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1
Woods, Anne, Kathleen Willison, Cindy Kington, and Alan Gavin. "Palliative Care for People with Severe Persistent Mental Illness: A Review of the Literature." Canadian Journal of Psychiatry 53, no. 11 (November 2008): 725–36. http://dx.doi.org/10.1177/070674370805301104.
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A systematic overview of the literature on palliative care for people with severe persistent mental illness (SPMI) was conducted to inform clinical practice, research, and education. Empirical studies and nonempirical papers were included. Few empirical studies exist. There is even less information about the palliative care needs of, or the nature of palliative care provided to, people with SPMI. Mental health, primary care, and palliative care providers need to partner with people who have SPMI in developing and providing palliative care. The field of palliative care for people with SPMI is wide open and in need of methodologically sound studies that will help define the issues that exist for this vulnerable population. Recognizing the similarities between mental health and palliative care should lead to collaborative ventures and discussions in an attempt to address common and parallel issues.
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Chapman, Simon, and Nick Hayes. "Palliative care and the Mental Capacity Act." Working with Older People 11, no. 1 (March 2007): 21–24. http://dx.doi.org/10.1108/13663666200700006.
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Tinkler, Marianne, Joanne Reid, and Kevin Brazil. "Co-Design of an Evidenced Informed Service Model of Integrated Palliative Care for Persons Living with Severe Mental Illness: A Qualitative Exploratory Study." Healthcare 9, no. 12 (December 9, 2021): 1710. http://dx.doi.org/10.3390/healthcare9121710.
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Background: Globally, close to one billion people are living with a mental health disorder, and it is one of the most neglected areas in Public Health. People with severe mental illness have greater mortality risk than the general population, experience health care inequalities throughout life and represent a vulnerable, under-served and under-treated population, who have been overlooked in health inequality research to date. There is currently a dearth of evidence in relation to understanding the palliative care needs of people with severe mental illness and how future care delivery can be designed to both recognise and respond to those needs. This study aims to co-design an evidenced informed service model of integrated palliative care for persons living with a severe mental illness. Methods: This qualitative sequential study underpinned by interpretivism will have six phases. An expert reference group will be established in Phase 1, to inform all stages of this study. Phase 2 will include a systematic literature review to synthesise current evidence in relation to palliative care service provision for people with severe mental illness. In Phase 3, qualitative interviews will be undertaken with both, patients who have a severe mental illness and in receipt of palliative care (n = 13), and bereaved caregivers of people who have died 6–18 months previously with a diagnosis of severe mental illness (n = 13), across two recruitment sties in the United Kingdom. Focus groups (n = 4) with both mental health and palliative care multidisciplinary staff will be undertaken across the two recruitment sites in Phase 4. Phase 5 will involve the co-design of a service model of integrated palliative care for persons living with severe mental illness. Phase 6 will develop practice recommendations for this client cohort. Discussion: Palliative care needs to be available at all levels of care systems; it is estimated that, globally, only 14% of patients who need palliative care receive it. Reducing inequalities experienced by people with severe mental illness is embedded in the National Health Service Long Term Plan. Internationally, the gap between those with a mental illness needing care and those with access to care remains considerable. Future policy and practice will benefit from a better understanding of the needs of this client cohort and the development of a co-designed integrated care pathway to facilitate timely access to palliative care for people with a severe mental illness.
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Chochinov, Harvey Max. "Palliative Care: An Opportunity for Mental Health Professionals." Canadian Journal of Psychiatry 49, no. 6 (June 2004): 347–49. http://dx.doi.org/10.1177/070674370404900601.
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Sheridan, Ann Josephine. "Palliative care for people with serious mental illnesses." Lancet Public Health 4, no. 11 (November 2019): e545-e546. http://dx.doi.org/10.1016/s2468-2667(19)30205-1.
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Croft, Suzy. "Palliative care within mental health: principles and philosophy." Disability & Society 28, no. 5 (July 2013): 737–38. http://dx.doi.org/10.1080/09687599.2013.801680.
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Etgen, Thorleif. "Case series of introducing palliative care consultation in psychiatry." Palliative Medicine 34, no. 5 (February 17, 2020): 680–83. http://dx.doi.org/10.1177/0269216319901241.
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Background: The significance of palliative care consultation in psychiatry is unclear. Actual case series: Analysis of the introduction of palliative care consultation in a large psychiatric hospital. Possible courses of action: Continue without offering, survey the need for or offer palliative care consultation, and analyse its introduction. Formulation of a plan: Palliative care consultation was established and details including patient age, department, diagnosis, main problem, solution and discharge were analysed during the first 2 years. Outcome: Two consultations in the first year and 18 consultations in the second year were requested (18 geriatric, 2 addiction, 0 general, clinical social and forensic psychiatry) involving two domains: delirium associated with dementia or another condition (75%) and mental illness (e.g. alcoholic psycho-syndrome, psychosis, suicidal tendency, schizophrenia, depression) and cancer (25%). Recommendations of consultations were realized in 95%. Lessons from the case series: Implementation of palliative care consultation in psychiatry is one possible method of how to introduce palliative care in a field of medicine with lack of palliative care. View: Future research should focus on reasons for reservations about palliative care in psychiatry, include more patients with severe persistent mental illness and assess the value of palliative care consultation in resolving this problem.
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May, Susann, Franziska Gabb, Yuriy Ignatyev, Jana Ehrlich-Repp, Kerstin Stahlhut, Martin Heinze, Matthew Allsop, Henrikje Stanze, and Felix Muehlensiepen. "Mental and Physical Well-Being and Burden in Palliative Care Nursing: A Cross-Setting Mixed-Methods Study." International Journal of Environmental Research and Public Health 19, no. 10 (May 20, 2022): 6240. http://dx.doi.org/10.3390/ijerph19106240.
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The working routines in palliative care nursing are associated with a variety of causes of stress with regional and setting-specific differences in Germany. This mixed-methods study aimed to investigate the mental and physical well-being among nurses in German palliative and hospice care and to gain a deeper understanding of procedural and structural aspects that may influence the mental and physical burden in palliative nursing care. The mixed-methods approach combined qualitative interviews, (n = 16) an online survey (n = 101), and subsequent data validation in a focus group (n = 6). Interview and focus group data were analysed using structured qualitative content analysis. Survey data were analysed using descriptive statistics and an explorative quantitative analysis. Moderate to very high levels of stress were reported across all settings, but were highest for nurses in specialized outpatient palliative care settings. Underlying causes of stress related to working conditions in the nursing profession across all palliative care settings were poor working hours, perceived inadequate remuneration, and high demands for documentation. To ensure sustainable high-quality palliative care, adaptations to working conditions that target causes of stress and burden in palliative care nurses are required.
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Lindblad, Anna, Gert Helgesson, and Manne Sjöstrand. "Towards a palliative care approach in psychiatry: do we need a new definition?" Journal of Medical Ethics 45, no. 1 (September 28, 2018): 26–30. http://dx.doi.org/10.1136/medethics-2018-104944.
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Psychiatry today is mainly practised within a curative framework. However, many mental disorders are persistent and negatively affect quality of life as well as life expectancy. This tension between treatment goals and the actual illness trajectory has evoked a growing academic interest in ‘palliative psychiatry’, namely the application of a palliative care approach in patients with severe persistent mental illness. Recently, Trachsel et al presented a working definition of palliative psychiatry. This first official attempt to capture the concept is based on WHO’s widely accepted definition of palliative care but modified and limited to include only severe persistent psychiatric illness. While this is a welcome step in the discussion on palliative care approaches in psychiatry, it also opens up for new questions. One of the most evident is whether psychiatry actually needs its own definition of palliative care or, put differently, whether there is something about mental disorders that differs so radically from other medical conditions that it calls for a separate definition. We acknowledge the need to discuss the goals of psychiatric care in patients with severe persistent psychiatric illness. However, we question whether a separate definition of palliative care exclusive to psychiatry is the right way to go. In this paper, we discuss why.
