-stress events are described, as is the CME domain, which includes routine Department of Surgery Death Rounds and a focus on palliative care concepts in Departmental Morbidity and Mortality conference. The Peer Support program and Surgical Palliative Care Journal Club round out our current educational endeavor. We describe our plans to create a full spectrum surgical palliative care curriculum that is fully integrated with the 5 clinical years of surgical residency, and include our proposed educational goals and year-specific objectives. The development of a Surgical Palliative Care Service is also described.

Implementation Status of Palliative Care for Patients Died in Peking Union Medical College Hospital,2019

Objective To reveal the current situation of palliative care for patients who died in Peking Union Medical College Hospital,so as to guide the practice of palliative care for patients in terminal stage. Methods A retrospective study was conducted on patients who died in Peking Union Medical College Hospital from January 1,2019 to December 31,2019.The general clinical data of the patients,whether they received palliative care,and the treatment details including invasive rescue measures,symptom controlling,and psychological,social,and spiritual care status before dying were collected for descriptive analysis. Results A total of 244 inpatients died in 2019,including 135 males and 109 females,with an average age of (65.9±16.4) years (1 day to 105 years).Among the 244 patients,112 (45.9%) died of neoplastic diseases and 132 (54.1%) died of non-neoplastic diseases.Sixty-one (25.0%) patients received palliative care before death,and they were mainly distributed in internal medicine departments such as nephrology (100.0%),gastroenterology (80.0%),and geriatrics (72.7%).Twenty-nine patients received sound palliative care,with all symptoms under control and no invasive treatment before death,and twenty-six patients received psychological,social,and spiritual care.Compared with the patients who were not exposed to the concept of palliative care,the patients who received palliative care showed decreased probabilities of cardiopulmonary resuscitation (0 vs 20.2%;χ2=13.009,P<0.001),tracheal intubation (3.3% vs 48.6%;χ2=38.327,P<0.001),and invasive mechanical ventilation (4.9% vs 47.5%;χ2=33.895,P<0.001) and an increased probability of psychological,social,and spiritual care (54.1% vs 2.4%;χ2=91.486,P<0.001). Conclusion The concept of palliative care has a positive impact on the death of end-stage patients.Palliative care services can increase the probability of end-stage patients receiving psychological,social,and spiritual care and reduce the use of invasive treatment.

Attitudes and knowledge of palliative care of Chinese undergraduate nursing students: A multicenter cross-sectional study

BackgroundHelping patients and families to relieve severe pain and manage grief are issues that palliative care is designed to address, but integrating these topics in nursing education and practice requires increased attention. It is necessary to understand the knowledge and attitudes of nursing students to develop a targeted approach toward integrating palliative care in practice settings. ObjectivesTo investigate attitudes and knowledge toward palliative care among undergraduate nursing students in China and to explore correlations and associated factors. DesignA cross-sectional study. SettingsSeven comprehensive universities in China. ParticipantsA total of 582 undergraduate nursing students participated. MethodsOnline questionnaires were available from December 2020 to February 2021. The Frommelt Attitude Toward Care of the Dying Scale and the Palliative Care Quiz for Nursing were used to measure students' attitude and knowledge of palliative care. Descriptive and correlational methods were used to analyse the associated factors and their correlation with knowledge and attitudes. ResultsAttitude scores showed significant differences in gender, education level, religious preference, previous education in palliative care, experience in caring for dying patients and previous experience with bereavement. Knowledge of palliative care was influenced by gender, religious preference, prior education in palliative care, experience in caring for dying patients, and previous experience with bereavement. A positive correlation exists between knowledge and attitudes toward palliative care among undergraduate nursing students. ConclusionsThe findings highlight the need to offer palliative care courses in nursing education and practice settings in Chinese health care settings. Nurse educators need to integrate the concept of palliative care into the curriculum of nursing education programs. Healthcare administrators and nurse leaders should promote investment and training in the education of nurses in practice settings to deliver high-quality palliative care services.

Learning to switch gears - Steering palliative care into emergency medicine.

Emergency care is largely seen as synonymous with resuscitation and saving lives. In most of the developing world where Emergency Medicine (EM) is still evolving, the concept of EM palliative care is alien. Provision of palliative care in such settings poses its own challenges in terms of knowledge gaps, socio-cultural barriers, dismal doctor-to-patient ratio with limited time for communication with patients, and lack of established pathways to provide EM palliative care. Integrating the concept of palliative medicine is crucial for expanding the dimension of holistic, value-based, quality emergency care. However, glitches in decision-making processes, especially in high patient volume settings, may lead to inequalities in care provision, based on socio-financial disparities of patients or premature termination of challenging resuscitations. Pertinent, robust, validated screening tools and guides may assist physicians in tackling this ethical dilemma.

