Objective In Indonesia, palliative care has not been uniformly implemented at all levels of healthcare facilities. Healthcare personnel play an important role in providing that care. This study aimed to explore the current conditions and expectations regarding palliative care from the perspective of healthcare personnel. Results A qualitative study was conducted with 12 physicians and five nurses from December 2017 to June 2018. In-depth interviews of these professionals were conducted. The responses were subjected to inductive thematic analysis, generating five themes and 24 subthemes. The themes were (1) family and environment, including barriers and contributions to palliative care; (2) numbers and competence of healthcare providers; (3) accessibility of palliative care; (4) case management of patient’s and family’s problems by healthcare personnel; and (5) barriers or enabling factors from the healthcare system. Patients, family members, and healthcare personnel contribute to case management. Attention must be paid to improving access and the healthcare system for thorough implementation of palliative care.

Background The understanding of health care providers’ experiences involved in malnutrition treatment is a key component that should be explored. Objective This systematic review aimed to explore the views and perceptions of community health care providers related to malnutrition and its management for older adults, through synthesizing the qualitative studies. Methods Six electronic databases were used to search relevant articles. Qualitative research synthesis using Sandelowski and Barroso’s method and thematic synthesis were used to broaden the range of methodology in this study. Joanna Briggs Institute (JBI) Critical Appraisal Tools for Qualitative Research was used to enable judgement about the strength of qualitative research. Results A total of four qualitative studies of health care providers’ views and perceptions related to malnutrition in older adults were analysed. The results showed that there are three main themes that reflect their malnutrition experiences: (i) knowledge and skills about malnutrition, (ii) management of malnutrition and (iii) the need for collaborative teams. Conclusion While health care professionals understand about the aetiology of malnutrition, however screening for malnutrition is not routine in their practice. Proper education and training about nutritional care is needed. Dietary changes and public education are preferable over oral nutritional supplements. Some solution and recommendations for management of malnutrition in older adult such as supportive interventions include environmental changes, nutritional counselling, food modification, oral nutrition supplement and pharmacotherapy if needed, routine screening and multidisciplinary approach.

Backgorund: Many models of palliative care have already been implemented, however, a model of health care cannot be directly applied in a country because of the differences in socio-cultural, disease patterns and health systems within the country. This study aimed to conduct a systematic review to analyze models of palliative care and elements of model for palliative care.  Methods: A systematic review was conducted. Articles were searched by four electronic databases; PubMed, Web of Science, Ovid and NICE Database. Three reviewers screened the search results and data were classified according to their main objective. Further synthesize was conducted to show element and model of care.  Results: The initial search strategy identified 218. Based on Hawker quality assessment scale, only 14 articles met criteria for review and synthesis. Out of 14, 4 articles describe palliative care for chronic disease (heart failure, end stage renal disease) and 10 for cancer. The integrated palliative care model has been the most frequently described. The other models are respite care, care-aide and personal alarm model, family centered advanced care, and end of life care for young adults. This systematic review also identified elements of model for palliative care and categorized as element from patient and family, personnel and health care system. Conclusion: A few studies are describing a model of palliative care and elements of model for palliative care in detail. More detailed methodological and population specifications are needed to accurately find the results.

Background The need for improving knowledge and practice of palliative care delivered by health workers become an agenda in several countries. In order to measure the practice, an instrument is needed. The study analyzed the validity and reliability of the instrument to assess the physician’s practice in the management of patients with terminal diseases. Methods This was a cross-sectional study involving 89 physicians practicing in primary health care. The instrument of practice has been developed and resulted 5 domains consist of 20 items. An overview of reliability, construct validity, uni-dimensionality, and hierarchy of the person-items of the instrument were analyzed using Rasch Model. Results The reliability of the instrument is excellent with a person measure reliability of 0.85 and the item measure reliability of 0.96. Construct validity is confirmed with the MNSQ outfit values in the range of 0.54 to 1.59 and Pt Measure Corr. values in the range of 0.31 to 0.8. This instrument has a value of more than 20% unidimensionality which indicates the level of independence for items is good. Conclusion The instrument has good validity and reliability to assess physician’s practice in the management of patients with terminal disease.

Background Ageing is accompanied by many changes that make it more difficult for nutritional needs to be met. Management of malnutrition in older adults requires collaboration among multiple clinical disciplines. Objective This study aimed to determine the effectiveness of interprofessional collaboration and practice (IPCP) implementation for older adults with malnutrition compared to usual care. Methods This was a quasi-experimental study using an untreated control group design with dependent pretest and posttest sample of older adults with malnutrition. The intervention group worked as a team to give the intervention based on their own roles and responsibilities. The older adults of the control group received usual care from primary health care. Outcome measurement of nutritional status used the Mini Nutritional Assessment (MNA). Results The study results show significant differences between before and after IPCP implementation in the intervention group which had better scores of MNA after implementation. In the control group, there was no significant difference between before and after implementation of usual care. The statistical analysis showed there was a significant difference between the control and intervention groups who had improved nutritional status after IPCP implementation. IPCP had strong correlation with nutritional status based on correlation analysis. These results demonstrate that the collaboration by more than one health profession can improve nutritional status better than usual daily care. Conclusion IPCP has a strong and significant correlation with the nutritional status in older adults. The IPCP implementation could significantly improve their nutritional status after the IPCP implementation compared to usual care.

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As a frequent and serious problem in elderly people, malnutrition is a complex health issue. It requires comprehensive care through interprofessional collaborative practice (IPCP) engaging five health professionals in primary care consisting of a physician, dentist, nurse, dietitian and pharmacist. In Indonesia, the usual care involves monthly health screening in community programmes named Posyandu. The current study aimed to explore perceptions of elderly people with malnutrition and their families’ experiences with interprofessional teams compared with usual care in primary care. This qualitative study used the phenomenological approach based on Creswell. Interviews were conducted with fourteen elderly people and their families in the intervention group and fourteen elderly people with their families in the control group. Data were analysed using the four steps of descriptive qualitative analysis described by Giorgi, including comparing the experiences of both groups. Elderly people with malnutrition in the intervention group had more valued experiences regarding two-way communication with the IPCP team and felt it involved more comprehensive care for malnutrition management. Participants in the control group experienced communication between the health care providers and elderly people; however, it was not clear enough. There were overlapping roles among health care providers in the usual care. However, both groups shared the experience that family members are partners in nutritional management. Elderly people and their families in the intervention group have more valuable experiences related to two-way communication and comprehensive care. Family as partners was experienced in both the intervention and control groups.