Palliative care delivery across health sectors: A population-level observational study

Tanuseputro, Peter; Budhwani, Suman; Bai, Yu; Wodchis, Walter P.

doi:10.1177/0269216316653524

Cited by 136 publications

(147 citation statements)

References 23 publications

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“…Concerning the description of activity data, the extension of PC services to frail noncancer patients (mean 7.1%) and pediatric patients (mean 1.2%) in complex and advanced chronic conditions, as confirmed internationally, it is still inadequate, as demonstrated by the described data.…”

Section: Discussionmentioning

confidence: 87%

Quality assessment of palliative home care in Italy

Scaccabarozzi¹,

Lovaglio

Limonta

et al. 2017

Evaluation Clinical Practice

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Section: Discussionmentioning

confidence: 87%

Quality assessment of palliative home care in Italy

Scaccabarozzi¹,

Lovaglio

Limonta

et al. 2017

Evaluation Clinical Practice

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“…The quality of end-of-life care received in settings such as hospices is critical, considering that the majority of patients who die receive palliative care for less than two months (Bennett et al, 2016;NHPCO, 2015;Tanuseputro et al, 2016). Furthermore, it is common for patients to access palliative care from multiple settings and providers (Lawson et al, 2006;Walker et al, 2011), and to transition between care settings during the last weeks of life (Hanratty et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

The care experiences of patients who die in residential hospice: A qualitative analysis of the last three months of life from the views of bereaved caregivers

et al. 2017

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Objective: Despite the increasing prominence of residential hospices as a place of death and that, in many regards, this specialized care represents a gold standard, little is known about the care experience in this setting. Using qualitative survey data, we examined the positive and negative perceptions of care in hospices and in other prior settings.Method: Qualitative comments were extracted from the CaregiverVoice survey completed by bereaved caregivers of decedents who had died in 16 residential hospices in Ontario, Canada. On this survey, caregivers reported what was good and bad about the services provided during the last three months of life as separate open-text questions. A constant-comparison method was employed to derive themes from the responses.Results: A total of 550 caregivers completed the survey, 94% (517) of whom commented on either something good (84%) and/or bad (49%) about the care experience. In addition to residential hospice, the majority of patients represented also received palliative care in the home (69%) or hospital (59%). Overall, most positive statements were about care in hospice (71%), whereas the negative statements tended to refer to other settings (81%). The hospice experience was found to exemplify care that was compassionate and holistic, in a comforting environment, offered by providers who were personable, dedicated, and informative. These humanistic qualities of care and the extent of support were generally seen to be lacking from the other settings.Significance of results: Our examination of the good and bad aspects of palliative care received is unique in qualitatively exploring palliative care experiences across multiple settings, and specifically that in hospices. Investigation of these perspectives affirmed the elements of care that dying patients and their family caregivers most value and that the hospices were largely effective at addressing. These findings highlight the need for reinforcing these qualities in other end-of-life settings to create comforting and supportive environments.

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“…Staff highlighted the benefits of joint patient information systems and multidisciplinary meetings to facilitate integration. While there have been international policy calls for greater integration [1], there has been a lack of clarity about implementation, and evidence of inequity for those in rural areas and with non-cancer [17]. Since undertaking the study, new recommendations from the WHO have been published outlining a model of comprehensive, person-centered, and integrated palliative care [18].…”

Section: Discussionmentioning

confidence: 99%

Enhancing integrated palliative care: what models are appropriate? A cross-case analysis

Payne¹,

Eastham²,

Hughes³

et al. 2017

BMC Palliat Care

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BackgroundEffective integration between hospices, palliative care services and other local health care services to support patients with palliative care needs is an important international priority. A previous model suggests that integration involves a cumulative stepped process of engagement with other organisations labelled as ‘support, supplant or supplement’, but the extent to which this model currently applies in the United Kingdom is unknown. We aimed to investigate accounts of hospice integration with local health care providers, using the framework provided by the model, to determine how service users and healthcare professionals perceived palliative care services and the extent of integration experienced.MethodsLongitudinal organisational case study methods were employed using qualitative serial interviews (interval 3 months) with patients and family carers focusing on how services responded to their needs; and group interviews with health professionals. Data were audio-recorded, transcribed verbatim, and analysed by qualitative content analysis and combined across data sources.ResultsThe study focused on four hospices in northern England, including 34 patients (diagnosis: 17 cancer, 10 COPD, 7 heart failure), 65% female, mean age 66 (range 44–89), 13 family carers of these patients (48% partners), and 23 health care professionals. While some care fell short of expectations, all patients reported high levels of satisfaction and valued continuity of care and efficient information sharing. All hospices supported and supplemented local providers, with three hospices also supplanting local provision by providing in-patient facilities.ConclusionUK hospices predominantly operate in ways that support and supplement other providers. In addition, some also supplant local services, taking over direct responsibility and funding in-patient care. They all contributed to integration with local services, with greater blurring of boundaries than defined by the original model. Integrated care offers the necessary flexibility to respond to changes in patient needs, however, constraints from funding drivers and a lack of clear responsibilities in the UK can result in shortfalls in optimal service delivery. Integrating hospice care with local healthcare services can help to address demographic changes, predominantly more frail older people, and disease factors, including the needs of those with non-malignant conditions. This model, tested in the UK, could serve as an example for other countries.

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Palliative care delivery across health sectors: A population-level observational study

Cited by 136 publications

References 23 publications

Quality assessment of palliative home care in Italy

Quality assessment of palliative home care in Italy

The care experiences of patients who die in residential hospice: A qualitative analysis of the last three months of life from the views of bereaved caregivers

Enhancing integrated palliative care: what models are appropriate? A cross-case analysis

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