Care of the Dying in Australia's Busiest Hospital: Benefits of Palliative Care Consultation and Methods To Enhance Access

Le, Brian; Watt, James

doi:10.1089/jpm.2009.0339

Cited by 58 publications

(73 citation statements)

References 15 publications

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“…(25,26) Factors related to the practice styles of medical and allied health professionals may facilitate referral, or lead to referral delays. (27,28) Despite their gate-keeping role, 78% of doctors in one US study felt that palliative care services were underutilised. (15) Medical professionals' communication styles potentially impact on referrals to PC services.…”

Section: Patient and Family-related Issuesmentioning

confidence: 99%

Barriers to accessing palliative care: A review of the literature

Love

Liversage

2013

Progress in Palliative Care

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The aim was to review factors affecting patients' access to palliative care. First, the benefits of palliative care for comprehensive care of patients and their families are identified. Despite these benefits, universal standards for access are lacking and referral typically occurs later than is recommended, limiting access to best practice care. Factors relating to access are reviewed in detail. They are grouped conceptually, combining those related to organisational factors, patient and family-related issues, which include characteristics of patients, preferences for curative care, and willingness to discuss and participate in palliative care, and factors attributed to physicians and health professionals, such as communication styles, sense of efficacy, perceptions of patient readiness, and knowledge of palliative care. Despite the accumulated evidence, the existing studies share methodological weaknesses, which are (1) Yet referrals to PC can still be untimely, poorly managed, or delayed. An earlier review of the literature has identified the problems and issues associated with accessing PC.(2) The aim of this paper is to review the literature published in the decade since, addressing factors associated with access to PC services and to suggest aspects of access to PC requiring further investigation. Referral to palliative careMany studies have demonstrated that earlier access to palliative care may have positive benefits, addressing issues such as anticipatory grief and loss throughout the trajectory, facilitating improved symptom management, improved mood, and overall quality of life. (3,4) Despite the demonstrated benefits, PC use is often less than optimal and opportunities are frequently missed. Table 1.Insert Table 1 about here Factors affecting access to palliative care servicesIn order to conceptualise the many interrelated factors that have been identified as affecting access to PC services, a theoretical model was devised (Figure 1). Patients are considered as part of a family system, including carers and other family members. Health care teams are spearheaded by treating physicians and are part of health organisations.Communication factors between patients and families and health care teams create the foundation on which relationships are formed. There is a broader context: the wider health care system and social and cultural factors are important influences on access to PC services.

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Section: Patient and Family-related Issuesmentioning

confidence: 99%

Barriers to accessing palliative care: A review of the literature

Love

Liversage

2013

Progress in Palliative Care

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“…How these operate concurrently or are evident within certain clinical contexts remains unknown. The benefits of timely, well-communicated and considered referrals for patients and carers in terms of quality-of-life measures,9 11 survival estimates,10 as well as for improving patient and carer experiences,7 11 18 23 are well-documented. Existing research focused on the motivations and triggers for referral has found that in practice, specialists still tend to base referrals primarily on physical/disease attributes rather than psychosocial factors 8 25 26.…”

Section: Introductionmentioning

confidence: 99%

Medical specialists’ motivations for referral to specialist palliative care: a qualitative study

Kirby

Broom

Good

et al. 2012

BMJ Support Palliat Care

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“…[4][5][6][7][8][9] Unfortunately there are continuing reports by patients and their families of unsatisfactory experiences of palliative and end-of-life care in acute hospitals. This is not limited to the UK 10 but also found internationally, in America, 11 Europe 12 and Australia 13 for example.…”

Section: Recognising the Problemmentioning

confidence: 71%

Short-stay, specialist beds in a UK teaching hospital as a model to integrate palliative care into the acute hospital culture

Paterson

Buchanan²,

F³

et al. 2012

J R Coll Physicians Edinb

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Short-stay, specialist beds in a UK teaching hospital as a model to integrate palliative care into the acute hospital culture ABSTRACT Hospital patients should have access to effective palliative care. In our study, three short-stay beds were re-allocated to specialist palliative care as part of a pilot programme. This paper describes the first 100 admissions of patients with inadequately controlled symptoms or distress. Median pain and distress scores were both seven out of a maximum of 10 (interquartile ranges [IQR] 4-10 and 1-10 respectively), reducing to 3.5 (IQR 1-5) and 0 (0-5) after 48 hours. Median length of stay was five days (IQR 3-10); 77% of patients were discharged: 32% to home, 26% to a hospice or community hospital, 19% to their original ward for treatment and 23% died in the unit. A unit education programme introduced as part of the study attracted 600 staff members. Pain and distress were rapidly improved by brief, intense palliative care in a small onsite facility. The pilot programme also influenced the understanding of palliative care in the hospital, demonstrating what it offered patients, family and staff. It demonstrated effective, concurrent working alongside an active disease-management approach, and encouraged collaborative discussions about the goals of care.

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Care of the Dying in Australia's Busiest Hospital: Benefits of Palliative Care Consultation and Methods To Enhance Access

Cited by 58 publications

References 15 publications

Barriers to accessing palliative care: A review of the literature

Barriers to accessing palliative care: A review of the literature

Medical specialists’ motivations for referral to specialist palliative care: a qualitative study

Short-stay, specialist beds in a UK teaching hospital as a model to integrate palliative care into the acute hospital culture

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