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Kozlov, E., and C. Reid. "BARRIERS AND FACILITATORS TO PROVIDING MENTAL HEALTH CARE WITHIN PALLIATIVE CARE." Innovation in Aging 2, suppl_1 (November 1, 2018): 66–67. http://dx.doi.org/10.1093/geroni/igy023.250.
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Chopra, Esther Macedo. "PALLIATIVE CARE: THE PRACTICE OF END OF LIFE CARE." SCHOLARLY RESEARCH JOURNAL FOR INTERDISCIPLINARY STUDIES 8, no. 65 (July 1, 2021): 14891–900. http://dx.doi.org/10.21922/srjis.v8i65.1331.
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Providing care to the sick is not an obligation but a duty that is bound with human connectedness to each other. Palliative care picks up the strings along with curative treatment to try and provide a comfortable death. Palliative care is provided after a complete assessment is done on the symptoms and the stage of the disease and the condition of the patient. This discipline works not in isolation but with the patient’s family or care giver. The family becomes a part of providing treatment to the patient and they are also given emotional and mental support.
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Donald, Erin E., and Kelli I. Stajduhar. "A scoping review of palliative care for persons with severe persistent mental illness." Palliative and Supportive Care 17, no. 04 (March 19, 2019): 479–87. http://dx.doi.org/10.1017/s1478951519000087.
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AbstractObjectivePeople with severe persistent mental illness (SPMI) experience a greater burden and severity of chronic disease, late diagnosis, and premature death compared with the general population. Those with SPMI also receive fewer medical treatments, poor quality of care, and are less likely to receive palliative care. A systematic scoping review was undertaken to determine the extent, range, and nature of research activity about people with SPMI requiring palliative care, and to identify gaps and opportunities for future research.MethodA systematic scoping review was undertaken in September 2017 and updated in May 2018 to map literature on this topic, determine the extent and range of what has been published, and report the findings. This five-stage framework was conducted by (1) identifying the research question; (2) identifying relevant studies; (3) determining study selection; (4) charting the data; and 5) collating, summarizing, and reporting the results. A narrative approach to analysis was used to synthesize and interpret findings. A search of multidisciplinary healthcare databases resulted in 46 included articles.ResultFour major themes were identified from the included studies: complexity of care; limited access to care (both through systems and healthcare providers); competence and autonomy; and the potential for relationships between mental health and palliative care.Significance of resultsThis review reveals a highly vulnerable population with complex needs that are not reliably being met by the healthcare system and providers. Research in this area must continue to develop using rigorous qualitative and quantitative study designs, and interventions should be developed and tested based on existing knowledge to inform care. The voices of people with SPMI in need of palliative care must be represented in future studies to address gaps. To expand a body of literature addressing mainly individuals, system perspectives and sociocultural analysis can bring much to contextualizing the experience of living with SPMI in the palliative phase of care. Adoption of a palliative approach, which promotes the principles of palliative care across nonspecialized care settings provided by nonspecialist palliative providers, has the potential to increase access to high-quality palliative treatment for people with SPMI.
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Rosenfeld, Barry, Rebecca Saracino, Kristen Tobias, Melissa Masterson, Hayley Pessin, Allison Applebaum, Robert Brescia, and William Breitbart. "Adapting Meaning-Centered Psychotherapy for the palliative care setting: Results of a pilot study." Palliative Medicine 31, no. 2 (July 21, 2016): 140–46. http://dx.doi.org/10.1177/0269216316651570.
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Aims: To establish preliminary evidence for the feasibility, acceptability, and utility of an abbreviated version of Meaning-Centered Psychotherapy tailored to the needs of palliative care patients in the final weeks or months of life. Background: Surprisingly, few mental health interventions have specifically targeted the psychological needs of palliative care patients, when physical comfort seems to take precedence over mental health and emotional needs. Yet the need for mental health services targeting these patients is clear, as one in three palliative care patients experience clinically significant depression and an equal proportion experience clinically significant anxiety. Design: This pilot study used an open-label design to assess the feasibility, acceptability, and perceived utility of Meaning-Centered Psychotherapy–palliative care, a brief intervention that focuses on enhancing meaning at the end of life. Setting/participants: A total of 12 patients admitted to a palliative care hospital for supportive care consented to participate in the study. Results: Of the 11 patients that began treatment (one patient died before the first session), 8 completed the three-session intervention. Patients expressed positive feedback about the structure, focus, and length of the intervention, but varied in precisely which elements they found most helpful. Conclusion: An abbreviated version of Meaning-Centered Psychotherapy tailored to the needs of palliative care patients (Meaning-Centered Psychotherapy–palliative care) appears to be feasible, acceptable, and has the potential to help patients better cope with the challenges inherent in confronting death and dying. Further research, with larger and more representative samples, is needed in order to clarify the strengths and weaknesses of this approach.
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Wheat, Janelle, Kirsty Smith, Julianne Whyte, and Janelle Thomas. "Closing the mental health treatment gap in palliative care." International Journal of Integrated Care 17, no. 5 (October 17, 2017): 394. http://dx.doi.org/10.5334/ijic.3712.
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Whyte OAM, Julianne, Janelle Thomas, Kirsty Smith, and Janelle Wheat. "Bridging the mental health treatment gap in palliative care." International Journal of Integrated Care 18, s1 (March 12, 2018): 144. http://dx.doi.org/10.5334/ijic.s1144.
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Awasthi, Supriya, Ajoke Akinola, and Ahmad M. Sedeqi. "CanSupport palliative care in India: commentary article." International Journal Of Community Medicine And Public Health 9, no. 3 (February 28, 2022): 1514. http://dx.doi.org/10.18203/2394-6040.ijcmph20220722.
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India is home to one of the largest palliative care organizations in Asia. Palliative care is specialized medical care for the well-being of the patients and their families facing challenges related to serious disease and deadly sickness. The aim of this communication is to reveal patients' palliative care for cancer treatment following a comprehensive assessment approach through the patient's physical, psychosocial, and spiritual symptoms. By visits of patients, we found the response of patients that palliative care is very helpful for cancer patients to minimize and manage their symptoms and assist in relieving their pains and manage other problems. Can support organization is the largest palliative care organization in India. This organization helps cancer patients especially those living in poverty. They try to reduce the symptoms and give support mental, physical, and psychological support to the patients and their families.
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Sutarta, I. Putu Candra Sasmita, and Ni Ketut Putri Ariani. "Psychospiritual in palliative care services: a literature review." Intisari Sains Medis 13, no. 1 (April 30, 2022): 315–18. http://dx.doi.org/10.15562/ism.v13i1.1230.
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Background: Palliative care provide holistic services at the physical, mental, and spiritual levels. Spiritual care is an intrinsic and essential component of palliative care that WHO has recognized. However, spiritual care is still not widely known by the community and health workers in the practice of palliative care. Methods: This literature review was written based on various books, journals, and scientific articles that related to spiritual care in palliative care. The quantitative and qualitative data were obtained, then collected and sorted into a report based on the appropriate topic. Result: Spirituality is one of the fundamental dimensions in the quality of life and maintaining culture. Thus, spirituality is an important component of palliative care. Many palliative patients understand their spiritual needs and want health professionals to help them address these needs. Various existing studies show that spiritual care provides benefits, especially in emotional needs and the search for meaning in life at the end of life. Palliative care professionals can provide spiritual care, but spiritual care is complex and requires specialized knowledge, expertise, and experience in assessing and meeting patient needs, requiring further training and education. Conclusion: Various studies have shown that palliative patients need psychospiritual care to support comfort and meaning in their lives towards the end of life. So, psychospiritual care in palliative care needs to be implemented and improved, especially in training for palliative care teams.
