How to Advance Palliative Care Research in South America? Findings From a Delphi Study

Paiva, Carlos Eduardo; Sierra, Patricia Bonilla; Tripodoro, Vilma; Rodríguez-Núñez, Alfredo; Simone, Gustavo De; Rodriguez, Liliana Haydee; Vidal, Edison Iglesias de Oliveira; Ríos, Miriam Riveros; Crispim, Douglas Henrique; Perez‐Cruz, Pedro Emilio; Nascimento, Maria Salete de Angelis; Ospina, Paola Marcela Ruiz; Lima, Liliana De; Pastrana, Tania; Zimmermann, Camilla; Hui, David; Bruera, Éduardo; Paiva, Bianca Sakamoto Ribeiro

doi:10.1016/j.jpainsymman.2022.11.020

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…Despite the continued efforts of international and Latin American associations to enhance access to PC services and eliminate barriers, this reality persists within the current healthcare system. Therefore, it is crucial to maintain a focused approach and explore further options to improve and provide additional tools to achieve this objective in future research, 21 this includes raising awareness and conducting training programs to underscore the significance of PC.…”

Section: Discussionmentioning

confidence: 99%

Assessing the impact of palliative care admission of end-of-life cancer adults

Díez-Concha,

Gómez-García,

Agudelo

et al. 2023

Palliat�Care

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Background: There is evidence that early admission to the palliative care (PC) program in adult cancer patients improves symptoms management, reduces unplanned hospital admissions, minimizes aggressive cancer treatments, and enables patients to make decisions about their end-of-life (EOL) care. Objectives: This retrospective cohort study aimed to determine whether late admission to a PC program is associated with aggressive treatment at the EOL in adult patients with oncological diseases from their admission until death. Design/Methods: The study evaluated the aggressiveness in EOL management in patients with advanced stage oncological diseases who died between 2017 and 2019. The study population was divided into two groups based on the time of admission to the PC program. Aggressiveness at the EOL was measured using five criteria: treatment, hospital admission and duration, emergency department care, and/or intensive care unit utilization. Results: The study found a significant difference in the rate of aggressive EOL treatments between late admission to PC care and early admission [adjusted EOL 79.6% versus 70.4%; relative risk (RR): 1.98, 90% CI: 1.08–3.59, p: 0.061]; In the analysis of secondary variables, a significant association was observed between early admission to PC and the suspension of active treatments at the EOL, leading to a decrease in aggressiveness (77% versus 55.8%; RR: 1.38, 95% CI: 1.14–1.67, p: 0.004). Conclusion: Our findings suggest that early referral to PC services is associated with less aggressive treatment at the EOL, including suspension of active treatments.

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Section: Discussionmentioning

confidence: 99%

Assessing the impact of palliative care admission of end-of-life cancer adults

Díez-Concha,

Gómez-García,

Agudelo

et al. 2023

Palliat�Care

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“…This in turn supports co-learning and teaching of principles related to screening of needs for patients potentially requiring palliative care support. 31,32…”

Section: Discussionmentioning

confidence: 99%

“…This in turn supports co-learning and teaching of principles related to screening of needs for patients potentially requiring palliative care support. 31,32 With regard to the inner setting and 'resource constrains', 'time' has traditionally been a significant issue in Singapore, 33 and most recently exacerbated by the COVID-19 pandemic. 34 With increasing demands on healthcare staff, achieving buy-in for IPOS implementation would almost certainly require significant systemic change related to 'workflows', as well as the use of appropriate 'technological' support and innovation.…”

Section: Main Findingsmentioning

confidence: 99%

Facilitators and barriers to implementation of a patient and staff reported measure for screening of palliative concerns of patients with heart failure: a qualitative analysis using the Consolidated Framework for Implementation Research

Neo,

Tan,

et al. 2023

Palliat�Care

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Background: Screening patients with patient-reported outcome measures allows identification of palliative care concerns. The Integrated Palliative Care Outcome Scale (IPOS) was developed in the United Kingdom for this purpose. Tools developed in another setting might not be readily usable locally. We previously evaluated the validity and reliability of the IPOS in our cardiology setting. However, it remains uncertain what factors would influence the subsequent implementation of IPOS for routine screening of patients with advanced heart failure in future practice. Objectives: This study aimed to identify the factors that could affect the IPOS implementation for patients with advanced heart failure. Design: This was a qualitative study conducted at the National Heart Centre Singapore. Methods: Patients with advanced heart failure who participated in our previous IPOS validation study were purposively recruited for semi-structured interviews. Healthcare workers caring for these patients and involved in the testing of the IPOS tool were also invited for interviews. The interviews were analyzed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: Our analysis identified six potential facilitators and six potential barriers to implementation across five major domains of the CFIR (intervention characteristics, inner setting, outer setting, individual characteristics, and process). Facilitators include: (i) perception of utility, (ii) perception of minimal complexity, (iii) perception of relatability, (iv) conducive culture, (v) dedicated resources, and (vi) advocates for implementation. Barriers include: (i) need for adaptation, (ii) mindsets/role strains, (iii) resource constraints, (iv) cultural concerns, (v) individual needs, and (vi) change process. Conclusion: Institutions could focus on cultivating appropriate perceptions and conducive cultures, providing dedicated resources for implementation and introducing facilitators to advocate for implementation. Adaptation of IPOS to suit workflows and individual needs, consideration of change processes, and systemic changes to alleviate cultural, resource, and staff role strains would improve IPOS uptake during actual implementation in clinical services. Trial registration: Not applicable.

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