Developing targets for public health initiatives to improve palliative care

Abstract

BackgroundPalliative Care is an approach that improves quality of life for patients and their families facing the problems associated with incurable life-threatening illness. In many countries, due to the rapidly ageing population, increasingly more people are suffering from serious chronic disease towards the end of life, making further development in palliative care a major public health challenge. The aim of this study was to develop the first targets for public health initiatives to improve palliative care in Germany.MethodsBased on the findings from pilot studies (qualitative interviews and surveys with different stakeholders in the health care system), we conducted a modified Delphi study with two rounds of questionnaires with experts in public health and palliative care. In the first round, the experts commented on the findings from the pilot studies. The answers were evaluated descriptively and with qualitative content analysis, resulting in the formulation of 25 targets. These were presented to the experts in the second Delphi round to assess each of them separately with regard to its importance and current implementation (7-point answer scales) and in relation to the other targets (defining the five most important of the 25 targets).ResultsSix most relevant targets for public health initiatives to improve palliative care in Germany were worked out: Supporting palliative care as a basic attitude for the care of people in the last phase of life; coordinating healthcare for people in the last phase of life; establishing cooperation among health professions and disciplines; establishing education in palliative care for all professional groups with contact to people in the last phase of life; reviewing the evidence of palliative care measures; offering support to family members who are caring for someone in the last phase of life.ConclusionsTo systematically develop palliative care, it makes sense to define fields of action with individual targets. For Germany, it can be recommended to give priority to the targets that were highlighted as the most relevant in this study. The next step will be to develop, implement and evaluate tangible measures to achieve these targets.

Assessment of Knowledge and Associated Factors towards Palliative Care among Greek Nurses

“…The aforementioned argument is based on a number of grounds including demographics and the aging societies, the spread of life-threatening incurable and chronic diseases, and that informal care, as for example within families, becomes uncommon due to socioeconomic factors. Indeed, due to these changes the number of older people with incurable chronic disease and multiple morbidities has significantly increased over the last two decades (Schneider et al, 2010). This imposes a major undertaking for health systems worldwide, enhancing the need for appropriate PC healthcare units.…”

O papel do profissional da Atenção Primária à Saúde em cuidados paliativos

“…O conhecimento das famílias, por vezes prévio ao diagnóstico de doença grave e fatal, leva os profissionais de APS a compreenderem suas dificuldades e as potencialidades em cada situação. 1,19,25 A manutenção do acompanhamento por profissionais da APS aos pacientes em cuidado especializado facilita a transição para os cuidados paliativos e contribui nas tomadas de decisão posteriores. 9,19,21,24 Os textos analisados trazem também que Responsabilizar-se pelo cuidado paliativo com a família leva os profissionais de APS a colocarem-se lado a lado com as famílias, agindo como tradutores do universo de exames, especialistas e laudos dos serviços especializados envolvidos nos tratamentos e paliação.…”

“…22 A família é frequentemente identificada como cuidadora, mas a APS vê a própria família como objeto do cuidado, buscando apoiá-la no exercício do cuidado com seu ente em processo de morrer, buscando fortalecê-la e protegê-la da sobrecarga. 1 Ao Buscar aprimoramento profissional em cuidados paliativos os profissionais de APS procuram suprir deficiências de sua formação hospitalocêntrica, focada em tecnologias duras e busca pela cura, não em qualidade de vida. 11,25 Os autores declaram que desde a formação do profissional que atuará na APS é fundamental que se tenha experiências com paliação, garantindo o aprendizado desse novo paradigma de cuidado.…”

“…Isso se deve ao progressivo envelhecimento da população e à maior sobrevida de portadores de doenças graves e fatais com evolução progressiva. 1,2 Sendo assim, torna-se cada vez mais urgente a priorização do provimento, organização e coordenação da prestação de cuidados adequados a essa população.…”

Few U.S. Public Health Schools Offer Courses on Palliative and End-of-Life Care Policy

“…In England, the work of Murtagh and colleagies refined methods for population-based estimates of palliative care need, 9 leading to new initiatives and funding models proposed by policymakers. 10 Recently German researchers developed the first targets for public health initiatives to improve palliative care in Germany, 11 and the European Association for Palliative Care has laid out a comprehensive palliative care agenda. 12 Despite progress in other developing and developed countries, the United States has largely left palliative care off of the public health agenda.…”