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Uitdehaag, Madeleen J., Rebecca K. Stellato, Peter Lugtig, Thirza Olden, and Saskia Teunissen. "Barriers to ideal palliative care in multiple care settings: the nurses' point of view." International Journal of Palliative Nursing 25, no. 6 (June 2, 2019): 294–305. http://dx.doi.org/10.12968/ijpn.2019.25.6.294.
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Background: Nurses and certified nursing assistants (CNA) have a crucial role in 24/7 continuity of palliative care for many vulnerable patients and families, however, their perspective has been largely omitted in reported barriers to palliative care. Aim: To describe barriers to ideal palliative care that are specific to nurses and CNAs working in all care settings. Methods: A cross-sectional, online survey was distributed to members of the Dutch Nurses' Association. Findings: Almost 50% of the participating 2377 nurses and CNAs experienced more than five barriers to ideal palliative care in their work situation; nurses and CNAs employed in regional hospitals, mental healthcare and nursing home settings encountered more barriers than those working in other settings. Conclusion: The three most common barriers were: lack of proactive care planning, lack of internal consultation possibilities and lack of assessment of care recipients' preferences and needs for a seamless transition to another setting.
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Abken, Elise, Molly Perkins, and Alexis Bender. "Assisted Living Administrators' Views of Palliative Care." Innovation in Aging 5, Supplement_1 (December 1, 2021): 899. http://dx.doi.org/10.1093/geroni/igab046.3264.
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Abstract As many older adults with progressive chronic conditions choose to age-in-place in assisted living (AL) communities, external healthcare workers (e.g., those who provide palliative care) increasingly support AL staff in caring for residents with complex health needs. Palliative care is a branch of healthcare dedicated to preserving quality of life by attending to the physical, mental, and spiritual needs of individuals with chronic, life-threatening diseases and is well suited to manage AL residents’ progressive medical conditions. However, AL residents and their care partners often face barriers to accessing palliative care. Using data from a larger 5-year NIA-funded study, we examined AL administrator knowledge and use of palliative care in seven AL communities around the Atlanta metropolitan area that were racially, ethnically, and socioeconomically diverse. Findings from thematic analysis of semi-structured interviews with 16 administrators indicated that 15 of 16 administrators were familiar with palliative care. A minority of administrators clearly distinguished palliative care from hospice services and conceptualized it as a “bridge” to hospice services. Administrators emphasized how palliative care assists communities in caring for health concerns in-house rather than having to send residents to the hospital. Despite their positive view of palliative care, administrators described infrequent use of palliative services in their communities. Findings show that although none of the AL communities integrate palliative care with their service offerings, AL administrators see value in palliative care for their residents. We provide recommendations for improving palliative care access and quality of life for AL residents at end of life.
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Mukharovska, Inna. "The psychological distress and psychic phenomena in cancer patients during palliative care." Psychosomatic Medicine and General Practice 1, no. 1 (November 15, 2016): 010113. http://dx.doi.org/10.26766/pmgp.v1i1.13.
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Background The diagnostic cancer in incurable stages, the transition to palliative care because of disease progression are significant psychological challenge for the patient. Psychological help for cancer patients during palliative treatment are no less important than medical therapy. Methods The study conducted at the Kyiv City Clinical Cancer Center during the 2012 - 2013 years in two phases. In first phase provided psychological investigation psychological condition of incurable cancer patients and its dynamics during palliative therapy with followed qualitative analysis of the data – participated 436 patients. Second phase included determining factors of psychological maladjustment and evaluation intensity of mental distress – participated 63 palliative cancer patients. The SCL-90r used for assessment of psychic distress. Results The prominent psychopathological symptoms in incurable cancer patients were somatization, depression and nonspecific symptoms. Less pronounced signs of mental distress in descending order of severity were anxiety, hostility, paranoid ideation, interpersonal sensitivity, obsessive-compulsive, psychoticism and phobic anxiety. Factors of psychological distress in cancer patients during palliative care include high physical distress; the impossibility of total control on physical and psychological symptoms; chronic pain; progressive deterioration of physical well-being; need to use opioids for relief pain; need for help; existential nature of stress; individual psychological characteristics. In patients identified psychological phenomena related to the palliative phase of treatment: psychological induction "pendulum", externalizing of mental stress, decentralization. Conclusion Cancer patients in the palliative stage of treatment experiencing intensive psychological distress and clinically constitute a special group with specific psychological needs, which need to be consider in providing psychological care.
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Kozlov, Elissa, Bahar Niknejad, and M. C. Reid. "Palliative Care Gaps in Providing Psychological Treatment: A Review of the Current State of Research in Multidisciplinary Palliative Care." American Journal of Hospice and Palliative Medicine® 35, no. 3 (August 8, 2017): 505–10. http://dx.doi.org/10.1177/1049909117723860.
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Background: Patients with advanced illness often have high rates of psychological symptoms. Many multicomponent palliative care intervention studies have investigated the efficacy of overall symptom reduction; however, little research has focused explicitly on how interventions address psychological symptoms associated with serious illness. Methods: The current study reviewed 59 multicomponent palliative care intervention articles and analyzed the mental health components of palliative care interventions and their outcomes in order to better understand the current state of psychological care in palliative care. Results: The majority of articles (69.5%) did not provide any details regarding the psychological component delivered as part of the palliative care intervention. Most (54.2%) studies did not specify which provider on the team was responsible for providing the psychological intervention. Studies varied regarding the type of outcome measure utilized; multi-symptom assessment scales were used in 54.2% of studies, mental health scales were employed in 25.4%, quality of life and distress scales were used in 16.9%, and no psychological scales were reported in 28.8%. Fewer than half the studies (42.4%) documented a change in a psychological outcome. Discussion and Conclusion: The majority of analyzed studies failed to describe how psychological symptoms were identified and treated, which discipline on the team provided the treatment, and whether psychological symptoms improved as a result of the intervention. Future research evaluating the effects of palliative care interventions on psychological symptoms will benefit from using reliable and valid psychological outcome measures and providing specificity regarding the psychological components of the intervention and who provides it.
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Agarwal, Rajiv, and Andrew Epstein. "The Role of Palliative Care in Oncology." Seminars in Interventional Radiology 34, no. 04 (December 2017): 307–12. http://dx.doi.org/10.1055/s-0037-1608702.
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AbstractPalliative care is a powerful adjunct to oncology that adds distinct value to the physical, mental, and psychosocial well-being of patients living with cancer. Its expanding role and integration with standard oncologic care has proven clinical benefit, as the practice of palliative care can help alleviate symptom burden, enhance illness and prognostic understanding, and improve both the quality of life and overall survival for patients. The primary aim of this review article is to highlight the significant interplay between palliative care and oncology and, in doing so, shed light on the areas for improvement and modern challenges that exist to meet the complex palliative care needs of patients with cancer.
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Fumaneeshoat, Orapan. "Home Visit and Palliative Care." Songklanagarind Medical Journal 35, no. 4 (December 28, 2017): 399. http://dx.doi.org/10.31584/smj.2017.35.4.756.
