Defining primary palliative care for universal health coverage

Munday, Daniel; Boyd, Kirsty; Jeba, Jenifer; Kimani, Kahaki; Moine, Sébastien; Grant, Liz; Murray, Scott A

doi:10.1016/s0140-6736(19)31830-6

Cited by 18 publications

(8 citation statements)

References 7 publications

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“…Primary healthcare workers may more likely to consider that palliative care is not meaningful in PLWD than in people with other life-limiting illnesses [ 51 ] or only acknowledged its benefit in terminal care, so they refer the people to the service late [ 49 ]. The resistance of timely palliative care approaches provided by HHC professionals, such as symptom management and initiating advance care planning discussion, can be further overcome through education, skills training, and discussion of moral dilemmas [ 47 , 49 , 52 ]. Further service commissioning and integration between HHC teams and external specialists such as geriatricians or palliative care may contribute to PLWD living and dying well at home [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of home healthcare on end-of-life outcomes for people with dementia: a systematic review

et al. 2022

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Background Home healthcare (HHC) comprises clinical services provided by medical professionals for people living at home with various levels of care needs and health conditions. HHC may reduce care transitions from home to acute hospitals, but its long-term impact on homebound people living with dementia (PLWD) towards end-of-life remains unclear. We aim to describe the impact of HHC on acute healthcare utilization and end-of-life outcomes in PLWD. Methods Design: Systematic review of quantitative and qualitative original studies which examine the association between HHC and targeted outcomes. Interventions: HHC. Participants: At least 80% of study participants had dementia and lived at home. Measurements: Primary outcome was acute healthcare utilization in the last year of life. Secondary outcomes included hospice palliative care, advance care planning, continuity of care, and place of death. We briefly reviewed selected national policy to provide contextual information regarding these outcomes. Results From 6831 articles initially identified, we included five studies comprising data on 4493 participants from USA, Japan, and Italy. No included studies received a “high” quality rating. We synthesised core properties related to HHC at three implementational levels. Micro-level: HHC may be associated with a lower risk of acute healthcare utilization in the early period (e.g., last 90 days before death) and a higher risk in the late period (e.g. last 15 days) of the disease trajectory toward end-of-life in PLWD. HHC may increase palliative care referrals. Advance care planning was an important factor influencing end-of-life outcomes. Meso-level: challenges for HHC providers in medical decision-making and initiating palliative care for PLWD at the end-of-life may require further training and external support. Coordination between HHC and social care is highlighted but not well examined. Macro-level: reforms of national policy or financial schemes are found in some countries but the effects are not clearly understood. Conclusions This review highlights the dearth of dementia-specific research regarding the impact of HHC on end-of-life outcomes. Effects of advance care planning during HHC, the integration between health and social care, and coordination between primary HHC and specialist geriatric/ palliative care services require further investigation.

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Section: Discussionmentioning

confidence: 99%

Impact of home healthcare on end-of-life outcomes for people with dementia: a systematic review

et al. 2022

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“…Primary palliative care refers to the delivery of basic palliative care competencies required of most physicians and includes skills such as the ability to have goals of care discussions, basic symptom management, and conducting shared decision-making for medical care. 24 In terms of cardiovascular palliative care, this often is provided by the patient's primary cardiologist, primary care provider, or inpatient medical team. Secondary palliative care is provided by a palliative care specialist with additional training and resources to address more complex symptom, psychosocial, or care coordination needs.…”

Section: Defining Types Of Palliative Carementioning

confidence: 99%

Expanding the Paradigm for Cardiovascular Palliative Care

Godfrey,

Kirkpatrick,

Kramer

et al. 2023

Circulation

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Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite medical advances, patients with CVD experience high morbidity and mortality rates, affecting their quality of life and death. Among CVD conditions, palliative care has been studied mostly in patients with heart failure, where palliative care interventions have been associated with improvements in patient-centered outcomes, including quality of life, end-of-life care, and health care use. Although palliative care is now incorporated into the American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines for heart failure, the role of palliative care for non–heart failure CVD remains uncertain. Across all causes of CVD, palliative care can play an important role in all domains of CVD care from initial diagnosis to terminal care. In addition to general cardiovascular palliative care practices applicable to all areas, disease-specific palliative care needs may warrant individualized palliative care models. In this review, we discuss the role of cardiovascular palliative care for ischemic heart disease, valvular disease, arrhythmias, peripheral artery disease, and adult congenital heart disease. Although there are multiple barriers to cardiovascular palliative care, we recommend a framework for studying and developing cardiovascular palliative care models to improve patient-centered goal-concordant care for this underserved patient population.

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“…This is defined as palliative care provided by primary healthcare workers in settings prior to specialized palliative care access. 26 Efforts are being undertaken globally to provide this education through international partnerships and even remote telehealth education. By furthering PPC education for wilderness first responders, humanitarian aid workers, and medical providers in LMICs, the likelihood increases that there will be a knowledgeable individual nearby when needed.…”

Section: Barriers To Implementationmentioning

confidence: 99%

Palliative Care’s Role in Austere Medicine

Woods

2022

Wilderness & Environmental Medicine

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The integration of palliative care across multiple domains has increased in recent years, particularly in austere medical settings such as humanitarian crises and low-and middle-income countries. Providing relief from suffering through a multifaceted approach for patients in austere environments is both an ethical imperative and perfectly suited to palliative care's ethos. Practical resources have been developed that can guide many levels of medical practitioners in the administration of palliative care techniques in these settings. Further education and advocacy continue to be needed both for the promotion of primary palliative care and for access to certain classes of medications by which to deliver this care.

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Defining primary palliative care for universal health coverage

Cited by 18 publications

References 7 publications

Impact of home healthcare on end-of-life outcomes for people with dementia: a systematic review

Impact of home healthcare on end-of-life outcomes for people with dementia: a systematic review

Expanding the Paradigm for Cardiovascular Palliative Care

Palliative Care’s Role in Austere Medicine

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