Palliative care provision in acute and critical care settings: What are the challenges?

Bloomer, Melissa

doi:10.1177/0269216319891789

Cited by 11 publications

(4 citation statements)

References 9 publications

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“…Many learners in this study emphasised the importance of prioritising the needs and wants of the patient and putting the patient at the centre of decisions around goals of care. Shared decision-making is an essential component of patient-centred care and should be prioritised for patients in hospital 6. Tools such as the ISBAR (Introduction, Situation, Background Assessment, Recommendation) and REMAP tool (Reframe, Expect Emotion, Map the Future, Align with the patients values, Plan medical treatments that match patient values) provide a framework for staff to raise concerns, speak up for patient needs and values and navigate goals of care discussions, keeping the patient at the centre 44 45…”

Section: Discussionmentioning

confidence: 99%

“…Hospitals are institutions that strive to cure, and in the context of such highly complex systems, providing both end-of-life and curative care can be a conundrum 5. When a patient with complex morbidity deteriorates in hospital, differentiating between reversible causes and ‘normal’ dying can be highly challenging for clinicians 6. Acute and critical care healthcare professionals (HCPs) work within a culture that can obstruct quality end-of-life care, in that it strives to prolong lives and treat or cure ill-health 7.…”

Section: Introductionmentioning

confidence: 99%

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Teams and continuity of end-of-life care in hospitals: managing differences of opinion

2022

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BackgroundRecognised as an essential element in end-of-life care by the Australian Commission on Safety and Quality in Health Care, effective teamwork can enhance the quality and safety of end-of-life care for patients in hospitals. End-of-Life Essentials (EOLE) is a Commonwealth funded project that delivers peer-reviewed, evidence-based, online education and practice change resources for doctors, nurses and allied health professionals working in hospitals. ‘Teams and Continuity for the Patient’ features in the suite of EOLE modules and includes education around effective teamwork in end-of-life care. The aim of this study was to explore the views of module learners on managing differences of opinion among staff regarding patient care management.MethodsParticipants were learners (health professionals) who registered to the EOLE website and engaged with the Teams module. Learner responses to a question posed at the end of the module ‘How do you manage differences of opinion among staff regarding patient care management?’ were extracted for a 12-month period. Qualitative data were analysed thematically in NVivo V.12, with pragmatism as an overarching theoretical framework. Data were coded using an inductive, open approach, and axial coding was used to organise the codes into themes and subthemes.FindingsA total of 293 learner statements were analysed, with subthemes organised into three overarching themes: prioritising the patient, team collaboration and communication skills and emotional awareness.ConclusionIn complex, fast-paced, hospital environments, the potential for conflict among teams is high. Quality care relies on team members who work in unison, who can also recognise conflict emerging and respond in respectful and appropriate ways. In this study, the management actions reported by health professionals as proving helpful when differences of opinion among team members arise, are valuable to organisations who are considering how to prepare for quality and safety accreditation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Teams and continuity of end-of-life care in hospitals: managing differences of opinion

2022

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“…When patients die in the hospital setting, they and their families may receive input from a variety of palliative and support services, both generalist and specialist. Challenges in end of life and bereavement care in acute settings are well established but services remain understudied [5][6][7] and notably, the services that provide support at this time are not well evaluated. 8 What is known is that patients and their loved ones express a need for clear communication about death, 9 timely provision of information 10 and compassionate support before and after the death.…”