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To date, an advance in medical technology and science increase the population’s life-span. Hence, palliative medicine, aiming to improve quality of life in patients’ life with incurable diseases becomes essentially significant. Palliative care is a holistic approach, incorporating physical, mental, social and spiritual health. Most Thai patients in the late stage of diseases prefer staying and receiving health care at home where they feel more familiar and restful. In addition, home is the place where they can be with their beloveds and relatives. Therefore, they would like to die at home rather than at hospital. However, many of them did not live, the way they want the remaining of their lives to be nor they die where they would like to die. This is because their caregivers could not manage the exacerbation of symptoms properly, along with the rapid progression of diseases, resulted in hospital admission at the end stage of patients’ lives. Hereafter, palliative home visit plays an important role to allow patients spend their precious time as they approach the end of their life and finally die peacefully at home as they wished. Palliative home visit must be well-planned and appropriate for each patient to ensure that patients, their families and caregivers receive the best health care, according to patients’ will.
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Horseman, Zoe, Libby Milton, and Anne Finucane. "Barriers and facilitators to implementing the Carer Support Needs Assessment Tool in a community palliative care setting." British Journal of Community Nursing 24, no. 6 (June 2, 2019): 284–90. http://dx.doi.org/10.12968/bjcn.2019.24.6.284.
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Family carers play a central role in community-based palliative care. However, caring for a terminally ill person puts the carer at increased risk of physical and mental morbidity. The Carer Support Needs Assessment Tool (CSNAT) enables comprehensive assessment of carer support needs. The present study aimed to identify barriers and facilitators to implementing the CSNAT in a community specialist palliative care service. Semi-structured interviews with 12 palliative care nurse specialists from two community nursing teams in Lothian, Scotland, June 2017. Data was audio-recorded, transcribed and analysed. Palliative care nurse specialists acknowledge the importance of carers in palliative care and encourage carer support practices. Nurses perceived the CSNAT as useful, but used it as an ‘add-on’ to current practice, rather than as a new approach to carer-led assessment. Further training is recommended to ensure community palliative care nurses are familiar with the broader CSNAT approach.
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Baby, Skaria, Manjit George, and Girijanandan D. Menon. "Palliative Care in COVID Times – Quality of Death Matters!!" Indian Journal of Palliative Care 28 (January 29, 2022): 113–14. http://dx.doi.org/10.25259/ijpc_72_21.
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Palliative care for patients with chronic non-malignant diseases is a less addressed area. In-hospital care, particularly, critical care of elderly population with advanced organ failure, can lead to poor resource management. ICU beds come under the strained resource category, more so in the backdrop of the recent COVID-19 pandemic. Home-based palliative care ensures better comfort to the patient and their kin, at the same time facilitating better resource utilisation. This approach may also reduce the mental trauma caused by the loss of a dear one. Major hurdles in providing palliative care for the chronically ill are lack of awareness and financial constraints. The need of the hour is enhanced awareness and promotion of the practice of palliative care. A favourable change in government policy and budget allocation will go a long way in achieving this goal. Home-based palliative care paves the way to care for the subset of patients with end-stage organ failure in a more humane manner.
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Stein, Gary L., Cathy Berkman, and Bonnie Pollak. "What are social work students being taught about palliative care?" Palliative and Supportive Care 17, no. 5 (February 4, 2019): 536–41. http://dx.doi.org/10.1017/s1478951518001049.
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AbstractObjectivePalliative social workers have taken steps to increase the numbers of social workers trained and competent to deliver effective psychosocial palliative care. Despite these developments, masters of social work (MSW) programs have only begun to develop curricula preparing students for entry-level practice. This study sought to determine the type and extent of content areas included in MSW courses dedicated to palliative care or with content related to palliative care practice.MethodA cross-sectional study using an online questionnaire was conducted. All 248 accredited MSW programs in the United States and 32 programs in Canada were invited to participate. Participants were asked to name the courses in their MSW program that were dedicated to, or included content on, palliative care, and submit the syllabi for these courses. Data comprised course content for each class session and required readings. A grounded theory approach was used to identify the topics covered.ResultOf the 105 participating programs that responded to the survey, 42 submitted 70 syllabi for courses with at least some palliative care content. There were 29 topics identified. The most common topic was grief, loss, and bereavement, followed closely by behavioral and mental health issues, and supporting family and friends; cultural perspectives and advance care planning were also common topics. For the 10 syllabi from courses dedicated to palliative care, supporting family was the most common topical area, followed closely by interprofessional practice and advance care planning.Significance of resultsAlthough there are many challenges to introducing palliative care content into MSW programs, including unqualified faculty and competing course material and electives of equally compelling content, there are model curricula for dedicated palliative care courses. With the large growth of palliative care programs, the time is ripe to add specialty palliative care courses and to add palliative care content into existing courses.
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Udo, Itoro, Zeid Mohammed, and Amanda Gash. "Article Commentary: Psychiatric Issues in Palliative Care: Assessing Mental Capacity." Palliative Care: Research and Treatment 7 (January 2013): PCRT.S10889. http://dx.doi.org/10.4137/pcrt.s10889.
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Issues surrounding capacity to consent to or refuse treatment are increasingly receiving clinical and legal attention. Through the use of 3 case vignettes that involve different aspects of mental health care in palliative care settings, mental capacity issues are discussed. The vignettes tackle capacity in a patient with newly developed mental illness consequent to physical illness, capacity in a patient with mental illness but without delirium and capacity in a patient with known impairment of the mind. These discussions give credence to best practice position where physicians act in the best interests of their patients at all times. It is important to emphasize that capacity decisions have to be made on a case by case basis, within the remit of legal protection. This is a fundamental requirement of the Mental Capacity Act 2005, England & Wales (MCA). The later is used as the legal basis for these discussions. The psychiatric liaison service is a useful resource to provide consultation, advice and or joint assessment to clinicians encountering complex dilemmas involving decision-making capacity.
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Black, Catherine, Elizabeth Hanson, John Cutcliffe, and Peter Goward. "Palliative care nurses and mental health nurses: sharing common ground?" International Journal of Palliative Nursing 7, no. 1 (January 2001): 17–23. http://dx.doi.org/10.12968/ijpn.2001.7.1.9039.
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Mann, Theresa, and Marc A. Cornock. "Decision-making in palliative care: the Mental Capacity Act 2005." International Journal of Palliative Nursing 13, no. 8 (August 2007): 402–7. http://dx.doi.org/10.12968/ijpn.2007.13.8.24539.
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Wozniak, Robert J., Daniel Shalev, and M. Carrington Reid. "Adapting the collaborative care model to palliative care: Establishing mental health–serious illness care integration." Palliative and Supportive Care 19, no. 6 (October 21, 2021): 642–45. http://dx.doi.org/10.1017/s147895152100170x.
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Lowe, Sonya S., Cheryl Nekolaichuk, Sunita Ghosh, Lara Fainsinger, Hue Quan, and Robin Fainsinger. "Clinical characteristics of patients having single versus multiple patient encounters within a palliative care programme." BMJ Supportive & Palliative Care 9, no. 3 (February 4, 2016): 291–99. http://dx.doi.org/10.1136/bmjspcare-2015-000985.
