ObjectivesThere has been little research conducted to understand the essential meaning of quality, community-based, end-of-life (EOL) care, despite the expansion of these services. The purpose of this study was to define what matters most for EOL care from the perspective of a diverse range of palliative care providers in the community who have daily encounters with death and dying.MethodsWe used interviews to explore the perceptions of providers and administrators from 14 specialised palliative care teams in Ontario, Canada. Participants were prompted with the question ‘What matters most for EOL care?’ Responses were analysed using a phenomenological approach to derive themes depicting the universal essence of EOL care.ResultsData from 107 respondents were obtained and analysed, from which 40 formulated concepts emerged; these were further grouped into 9 themes. Of the respondents, 39% were nurses, 19% physicians, 27% were supervisors or executives and 15% other. The most predominate concept was that Patient's Wishes are Fulfilled, cited by almost half the respondents. The most prominent themes were Addressing the Non-physical Needs, Healthcare Teams’ Nature of Palliative Care Delivery, Patient Wishes are Honoured, Addressing the Physical Needs, Preparing for and Accepting Death, Communication and Relationship Development, and Involving and Supporting the Family.Conclusions9 critical domains of EOL care evolved from the interviews, indicating that quality EOL care extends beyond managing physical pain, but includes a holistic perspective of care, a healthcare team dedicated to the EOL journey and a patient-centred pathway. Tailoring the provision of care to consider these important elements plays a critical role in supporting a positive EOL experience for patients and families.
ObjectiveEvidence has shown that, despite wide variation in models of care, community-based specialist palliative care teams can improve outcomes and reduce acute care use at end of life. The goal of this study was to explore similarities in care practices among effective and diverse specialist teams to inform the development of other community-based teams.MethodsInterviews with 78 providers and administrators from 11 distinct community-based specialist palliative care teams from Ontario, Canada were conducted. Interviews were audio-recorded, transcribed and analysed using an inductive approach to identify common themes.Results3 key themes across all teams emerged. First, the distinct models of care were generally summarised into 3 models: primary care and specialist providers either collaborated by transferring, sharing or consulting in care. Second, teams explicitly or implicitly followed 7 common care practices related to: specialised expertise 24/7; intrateam communication; timeliness; physical symptom and psychosocial–spiritual management; education; peace and fulfilment; and advocacy for patient preferences. Third, all teams emphasised the importance of team building, even more than using clinical tools and processes.ConclusionsDespite wide variation in models of care among community-based specialist palliative care teams, this large qualitative study identified several common themes in care practices that can guide the development of other teams.
The qualitative survey data in this study provided key recommendations toward making care more responsive to the needs of dying patients and their families. Capturing the narrative responses of bereaved caregivers is feasible and informative for palliative care program development.
This pilot study provides preliminary evidence that it is feasible to capture the patient and caregiver experience at EOL using a comprehensive survey, though survey distribution method greatly affected response rates. The majority of responses rated care as excellent or very good, although several specific areas for improvement were identified.
Aim: This paper describes a newly created primary care oral surgery specialist service operating in a managed clinical network caring for the United Kingdom military population. It aims to review its outcomes and to consider the structure of the service in relation to the recommendations of the 2010 NHS sponsored 'Review of Oral Surgery Services and Training' by Medical Education England which made recommendations for the delivery of UK oral surgery services. Materials and methods: A retrospective audit of patient records and referral data. Results: This paper describes a primary care focused, specialist delivered oral surgery referral service that has demonstrated how the recommendations of this review can be successfully implemented to the benefit of patients and those that commission and resource care whilst simultaneously delivering clinical training to General Dental Practitioners in oral surgery. Furthermore it illustrates the successful implementation and integration of a managed clinical network for the delivery of oral surgery referral services from primary care general practice through primary care specialist practice to secondary care hospital services. Conclusions: The benefits of the service include an efficient, effective and fiscally economical patient centred service with referral to treatment timings and complication rates that compare favourably to current alternatives and with the structures and processes that facilitate the achievement of quality outcomes.
Clinical relevanceScientific rationale for study: To assess the delivery of core oral surgery services in a primary care setting.Principal findings: Of a sample of 795 cases, 92% were definitively managed in the primary care clinic. Of those referrals transferred for management in a hospital unit, 85% were due to a requirement for general anaesthesia with only seven cases (1% of total referrals) judged to be for care that fell out with the oral surgery core competencies.Practical implications: Specialists in oral surgery can deliver a substantial portion of their services in the primary care setting with benefits to patients and to commissioners of care while maintaining a postgraduate teaching commitment.Primary care oral surgery referral service Davies et al.
66Oral Surgery 6 (2013) 61-66.
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