Section: Introductionmentioning

confidence: 99%

End-of-life and immediate postdeath acute hospital interventions: scoping review

Green

Stewart-Lord

Baillie

2022

BMJ Support Palliat Care

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BackgroundHospital remains the most common place of death in the UK, but there are ongoing concerns about the quality of end-of-life care provision in this setting. Evaluation of interventions in the last days of life or after a bereavement is methodologically and ethically challenging.AimThe aim was to describe interventions at the very end of life and in the immediate bereavement period in acute hospitals, with a particular focus on how these are evaluated.MethodA scoping review was conducted. Studies were restricted to peer-reviewed original research or literature reviews, published between 2011 and 2021, and written in the English language. Databases searched were CINAHL, Medline and Psychinfo.ResultsFrom the search findings, 42 studies were reviewed, including quantitative (n=7), qualitative (n=14), mixed method (n=4) and literature reviews (n=17). Much of the current research about hospital-based bereavement care is derived from the intensive and critical care settings. Three themes were identified: (1) person-centred/family-centred care (memorialisation), (2) institutional approaches (quality of the environment, leadership, system-wide approaches and culture), (3) infrastructure and support systems (transdisciplinary working and staff support). There were limited studies on interventions to support staff.ConclusionCurrently, there are few comprehensive tools for evaluating complex service interventions in a way that provides meaningful transferable data. Quantitative studies do not capture the complexity inherent in this form of care. Further qualitative studies would offer important insights into the interventions.

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“…Den akuta vårdkontexten är ofta fokuserad på livsförlängande behandlingar och rutinmässiga uppgifter. Det innebär ofta fulla scheman, hög arbetsbelastning och brist på personal, vilket kan medföra att det blir en utmaning att prioritera psykosocialt stöd och kommunikation inom sjukhusvården (19)(20)(21). Det kan således vara svårt för vårdpersonal att tillgodose palliativa vårdbehov, och vårdpersonal kan uppleva sin arbetssituation stressig och emotionellt betungande (22,23).…”

Section: Introduktionunclassified

Samtal vid allvarlig sjukdom - Kronobergsmodellen

Granat

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Aim: The overall aim of this thesis was to explore clinicians’ perceptions and self-efficacy regarding the use of the ‘Serious illness conversation’ structured workflow, and to explore their self-efficacy in caring for patients with palliative care needs. Methods: This thesis is comprised of four studies: two qualitative studies, one methodological study, and one quantitative study. In studies I and II, observations of clinic meetings and training sessions were undertaken with clinicians. Interviews were performed and a thematic analysis was conducted. In study III, the Self-Efficacy in Palliative Care scale (SEPC) was translated, adapted, and validated. In study IV, the SEPC-SE was completed by nurses and physicians. Factor analysis and Cronbach's alpha were calculated, and the Mann-Whitney U test was used to compare self-efficacy. Multiple linear regression was used to explore associated factors. Results: In study I, clinicians expressed that working with serious illness conversations was vital, but the conversations were also considered in terms of risks. The conversation training sessions created feelings of exposure but were perceived to be rewarding due to an increase in self-awareness. Obstacles in practice were identified as barriers to change. Study II showed that positive experiences and the group’s level of support, consensus, and behaviour was important for self-efficacy. Some clinicians were affected by perceived high demands, failures, anxiety, stress, when working with serious illness conversations. Study III showed that the SEPC-SE needed improvements in understandability and clarity. In study IV, the SEPC-SE reported high reliability. Physicians reported higher self-efficacy than nurses. Education at work and experience in advanced homecare had the strongest associations with self-efficacy. Conclusions: Implementing serious illness conversations can increase clinicians’ awareness about the importance of engaging in serious illness conversations and thus contribute to increased motivation through behavioural and attitudinal changes. However, building a support system for clinicians within the organisation seems essential for improving self-efficacy. The SEPC-SE was found to be valid and reliable. Clinicians’ estimation of their perceived self-efficacy indicates that healthcare organisations should prioritise work-related education and experience to improve self-efficacy in providing palliative care.

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Palliative care provision in acute and critical care settings: What are the challenges?

Cited by 11 publications

References 9 publications

Teams and continuity of end-of-life care in hospitals: managing differences of opinion

Teams and continuity of end-of-life care in hospitals: managing differences of opinion

End-of-life and immediate postdeath acute hospital interventions: scoping review

Samtal vid allvarlig sjukdom - Kronobergsmodellen

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