Palliative care in China: a way out of the dilemma

It is still common for terminally ill patients to suffer from pain, and the development of palliative care faces many obstacles. The value of death to human society is ignored, and the intrinsic relationship between the meaning of life and the value of death has not been fully explored. This article discusses the current status of palliative care in China, how clinicians reflect and respond, the change of the whole society's concept of palliative care, and suggestions for action, and tries to provide a medical humanistic perspective for walking out of the dilemma of palliative care.

Satisfaction with care provided by home-based palliative care service to the cancer patients in Dhaka City of Bangladesh: A cross-sectional study.

Patient satisfaction is an important quality indicator of health care service. The concept of home-based palliative care has been recently introduced in Bangladesh, but the patients' satisfaction with this care remained unexplored. This study aimed to assess the satisfaction of the cancer patients receiving this care. This cross-sectional study was conducted among 51 surviving cancer patients above 18 years of age registered under the home-based care service of the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Data were collected by face-to-face interviews using a structured questionnaire based on the FAMCARE P16 questionnaire from February to March 2019. Descriptive analysis was done for the sociodemographic and satisfaction-related indicators. A correlation matrix was done to see the correlation among the satisfaction indicators. The majority of the patients (88.2%) were satisfied with the service provided by the home care team. Most (76.5%) of the patients were women, and the mean age was 56.25 ± 14.8 years. The median duration of getting home-based care was 4 months. Main satisfaction indicators were-assessment of physical symptoms (70.6%), providing information about pain management (70.6%), the inclusion of the family in decision making (76.5%), coordination of care between the members of the home care team (84.3%) and availability of doctors, nurses and palliative care assistants (74.5%). A high correlation was observed between satisfaction regarding the care of physical symptoms and provision of information (R = 0.814, p < 0.001). Also, satisfaction regarding the provision of information and support provided to the family is highly correlated (R = 0.722, p < 0.001). Despite the limitations, the overall satisfaction level of the patients regarding home-based palliative care services in Bangladesh is very high. Home-based palliative can be a solution to provide palliative care to patients who are unable to access institution-based care and improve their quality of life.

Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review.

The provision of palliative care in the intensive care unit (ICU) is increasing. While some scholars have suggested the goals of palliative care to not be aligned with the ICU, some evidence show benefits of the integration. This review aimed to explore and synthesize research that identified barriers and facilitators in the provision of palliative care in the ICU. This review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines based on population, concept, and context. We searched for eligible studies in five electronic databases (Scopus, PubMed, ProQuest, Science Direct, and Sage) and included studies on the provision of palliative care (concept) in the ICU (context) that were published in English between 2005-2021. We describe the provision of palliative care in terms of barriers and facilitators. We also describe the study design and context. A total of 14 papers was included. Several barriers and facilitators in providing palliative care in the ICU were identified and include lack of capabilities, family boundaries, practical issues, cultural differences. Facilitators of the provision of palliative care in an ICU include greater experience and supportive behaviors, i.e., collaborations between health care professionals. This scoping review demonstrates the breadth of barriers and facilitators of palliative care in the ICU. Hospital management can consider findings of the current review to better integrate palliative care in the ICU.

Palliative and Hospice Care in Nursing Homes: Discrepancies Between Theoretical Framework and Everyday Practice

Despite the existence of a legislative framework, palliative care and hospice support in nursing homes vary widely. Although most nursing homes have palliative care concepts by now, they are rarely integrated into everyday practice. This study aims to examine differences in palliative and hospice care and to determine the causes of discrepancies between theoretical framework and everyday practice. Based on a pilot project, in depth structural and process analyses of two nursing homes in urban and rural areas in North Rhine-Westphalia were conducted. In addition, three nursing homes of an extended group of providers as well as an expert advisory board was included to minimize (provider-) specific characteristics and to expand findings. Although the proportion of palliative residents and their average age was comparable, analyses revealed significant differences between the nursing homes regarding the palliative length of stay (213.2 days vs. 88.6 days) as well as the mortality rate of palliative residents among all death cases (26% vs. 63.6%). Furthermore, internal processes within the nursing homes differed vastly despite similar concepts and procedural instructions. As a result, palliative care formally started at an earlier stage in nursing home X. Besides that, the identification of palliative care situations, as well as communication, organizational processes and the inclusion of cooperation partners, took place without fixed structures and was based on the subjective handling of staff members in both facilities. It turns out to be challenging for nursing homes to implement theoretical framework into everyday practice. To facilitate this process, aside from practicable assessments, defined responsibilities and organizational support, financing concepts at health policy level need to be established.