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ObjectiveThe objective of this study was to describe the clinical characteristics of patient initial presentations, and to explore associations between patients’ clinical characteristics at initial presentation and number of encounters (single vs multiple) to an integrated palliative care programme.MethodsThis was a retrospective study of a decedent cohort of 2922 patient initial presentations to the Edmonton Zone Palliative Care Program (EZPCP). Data included age, gender, setting of encounter, diagnosis, Edmonton Symptom Assessment System, CAGE, Mini-Mental Status Examination, Palliative Performance Status, Edmonton Classification System for Cancer Pain and time to death.ResultsOn initial presentation to the EZPCP, the mean age was 73 (SD 14 years), with 1358 (46%) being female, and the majority having a cancer diagnosis (n=2376, 81%), the most common of which was gastrointestinal primary (n=681, 29%). In univariate analyses, patients with younger age (<60), higher palliative performance status (>40%), a malignant diagnosis, gastrointestinal primary or unimpaired cognition at initial presentation were significantly associated with multiple encounters with an integrated palliative care programme (p<0.05). In a multivariate regression analysis, a malignant diagnosis, longer survival, higher performance status and initial entry through acute care sites were independently associated with multiple encounters in the programme (p<0.001).ConclusionsLarger prospective studies are warranted to further elucidate the complex relationships between patient clinical characteristics, initial presentations and subsequent encounters to an integrated palliative care programme.
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Val, Bellman,, Kiolbasa, Megan, Vasquez Franjul, Manuel, Namdev, Vaishalee, Choi, Sarang, and Isola, Sasank. "Medical Cannabis in Palliative Psychiatry: Clinical Aspects of Affective Regulation and Legal Challenges." International Journal of Innovative Research in Medical Science 6, no. 09 (September 16, 2021): 588–607. http://dx.doi.org/10.23958/ijirms/vol06-i09/1203.
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Millions of Americans use cannabis for medical purposes including but not limited to pain, nausea, mood changes and appetite stimulation. The use of cannabinoid in the palliative care setting is a relatively new trend. Given the fact that a patient receiving palliative care is not necessarily approaching death, the increasing need for palliative care as the American population ages, this literature review was compiled in order to examine the potential efficacy of cannabis in treating the mental health comorbidities of palliative care patients. We attempted to create the most comprehensive report on cannabinoid use in palliative psychiatry. It summarizes the most recently published science on cannabinoid use in palliative care patients and its impact on mood and anxiety symptoms. The mechanism of action of cannabinoids on their associated receptors was elucidated, as were the pharmacological roles that specific molecules in cannabinoids, like cannabidiolic acid and terpenes, play in cannabinoids’ overall efficacy. The legal impediments to widespread cannabis use were also explored. While the potential efficacy of cannabinoids has proven to be mixed, more research is necessary to ensure that a potentially vital resource in treating palliative care patients does not go underutilized.
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Chochinov, Harvey Max. "Psychiatry and Terminal Illness." Canadian Journal of Psychiatry 45, no. 2 (March 2000): 143–50. http://dx.doi.org/10.1177/070674370004500204.
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Objective: To provide an overview of the palliative care literature salient to the psychiatric aspect of end-of-life care. Method: A literature review was conducted, targeting primarily empirical studies that addressed the following topics: 1) psychological issues pertaining to life-threatening conditions; 2) family issues in the context of palliative care; 3) psychological issues and challenges faced by end-of-life health care providers; and 4) psychiatric disorders, including depression, anxiety, and organic mental disorders, in people with terminal illness. Results: There is a small but emerging literature that can guide psychiatrists in their role of providing care to dying patients. Conclusions: While psychiatry has made tremendous inroads toward providing care to patients throughout the life cycle, its presence is only just beginning to be felt in end-of-life care. Within the domain of palliative care, psychiatry has an expanded and important role to play.
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Carlsson, Maria E. "Fatigue in relatives of palliative patients." Palliative and Supportive Care 7, no. 2 (June 2009): 207–11. http://dx.doi.org/10.1017/s1478951509000261.
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ABSTRACTObjectives:The relatives’ burdens in palliative care are considerable and may cause fatigue. The overall aim of this study was to gain a greater understanding of fatigue in relatives of patients cared for in palliative care settings.Methods:This study has a descriptive, comparative, and cross-sectional design. The sample consisted of relatives of all patients cared for in palliative care settings in Uppsala County during a specific day. Relatives completed a questionnaire consisting of the Multidimensional Fatique Inventory (MFI-20) and questions from the Karolinska Sleepiness Scale (KSS) and Karolinska Sleep questionnaire (KSQ).Results:Relatives (n = 56) scored high on every dimension on the MFI-20 scale. Two significant negative correlations were found to exist between age and fatigue, with younger relatives reporting more mental fatigue (p < .01) and more reduced activity (p < .01) than older relatives. Relatives of patients in institutional care had higher values concerning mental fatigue (p < .01) and reduced motivation (p < .05). Relatives of mostly bedridden patients were significantly more tired but did not have significantly less motivation than relatives of mostly ambulatory patients.Significance of results:The findings imply that fatigue is highly prevalent in relatives of patients in palliative care. The sample in this study scored higher in comparison with norm values and also in comparison with relatives of patients with end-stage renal disease. Their scores were similar to those of cancer patients undergoing radiotherapy.
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Boycheva, Tsvetka, and Mariya Dimitrova. "NEEDS OF PATIENTS NEEDING PALIATIVE CARE." Knowledge International Journal 34, no. 4 (October 4, 2019): 997–1002. http://dx.doi.org/10.35120/kij3404997b.
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Palliative care satisfies the physical, mental, social, cultural and spiritual needs of terminally ill patients. They target the family and loved ones of the sick, provide support and training, help people overcome the grief and sorrow of losing a loved one. Palliative care for a lot of people becomes a necessity at some point in their lives, enabling them to adequately complete their earthly journey. The patients undergoing these care have gone through diagnosis and treatment and are in the last stages of their lives, filled with much suffering, pain and hopelessness. The purpose of this study is to determine the extent to which the healthcare system is able to meet the specific needs of patients in need of palliative care. The study focuses on 602 relatives of seriously ill patients and 376 healthcare professionals caring for terminally ill patients. Using a direct individual survey, their opinion was examined. Statistical methods have been used to process and analyze the results. The study was conducted from 01.11.2017 to 30.11.2018 in a total of 30 hospitals, hospices and social homes in the country. Results: Almost half of the healthcare professionals surveyed (46.0%) devised an individual care plan for each patient, and every third of the seriously ill relatives (36.8%) felt that they were tailored to the individual needs of each patient. In the current health care system, the offered palliative care is able to meet patients' physical and social needs, but their mental, spiritual and cultural needs remain somewhat unmet. Conclusions: The lack of sufficient time to communicate with the patient and the lack of staff in the healthcare system are the reasons for the unmet need of the terminally ill. Creating training programs for healthcare professionals to improve their communication knowledge and skills, as well as the inclusion of different specialists in palliative care teams, will increase care coverage and improve the quality of life of seriously ill patients and their families.
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Huey, Ng, Ng Guan, Jesjeet Gill, Koh Hui, Ahmad Sulaiman, and Sharmilla Kanagasundram. "Core Symptoms of Major Depressive Disorder among Palliative Care Patients." International Journal of Environmental Research and Public Health 15, no. 8 (August 16, 2018): 1758. http://dx.doi.org/10.3390/ijerph15081758.
