In a new team, close communication is particularly important for staff as they reorientate themselves to the dynamics of a new peer group. The results confirm the overwhelming importance of clarity, commitment and close, positive exchange among team members for successful team work.
The initiation of therapy seems to be easier than withdrawing and withholding, as involvement of other team members in the decision-making process was then sought more often. When antibiotics were given until death, the indication should be reconsidered because of a possibly undesirable prolongation of the dying process. Clinical practice may benefit from clear definitions of treatment goals and outcome criteria to better evaluate the necessity for and success of antimicrobial treatment.
PurposeThe call for clinically relevant outcome criteria has been raised, as assessment of adequate quality of service providers is essential with increasing momentum in the development of palliative care in most European countries. The aim of this study is to investigate important dimensions and indicators for assessment and evaluation of palliative care from the perspective of multi-disciplinary German experts working over years in the field of palliative care.MethodsA focus group, using the structured consensus method of the improved nominal group technique (INGT), with nine experts from different disciplines was conducted in Germany.ResultsAn abundance of topics (16) were identified, pointing at the complexity of the issue. Main topics were: quality of life, needs assessments of patients and relatives, resource assessment, surveillance of decision-making processes, as well as spiritual well-being. The following properties were claimed as essential for outcome criteria sensitivity, without additional burden on patients, easy applicability, scientific validity, and helpful for communication within the team, ethical discussions as well as for quality management.ConclusionsThe study identified topics considered important by experts in clinical practise. The discussions exposed the diversity of demands on outcome assessment put up by different stakeholder groups. This and the high number of relevant items show the complexity for the agreement on a unique set of outcome criteria. Further research considering other perspectives is needed.
Based on limited evidence, we cannot recommend a specific drug for treatment of fatigue in palliative care patients. Surprisingly, corticosteroids have not been a research focus for fatigue treatment, although these drugs are frequently used. Recent fatigue research seems to focus on modafinil, which may be beneficial although there is no evidence currently. Amantadine and methylphenidate should be further examined. Consensus regarding fatigue assessment in advanced disease is needed.
The MIDOS tool was perceived as a helpful and valuable complement to existing tools. Participants expressed some concerns regarding the subjective nature of perceiving symptoms and clinical decision making. The use of tools such as the MIDOS tool has the potential to enhance the quality of palliative care in dementia care.
The single item is unable to completely replace comprehensive questionnaires, but it is useful to initiate communication on QoL and can be recommended as a substitute for physical-functional aspects of QoL assessment in the palliative care setting.
Background
In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program ‘Palliative care in Pandemics’ (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON).
Methods
Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified.
Discussion
For a future “pandemic preparedness” national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.
Der Zweck dieses Konsensus-Dokuments ist die Beantwortung der Frage: "Welche Kompetenzen sind in Bezug auf den klinischen Einsatz von Palliativversorgung für alle Fachkräfte wichtig, und zwar unabhängig von ihrer spezifischen Berufsgruppenzugehörigkeit?" Es ist allgemein anerkannt, dass die Palliativversorgung in einem breiten Spektrum von Bereichen der Gesundheitsversorgung durchführbar ist, vom Krankenhaus der Maximalversorgung bis hin zur medizinischen Grundversorgung. Alle in der Gesundheitsversorgung Beschäftigten sollten eine angemessene Palliativversorgung anbieten können. Sie müssen daher aus-und weitergebildet werden, den herausfordernden Bedürfnissen der Patienten und ihrer Familien gerecht zu werden, um den höchstmöglichen Versorgungsstandard zu erreichen, unabhängig von der zugrunde liegenden Diagnose. Das vorliegende EAPC-Weißbuch zeigt Expertenmeinungen zu globalen Kernkompetenzen für die professionelle Praxis unabhängig von Berufsgruppen auf und ist als eine Ressource für Praktiker und Lehrende gleichermaßen gedacht. Die hier beschriebenen 10 Kernkompetenzen könnten dabei helfen, Rollen und Verantwortlichkeiten von Teams zu entwickeln, die Palliativversorgung in ihren Gesundheitssystemen anbieten und weiterentwickeln möchten.
Abstract
!The purpose of this White Paper is to address the question: "What competencies for clinical practice in palliative care are important for all practitioners, irrespective of their specific discipline?". It is widely recognised that palliative care is applicable across a range of healthcare settings, from tertiary hospitals to primary care. All healthcare professionals and workers should be able to provide appropriate palliative care and thus need to be trained to provide the highest possible standards of care in order to meet the challenging needs of patients and families, irrespective of diagnosis. This EAPC White Paper presents expert opinion on global core competencies for professional practice, irrespective of discipline, and is intended as a resource for practitioners and educators alike. We propose that the ten core competencies identified in this White Paper may assist in scoping the roles and responsibilities of palliative care teams as they strive to provide care within different healthcare systems.
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