Integrating palliative care into neurology services: what do the professionals say?

Hepgul, Nilay; Gao, Wei; Evans, Catherine J; Jackson, Diana; Vliet, Liesbeth M. van; Byrne, Anthony; Crosby, Vincent; Groves, Karen; Lindsay, Fiona; Higginson, Irene J

doi:10.1136/bmjspcare-2017-001354

Cited by 31 publications

(31 citation statements)

References 8 publications

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“…It is patient-centered and involves diagnosis of clinical problems at all stages, rehabilitation to maintain function, care coordination and appropriate palliation to relieve symptoms". Recently, an increasing number of authors have focused on the integration of palliative care into neurology [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

The effect of neuropalliative care on quality of life and satisfaction with quality of care in patients with progressive neurological disease and their family caregivers: an interventional control study

2020

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Background It is recommended that patients with progressive neurological disease (PND) receive general and specialized palliative care. The purpose of this study was to determine the effect of neuropalliative care on quality of life (QoL) and satisfaction with provided care in both patients with PND in advanced stages of disease and their family caregivers. Methods The sample consisted of 151 patients with PND and 140 family caregivers. The PNDQoL questionnaire was used for data collection. Patients and family caregivers completed the questionnaires both before and 3 months after the intervention. Results Before intervention, there were no statistically significant differences in the individual domains of QoL in patients and family caregivers in either the intervention or the control group. After intervention, differences were identified in the sample of patients in the domains of symptoms burden (p < 0.001), emotional (p < 0 .001), social functioning (p = 0.046), spiritual area (nonreligious) (p = 0.050), and in QoL. In the sample of family caregivers, there were differences in the domains of symptoms burden (p < 0.001), emotional functioning (p = 0.016), spiritual area (nonreligious) (p = 0.042), and in the assessment of health (p = 0.002), and QoL (p = 0.002). Patients and family caregivers from the intervention group evaluated their satisfaction with the quality of care provided significantly more positively in all five analyzed domains. Conclusion The provision of neuropalliative care to patients with advanced stages of PND helped to maintain and slightly improve their QoL, and symptoms burden, and resulted in a more positive assessment of satisfaction with the quality of care provided.

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Section: Introductionmentioning

confidence: 99%

The effect of neuropalliative care on quality of life and satisfaction with quality of care in patients with progressive neurological disease and their family caregivers: an interventional control study

2020

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“…Contemporary palliative care practice and research focuses on disease-oriented (cancer and noncancer disease) [42,43] and setting-oriented (palliative ward, ED, intensive care unit, home-based, long-term care facility, and community-based setting) approaches. [44][45][46][47] Triage level I resuscitation is a common pathway of patients with advanced and progressive deterioration illnesses, as well as those with incurable frailty or co-existing conditions. Our study showed the average number of survival days of post-ED triage level I resuscitation is 351 days, which fits the definition of palliative care in the time dimension.…”

Section: Results Discussionmentioning

confidence: 99%

Choosing and Doing Wisely: Triage Level I Resuscitation a Possible New Field for Starting Palliative Care and Avoiding Low-Value Care-A nationwide matched-pair retrospective cohort study

Lin

Lee

2020

Preprint

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Background The association between palliative care and life-sustaining treatment for patients following emergency department (ED) resuscitation is unclear.Objective To analyze ED triage level I resuscitation patients the use of palliative care and its life-sustaining treatment usage based on a national representative sample of a population of about 2.3 million.Methods A matched-pair retrospective cohort study was conducted to examine the association between palliative care and the outcome variables using multivariate logistic regression and Kaplan–Meier survival analyses.Participants: Between 2009 and 2013, 336 ED triage level I resuscitation patients received palliative care services (palliative care group) in a universal health insurance scheme. Retrospective cohort control selection was matched using a 1:4 ratio for confounding factors with those who received usual care (usual care group).Main outcomes Outcome variables include numbers of emergency and outpatient department visits, hospitalization days, total medical expenses, life-sustaining treatment utilization, and days of survival after the ED triage level I resuscitation index date.Results The mean survival post-ED triage level I resuscitation days was less than one year, that, fit the end-of-life definition. Palliative care services provided to 15% of ED triage level I resuscitation patients. The palliative care group was more consistently and significantly associated with less life-sustaining treatment use than the usual care group.Conclusion Palliative care decisions correlate with the reduction of life-sustaining treatments for patients receiving triage level I resuscitation. Furthermore, triage level Ⅰ resuscitation status may present a possible new field for starting palliative care intervention and reducing low-value care.