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A valid method to diagnose depression in palliative care has not been established. In this study, we aim to determine the prevalence of depression and the discriminant validity of the items of four sets of diagnostic criteria in palliative care. This is a cross-sectional study on 240 palliative care patients where the presence of depression was based on the Diagnostic and Statistical Manual of Mental Disorders, DSM–IV Criteria, Modified DSM–IV Criteria, Cavanaugh Criteria, and Endicott’s Criteria’s. Anxiety, depression, and distress were measured with Hospital Anxiety and Depression Scale and Distress Thermometer. The prevalence of depression among the palliative care patients was highest based on the Modified DSM–IV Criteria (23.3%), followed by the Endicott’s Criteria (13.8%), DSM–IV Criteria (9.2%), and Cavanaugh Criteria (5%). There were significant differences (p < 0.05) in the depressive symptoms showed by DSM–IV item 1 (dysphoric mood), item 2 (loss of interest or pleasure), and Endicott’s criteria item 8 (brooding, self-pity, or pessimism) among the palliative patients, even after adjustment for the anxiety symptoms and distress level. We found that dysphoric mood, loss of interest, and pessimism are the main features of depression in palliative patients. These symptoms should be given more attention in identifying depression in palliative care patients.
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Waterman, Lauren Z., David Denton, and Ollie Minton. "End-of-life care in a psychiatric hospital." BJPsych Bulletin 40, no. 3 (June 2016): 149–52. http://dx.doi.org/10.1192/pb.bp.114.049833.
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SummarySince the Liverpool Care Pathway has been withdrawn in the UK, clinicians supporting the palliative needs of patients have faced further challenges, particularly for patients with dementia who are unable to go to a hospice owing to challenging behaviours. It is becoming more important for different services to provide long-term palliative care for patients with dementia. Mental health trusts should construct end-of-life care policies and train staff members accordingly. Through collaborative working, dying patients may be kept where they are best suited. We present the case study of a patient who received end-of-life care at a psychiatric hospital in the UK. We aim to demonstrate how effective end-of-life care might be provided in a psychiatric hospital, in accordance with recent new palliative care guidelines, and highlight potential barriers.
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Tadipatri, Ramya, Amir Azadi, Madison Cowdrey, Samuel Fongue, Paul Smith, Evangelia Razis, Maria Boccia, and Ekokobe Fonkem. "QOLP-03. NEURO-ONCOLOGY PALLIATIVE CARE SURVEY OF PHYSICIANS IN SUB-SAHARAN AFRICA." Neuro-Oncology 22, Supplement_2 (November 2020): ii175. http://dx.doi.org/10.1093/neuonc/noaa215.728.
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Abstract BACKGROUND Early access to palliative care is a critical component of treating patients with advanced cancer, particularly for glioblastoma patients who have low rates of survival despite optimal therapies. Additionally, there are unique considerations for primary brain tumor patients given the need for management of headaches, seizures, and focal neurological deficits. METHODS We conducted a survey of 109 physicians in Sub-Saharan Africa in order to determine level of understanding and skill in providing palliative care, types of palliative care therapies provided, role of cultural beliefs, availability of resources, and challenges faced. Demographic data including age, gender, and prior training was collected and analyzed using ANOVA statistical testing. RESULTS Among the participants, 48% felt comfortable in providing palliative care consultations, 62% have not had prior training, 52% believed that palliative care is only appropriate when there is irreversible deterioration, 62% expressed having access to palliative care, 49% do not have access to liquid opioid agents, 50% stated that cultural beliefs held by the patient or family prevented them from receiving, palliative care, and 23% stated that their own beliefs affected palliative care delivery. Older providers (age > 30) had a clearer understanding of palliative care (p = 0.004), were more comfortable providing consultation (p = 0.052), and were more likely to address mental health (p < 0.001). CONCLUSIONS Palliative care delivery to glioblastoma patients in Sub-Saharan Africa is often delayed until late in the disease course. Barriers to adequate palliative care treatment identified in this survey study include lack of training, limited access to liquid opioid agents, and cultural beliefs. Challenges most often identified by participants were pain management and end-of-life communication skills, but also included patient spirituality and psychological support, anxiety and depression, terminal dyspnea, ethics, and intravenous hydration and non-oral feeding.
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Lin, Hui-Mei, Chih-Kuang Liu, Yen-Chun Huang, and Ming-Chih Chen. "Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life." International Journal of Environmental Research and Public Health 19, no. 7 (April 2, 2022): 4263. http://dx.doi.org/10.3390/ijerph19074263.
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Background: Previous research mostly analyzed the utilization of palliative care for patients with cancer, and data regarding non-cancer inpatients are limited. Objectives: This research aimed to investigate the current situation regarding palliative care and the important factors that influence its utilization by inpatients (including inpatients with and without cancer) at the end of their lives. We also explored the feasibility of establishing a prediction model of palliative care utilization for inpatients at the end of their lives. These findings will allow medical staff to monitor and focus on those who may require palliative care, resulting in more end-of-life patients receiving palliative care and thereby reducing medical expense and improving their quality of life. Methods: This was a retrospective study based on real-world health information system (HIS) data from 5 different branches of Taipei City Hospital between 1 January 2018 and 31 December 2018 that enrolled a total of 1668 deceased inpatients. To explore palliative care utilization at the end of life, we used 5-fold cross-validation in four different statistical models to obtain the performance of predictive accuracy: logistic regression (LGR), classification and regression tree (CART), multivariate adaptive regression spline (MARS), and gradient boosting (GB). The important variables that may affect palliative care utilization by inpatients were also identified. Results: The results were as follows: (1) 497 (29.8%) inpatients received palliative care; (2) the average daily hospitalization cost of patients with cancer who received palliative care (NTD 5789 vs. NTD 12,115; p ≤ 0.001) and all patients who received palliative care (NTD 91,527 vs. NTD 186,981; p = 0.0037) were statistically significantly lower than patients who did not receive palliative care; (3) diagnosis, hospital, and length of stay (LOS) may affect palliative care utilization of inpatient; diagnosis, hospitalization unit, and length of hospitalization were statistically significant by LGR; (4) 51.5% of patients utilized palliative consultation services, and 48.5% utilized palliative care units; and (5) MARS had the most consistent results; its accuracy was 0.751, and the main predictors of palliative care utilization are hospital, medical expense, LOS, diagnosis, and Palliative Care Screening Tool-Taiwan version (TW-PCST) scores. Conclusions: The results reveal that palliative care utilization by inpatients remains low, and it is necessary to educate patients without cancer of the benefits and advantages of palliative care. Although data were limited, the predictability of the MARS model was 0.751; a better prediction model with more data is necessary for further research. Precisely predicting the need for palliative care may encourage patients and their family members to consider palliative care, which may balance both physical and mental care. Therefore, unnecessary medical care can be avoided and limited medical resources can be allocated to more patients in need.
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Dressel, Anne, Elizabeth Mkandawire, Kaboni Whitney Gondwe, Lucy Mkandawire-Valhmu, Stacia Nordin, Nokuthula Vilakazi, Victoria Scheer, et al. "The intersection of food insecurity and health for rural Malawian women at the end of life." International Journal of Palliative Nursing 26, no. 7 (October 2, 2020): 372–82. http://dx.doi.org/10.12968/ijpn.2020.26.7.372.
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Background One of the poorest countries in the world, Malawi's palliative care system is under-resourced, and one-third of the population is food-insecure. Aims This study describes the lived experience of female palliative care patients, and their caregivers, and aimed to: (1) analyse their physical, spiritual and mental health needs; and (2) analyse best palliative nursing practice for patients at the end of life. An unexpected finding was the impact of food insecurity on the women and their caregivers. Methods We conducted interviews with 26 women who at the end of life and 14 of their caregivers. All were participating in a community palliative care programme offered by an AIDS support organisation in Kasungu, Malawi. We used deductive qualitative analysis to organise identified themes using the four pillars of food security: availability, access, utilisation and stability. Findings All study participants experienced challenges with food security. Conclusions We offer policy recommendations for palliative care nurses, and other allied health professionals.