Experiences of Nurses in Nursing Homes during the COVID-19 Pandemic in Germany: A Qualitative Study.

(1) Background: The aim of this qualitative study was to examine pandemic-related changes in nursing work in nursing homes, the resulting work-related stresses and external as well as internal alleviating measures. (2) Methods: We conducted 10 interviews from March to June 2021 with nurses from eight facilities. Data were analysed according to qualitative content analysis. (3) Results: Nurses faced increased workloads due to regulations and guidelines paired with staffing shortages. Work became more difficult due to personal protective equipment (PPE), conflict with residents’ relatives and, in the case of outbreaks, excess death and suffering. Nurse-to-resident care work became more emotionally demanding, with residents more distressed due to the lockdown, while families and social workers were not allowed into the facility. Residents with dementia posed an additional challenge, as they did not remember hygiene and distancing rules. Internal and external measures were not sufficient to alleviate the situation. However, some measures, such as training programmes or existing palliative care concepts, were considered helpful. (4) Conclusions: Facing other possible upcoming pandemics, ways to improve facility administration to prepare for future pandemics are highly needed, such as regular training programmes to prepare for possible lockdown scenarios, PPE use or potential hygiene measures.

An Evolutionary Concept Analysis of Palliative Care in Oncology Care.

This evolutionary concept analysis reports on the concept of palliative care in oncology. Despite its relevance to oncology, the concept of palliative care remains misunderstood, resulting in erroneous interpretations by nurses and health care providers alike. Consequently, integration of palliative care remains heterogeneous and highly contextual. Findings highlight the complexity and ambiguity of the concept of palliative care in the context of oncology care. The nuances and complexity of when to integrate palliative care for patients living with cancer, as well as its evolution from its origins in the hospice movement, have led to its ambiguity in clinical practice.

Teaching in Times of Crisis Through a Palliative Care Lens.

The disruption of classroom and clinical education caused by the COVID-19 pandemic resulted in student distress and worry regarding the future of their education. Faculty trained in palliative care adapted the SPIKES mnemonic and applied it to real-time interactions with students in an effort to decrease distress and enable continued learning. Palliative care concepts, approaches, and techniques can be used to successfully facilitate faculty-student interactions during times of crisis and rapidly changing educational environments.

Quality of life of the cancer patients receiving home-based palliative care in Dhaka city of Bangladesh.

The concept of home-based palliative care has been recently introduced in Bangladesh, but the patients' quality of life remains unexplored. This study aimed to assess the quality of life and its determinants of the cancer patients receiving home-based palliative care in Dhaka, Bangladesh. This cross-sectional study was conducted among 51 surviving cancer patients above 18 years registered under the home-based care service of the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Data was collected by face-to-face interview using a structured questionnaire based on the "Functional Assessment of Chronic Illness Therapy-Palliative (FACIT-Pal)" questionnaire from February to March 2019. Descriptive analysis was done for the socio-demographic, disease and treatment related factors. Mann-Whiteney U test, Kruskal-Wallis H test, and logistic regression were done to determine the relationships between independent variables and QoL. The majority of the patients (76.5%) were women. The mean age of the respondents was 56.2±4.8 years. Common primary sites of cancer were breast (39.2%), gastrointestinal (17.6%), and genitourinary system (23.5%). The median duration of getting home-based care was four months. The most prevalent problems were pain, sadness, feeling ill, and lack of satisfaction regarding sexual life. The majority (88.2%) of the patients had an average and above-average quality of life. Although, 92.1%patients had average or above-average social and emotional wellbeing, 60.8% had below-average physical wellbeing. Patients' marital status, belief about disease prognosis, and duration of getting home-based care had a positive influence, and age negatively influenced the quality of life. The majority of the patients receiving home-based palliative care in Dhaka city had average or above-average quality of life. However, these patients had better social and emotional wellbeing, but the physical wellbeing and symptom control were below-average according to the individual domain.