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“…Our training course has helped the HPs (i) develop a new concept of PC centred on the response to the needs of people [43] and not only to care; (ii) understand that PC can also be extended to non-oncological patients [44,45] in advanced illness stages; (iii) gain empowerment and increased selfesteem from learning about the logistical and structural organization of PC to activate and implement PC [46][47][48]; (iv) appreciate the need to share personal aspects of their professional life; (v) appreciate the cooperation and joint multiple competences that enable a synergistic approach and enhanced outcomes [7,49].…”

Section: Discussionmentioning

confidence: 99%

“…The training programme, lasting 4 hours in two different editions to facilitate participation, was taught by II-level PC specialists to health professionals of all departments (I-level). The training focussed on the vision of PC by the World Health Organization (WHO) [1], the purpose of a PC unit in hospital and the sharing of PC needs in hospital wards [7,34].…”

Section: The Interventionmentioning

confidence: 99%

Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation

Artioli

Bedini²,

Bertocchi

et al. 2019

Preprint

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Background Despite the great advances in the concept of palliative care (PC) and its benefits, its application seems to be delayed, leaving unfulfilled the many needs of patients and family members. One way to overcome this difficulty could be to develop a new training programme by palliative care specialists to improve PC primary skills in healthcare professionals The aim of this study was to evaluate the training's impact on trainees within a hospital setting using Kirkpatrick’s and Moore's models. Methods We adopted a mixed-method evaluation with concurrent triangulation. The evaluation followed the first three steps of Kirkpatrick’s and Moore’s models and included a pre- and post-training evaluation through self-administered questionnaires and focus groups. We used the McNemar statistical test. Results The results highlighted the significant amount of knowledge acquired by the hospital professionals after training, in terms of increasing their knowledge of palliative care and in terms of the change in meaning that they attributed to phenomena related to chronicity and incurability, which they encounter daily in their professional practice. In both quantitative and qualitative research, the results, in synthesis, highlight: (i) the development of a new concept of palliative care, centred on the response to the holistic needs of people; (ii) that palliative care can also be extended to non-oncological patients in advanced illness stages (our training was directed to Geriatrics and Nephrology/Dialysis professionals); (iii) the empowerment and the increase in self-esteem that healthcare professionals gained, from learning about the logistical and structural organization of palliative care, to activate and implement PC; (iv) the need to share personal aspects of their professional life (this result emerges only in qualitative research); (v) the appreciation of cooperation and the joining of multiple competences towards a synergistic approach and enhanced outcomes. Conclusion It is necessary to further develop rigorous research on training evaluation, at the most complex levels of the Kirkpatrick and Moore models, to measure primary skills in health care professionals. This will develop the effectiveness of the integration of I- and II-level palliative care competencies in hospitals and improve outcomes of patients’ and families’ quality of life.

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Integrating palliative care into neurology services: what do the professionals say?

Cited by 31 publications

References 8 publications

The effect of neuropalliative care on quality of life and satisfaction with quality of care in patients with progressive neurological disease and their family caregivers: an interventional control study

The effect of neuropalliative care on quality of life and satisfaction with quality of care in patients with progressive neurological disease and their family caregivers: an interventional control study

Choosing and Doing Wisely: Triage Level I Resuscitation a Possible New Field for Starting Palliative Care and Avoiding Low-Value Care-A nationwide matched-pair retrospective cohort study

Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation

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