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Chidiac, Claude, Kate Grayson, and Kathryn Almack. "Development and evaluation of an LGBT+ education programme for palliative care interdisciplinary teams." Palliative Care and Social Practice 15 (January 2021): 263235242110513. http://dx.doi.org/10.1177/26323524211051388.
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Background: Despite national policy recommendations to enhance healthcare access for LGBT+ (lesbian, gay, bisexual, transgender, and those who do not identify as cisgender heterosexual) people, education on LGBT+ issues and needs is still lacking in health and social care curricula. Most of the available resources are focused on primary care, mental health, and sexual health, with little consideration to broader LGBT+ health issues and needs. The limited available educational programmes pertaining to LGBT+ individuals outside the context of sexual or mental health have mainly focused on cancer care or older adults. Aim: To support palliative care interdisciplinary teams to provide LGBT+ affirmative care for people receiving and needing palliative and end-of-life care. Methods: A 1½-h workshop was developed and evaluated using Kotter’s eight-step process for leading change. Across four hospices, 145 health and social professionals participated in the training. A quasi-experimental non-equivalent groups pre–post-test design was used to measure self-reported levels of knowledge, confidence, and comfort with issues, and needs and terminology related to LGBT+ and palliative care. Results: There was a significant increase in the reported levels of knowledge, confidence, and comfort with issues, needs, and terminology related to LGBT+ and palliative care after attending the training. Most participants reported that they would be interested in further training, that the training is useful for their practice, and that they would recommend it to colleagues. Conclusion: The project illustrates the importance of such programmes and recommends that such educational work is situated alongside wider cultural change to embed LGBT+-inclusive approaches within palliative and end-of-life care services.
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Stajduhar, Kelli I., Melissa Giesbrecht, Ashley Mollison, and Margo d'Archangelo. "“Everybody in this community is at risk of dying”: An ethnographic exploration on the potential of integrating a palliative approach to care among workers in inner-city settings." Palliative and Supportive Care 18, no. 6 (May 7, 2020): 670–75. http://dx.doi.org/10.1017/s1478951520000280.
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AbstractObjectiveAt the end of life, the need for care increases. Yet, for structurally vulnerable populations (i.e., people experiencing homelessness and poverty, racism, criminalization of illicit drug use, stigma associated with mental health), access to care remains highly inaccessible. Emerging research suggests that enhancing access to palliative care for these populations requires moving care from traditional settings, such as the hospital, into community settings, like shelters and onto the street. Thus, inner-city workers (ICWs) (e.g., housing support and community outreach) have the potential to play pivotal roles in improving access to care by integrating a “palliative approach to care” in their work.MethodDrawing upon observational field notes and interview data collected for a larger critical ethnographic study, this secondary thematic analysis examines ICWs’ (n = 31) experiences providing care for dying clients and garners their perspectives regarding the constraints and facilitators that exist in successfully integrating a palliative approach to care in their work.ResultsFindings reveal three themes: (1) Approaches, awareness, and training; (2) Workplace policies and filling in the gaps; and (3) Grief, bereavement, and access to supports. In brief, ICWs who draw upon harm reduction strategies strongly parallel palliative approaches to care, although more knowledge/training on palliative approaches was desired. In their continuous work with structurally vulnerable clients, ICWs have the opportunity to build trusting relationships, and over time, are able to identify those in need and assist in providing palliative support. However, despite death and dying is an everyday reality of ICWs, many described a lack of formal acknowledgement by employers and workplace support as limitations.Significance of resultsFindings contribute promising practices for enhancing equitable access to palliative care for society's most vulnerable populations by prioritizing front-line workers’ perspectives on how best to integrate a palliative approach to care where structurally vulnerable populations live and die.
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Voncina, Luka. "Integrating care in Croatia: case studies in family medicine, mental health and palliative care." International Journal of Integrated Care 21, S1 (September 1, 2021): 231. http://dx.doi.org/10.5334/ijic.icic2097.
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Gersten, Rebecca A., Amanda C. Moale, Bhavna Seth, Judith B. Vick, Hannah Brown, Michelle N. Eakin, Stephen C. Mathai, and Sonye K. Danoff. "A scoping review of palliative care outcome measures in interstitial lung disease." European Respiratory Review 30, no. 161 (August 3, 2021): 210080. http://dx.doi.org/10.1183/16000617.0080-2021.
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Interstitial lung disease (ILD) confers a high mortality and symptom burden, substantially impacting quality of life. Studies evaluating palliative care in ILD are rapidly expanding. Uniform outcome measures are crucial to assessing the impact of palliative care in ILD. This scoping review evaluates existing outcome measures in general health-related quality of life (HRQoL), physical health, mental health, social health and advance care planning (ACP) domains in patients with ILD. Articles in English with quantitative assessment of at least one measure of general HRQoL, physical health, mental health, social health or ACP in patients with ILD were included. Searches across three databases yielded 3488 non-duplicate articles. 23 met eligibility criteria and included three randomised controlled trials (RCTs) or secondary analysis of an RCT (13%), three cross-sectional studies or secondary analysis of cross-sectional study (13%), one prospective study (4%) and 16 retrospective studies (70%). Among eligible articles, 25 distinct instruments were identified. Six studies assessed general HRQoL (26%), 16 assessed physical health (70%), 11 assessed mental health (48%), six assessed social health (26%) and 16 assessed ACP (70%). The ability to compare results across studies remains challenging given the heterogeneity in outcome measures. Future work is needed to develop core palliative care outcome measures in ILD.
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Grealish, Laurie. "Mini-Mental State Questionnaire: problems with its use in palliative care." International Journal of Palliative Nursing 6, no. 6 (May 2000): 298–302. http://dx.doi.org/10.12968/ijpn.2000.6.6.9079.
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Mamom, Jinpitcha, and Hanvedes Daovisan. "How Buddhist Religious Care Is Incorporated for End-of-Life Stroke Patients Receiving Palliative Care at Home during the COVID-19 Pandemic: Revisiting Constructivist Grounded Theory." Religions 13, no. 10 (October 20, 2022): 1000. http://dx.doi.org/10.3390/rel13101000.
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Coping with the COVID-19 pandemic has involved unprecedented health challenges, impacting not only the receipt of palliative care, but also that of religious care. The present article aimed to explore how Buddhist religious care is incorporated for end-of-life stroke patients receiving palliative care at home during the COVID-19 pandemic in Thailand. A constructivist grounded theory (CGT) was utilised with theoretical sampling of 30 respondents in the Angthong, Ayutthaya, and Pratumthani provinces, central Thailand, from June 2020 to March 2022. Online in-depth interviews were video-recorded and transcribed, using written memos and constant comparative methods. Data transcripts were analysed using open, axial, selective coding, categorising, and themes. Our CGT study identified five themes of Buddhist religious care incorporated for end-of-life stroke patients receiving palliative care at home, namely Buddhist therapies, religious beliefs, religious life satisfaction, religious mental care, and religious needs. The implications of Buddhist religious care being incorporated for end-of-life stroke patients receiving home palliative care during the COVID-19 pandemic are discussed.
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Salmi, Liz, Shirley Otis-Green, Adam Hayden, Lynne Taylor, and Bethany Kwan. "INNV-05. SOCIAL MEDIA AND “TWEET CHAT ANALYSES” TO INFORM QOL AND PALLIATIVE CARE NEEDS IN PATIENTS WITH PRIMARY BRAIN TUMORS." Neuro-Oncology 21, Supplement_6 (November 2019): vi131. http://dx.doi.org/10.1093/neuonc/noz175.548.
