A note on versions:The version presented here may differ from the published version or, version of record, if you wish to cite this item you are advised to consult the publisher's version. Please see the 'permanent WRAP URL' above for details on accessing the published version and note that access may require a subscription For more information, please contact the WRAP Team at: wrap@warwick.ac.uk Significance of ResultsFurther research is needed to fully explore the effectiveness of existing training interventions in this population, and evidence using objective measures in particular is needed. Ideally, randomised controlled trials, or studies using control groups and longer follow ups are needed to test the effectiveness of interventions. There has been no recent review that has focused on non-cancer services and patients, and with evidence highlighting gaps in effective communication between staff and patients about EoL care in acute hospitals (e.g. Hewison et al., 2014), it is timely to focus on communication skills training in non-cancer acute services. Therefore this review seeks to establish, through the available literature, the effectiveness of communication skills training in non-cancer EoL care in acute hospital based services.
Organization of end-of-life care in acute hospitals is challenging, and care pathways provide a degree of guidance as to how services can be delivered. However, even when there is effective leadership at all levels of an organization and an extensive program of education for all staff support the use of care pathways, significant barriers to their introduction remain. These include staff anxieties concerning diagnosing dying and discussing dying and end-of-life care planning with patients and their families. It is hoped these findings can inform the development of the proposed new care plans which are set to replace end of life care pathways in England.
The paper describes and explains a previously unarticulated tension in health organisations between values and practice in patient centred care and patient involvement in service redesign.
The purpose of this study was to determine the opinions of outpatients receiving physical therapy in Indiana about physical therapy evaluation and treatment without referral (direct access). Subjects were 361 individuals being treated at one of 25 privately owned clinics. Each subject completed a 15-item questionnaire. Results showed that 82.8% of the respondents supported direct access to physical therapy. A majority indicated they would seek physical therapy services without referral if they were available. Physical therapists were cited as frequently as all other health care professionals combined as the practitioners providing the most thorough evaluation. Physical therapists were cited far more often than other health care professionals combined as the practitioners providing the best information about the control of symptoms. Subjects who had received more treatments than others were significantly more likely to support direct access (p less than .05). Conclusions were that individuals who have received physical therapy at private outpatient physical therapy clinics in Indiana are supportive of direct access to physical therapy services.
Heart failure (HF) is an increasingly prevalent long-term condition that affects around 900,000 people in the United Kingdom (National Institute for Health and Clinical Excellence). The study examined how HF services in the English National Health Service (NHS) were changing, focusing particularly on the primary/secondary care interface. The maintenance of continuity in care in the face of increasing demand and financial pressures on health and social care was a key concern. Semi-structured interviews were conducted with 22 members of staff working in HF services in three NHS acute Trusts in the West Midlands of England. Interviews were conducted between April and December 2011 with purposively selected participants and data were analysed using the Framework Method. Four main themes emerged from the analysis: service context, capacity, the primary/secondary interface and communication across boundaries. Barriers to, and facilitators of, continuity of care for patients with HF were identified within these themes. The findings provide insights into the structure, management and work of HF services in the acute and community settings. They highlight how local systems for the management of HF patients are developing in ways which are not necessarily consistent with national policy.
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