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Abstract BACKGROUND Despite a standard of care protocol for the treatment of brain cancer, patients often suffer motor and cognitive deficits and chronic exposure to stress and anxiety, detrimental to patient quality of life (QOL). Palliative care addresses patient and care partner (caregiver) QOL needs as a complement to curative treatment, using a team-based, multidisciplinary approach. Elements of palliative care that are highest priority for patients with brain cancer are not known. METHODS A multi-stakeholder group including clinicians, researchers, patients, and care partners convened (hereafter: “stakeholders”), led jointly by a brain cancer patient and health services researcher. The stakeholders identified QOL needs for patients with brain cancer and their care partners, and mapped these needs onto a brain cancer-specific palliative care model. In 2018, patients, researchers, and clinicians participated in two moderated “tweet chats” to test and further inform QOL definitions and palliative care needs (n=79). RESULTS Thematic analysis of tweet chat transcripts revealed patients and care partners were most concerned by: challenging behaviors resulting from tumor and resulting treatment; depression and anxiety; changes in sexuality/intimacy loss; grief over the loss of identity and things one previously enjoyed/was able to do; financial toxicity; changes in close relationships; and dependence on a broader social network. The stakeholders used this work to inform a set of QOL needs and corresponding palliative care elements. Each need was mapped onto a corresponding element for development of a palliative care model. Further research questions were identified to inform further research in this area. CONCLUSIONS Patients with brain cancer have complex QOL needs beyond symptom management. A palliative care model for brain cancer should include a multidisciplinary care team including care partner support and education. In addition to the palliative care physician, additional disciplines may include a social worker, chaplain, mental health professional, and rehabilitative services therapists.
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Porche, Kay, Liz Reymond, John O' Callaghan, and Margaret Charles. "Depression in palliative care patients: a survey of assessment and treatment practices of Australian and New Zealand palliative care specialists." Australian Health Review 38, no. 1 (2014): 44. http://dx.doi.org/10.1071/ah13041.
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Objective To explore the practices of members of the Australian and New Zealand Society of Palliative Medicine (ANZSPM) in assessing and treating depression in palliative care patients. Methods Semistructured questionnaires were forwarded to ANZSPM members in consecutive mail-outs to survey diagnostic and treatment practices for depression. Results The response rate was 62.3%. The median prevalence of depression, as perceived by respondents, in the present respondent patient populations was 20% (range 0%–90%); 57.1% of respondents always assessed for depression, whereas 42.9% assessed for depression sometimes. The majority (98.9%) of respondents relied on clinical interviews to assess depression; non-somatic symptoms of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria were more useful than somatic symptoms. The depression screening tools most frequently used were one- and two-item questions. Pharmacological and non-pharmacological methods were used to treat depression, with selective serotonin reuptake inhibitors the most frequently prescribed medications. Psycho-educational and supportive counselling were the most frequently used non-pharmacological interventions. Nominated measures to augment depression management included improving access to psychiatry, psychology and other allied health services, the development of a screening tool specific to palliative care patients and associated guidelines for depression management. Conclusions This is the first Australasian study to explore the practice of medical practitioners regarding depression in palliative patients. Incorporation of screening tool questions into palliative care assessment interviews may warrant future research. What is known about the topic? Depression in palliative care patients has a negative impact on quality of life; however, little is known about how Australasian palliative care medical practitioners manage depression in this patient population. What does this paper add? To the researchers’ knowledge, this is the first Australasian study that explores the practices of local palliative care specialists in the management of depression in palliative patients. What are the implications for practitioners? Overall management of depression in palliative care populations by Australasian practitioners is similar to that of their European colleagues. Consensus is that for assessment of depression in palliative patients, non-somatic symptoms of DSM-IV criteria are more useful than somatic symptoms. Practitioners report the need for improved access to psychiatric, psychological and other support services, for a palliative care-specific depression screening tool and for depression management guidelines applicable to palliative care patients.
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Pommer, Wolfgang, Sarah Wagner, and Julia Thumfart. "Conservative Care, Dialysis Withdrawal, and Palliative Care: Results from a Survey of a Non-Profit Dialysis Provider in Germany." Kidney and Blood Pressure Research 44, no. 2 (2019): 158–69. http://dx.doi.org/10.1159/000498994.
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Background: In Germany, practice patterns of conservative renal care (CRC), dialysis withdrawal (DW), and concomitant palliative care in patients who choose these options are unknown. Method: A survey was designed including 13 structured and one open questions on the management and frequency of CRC and DW, local palliative care structure, and fundamentals of the decision-making process, and addressed to the head physicians of all renal centers (n = 193) of a non-profit renal care provider (KfH – Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany). Results: Response rate was 62.2% (n = 122 centers) comprising 14,197 prevalent dialysis patients and 159,652 renal outpatients. Two-thirds of the respondents were men (85% in the age group between 45 and 64 years). Mean time of experience in renal medicine was 22.2 years in men, 20.8 years in women. 94% of all centers provided CRC with a different frequency and proportion of patients (mean 8.4% of the center population, median 5%, range 0–50%). Mean proportion of DW was 2.85% per year (median 2%, range 1–15%). Physicians and center features were not significantly associated with utilization of CRC or DW. Palliative care management varied including local palliative teams, support by general physicians, or by the renal team itself. Hospice care was only established in patients undergoing CRC. Fundamentals of the decision-making process were the desire of the patient (90% in CRC, 67% in DW). Patients undergoing CRC changed their opinion towards treatment modality “frequently” in 18% of the cases, “occasionally” in 73%. Physicians’ decisions were mostly driven by presumed fatal prognosis and poor physical or mental conditions of the individual patient. Different barriers to provide palliative care for the renal population like lack of education in palliative medicine, shortness of staff, lack of financial resources, and local palliative care structures were reported. Conclusion: Compared to international numbers, in Germany, proportion of CRC and DW reported by non-profit renal centers is in the lower range. Center practice of palliative care management varies and is driven by availability of local palliative care resources and presumably by attitudes of the renal teams. Quality of palliative care and the decision-making process need further evaluation.
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Mitchell, Sarah, Isabel Leach, Nicola Turner, and C. R. Mayland. "Understanding patient views and experiences of the IDENTIfication of PALLiative care needs (IDENTI-Pall): a qualitative interview study protocol." BMJ Open 12, no. 6 (June 2022): e062500. http://dx.doi.org/10.1136/bmjopen-2022-062500.
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IntroductionMore people are living with multimorbidity, defined as two or more long-term physical or mental health conditions. Multimorbidity is associated with poor quality of life and high treatment burden. Palliative care identification tools have been developed for use in primary care to seek out patients who could benefit from a palliative approach to their care. There has been little evaluative research on such tools; patient perspectives on the process of identifying their palliative care needs is a significant gap. The aim of this research is to provide new understanding into patient perspectives of the experience of having their palliative care needs identified, and the impact on their healthcare.Methods and analysisThis qualitative study will employ semistructured interviews to elicit the views of participants. We will purposively sample 10–12 adults with advanced serious illness who have been identified by their primary care team as having palliative care needs, and/or are receiving care from specialist palliative care services. A family member or carer may be included in an interview at the participant’s request. A descriptive, thematic analysis will be carried out using the data analysis software NVivo.Ethics and disseminationEthical approval has been granted by the North of Scotland Research Ethics Committee. Study findings will be disseminated in peer-reviewed journals and through conference presentations. Other activities include the development of patient-centred outcomes for clinical practice and policy in relation to the use of palliative care identification tools.Trial registration numberNational Institute for Health Research (NIHR) Clinical Studies Portfolio, UK Clinical Research Network (UKCRN) Study number 51296.