Strategies for Introducing Outpatient Specialty Palliative Care in Gynecologic Oncology

Hay, Casey M.; Lefkowits, Carolyn; Crowley‐Matoka, Megan; Bakitas, Marie; Clark, Leslie H.; Duska, Linda R.; Urban, Renata R.; Creasy, Stephanie L.; Schenker, Yael

doi:10.1200/jop.2017.020818

Cited by 21 publications

(8 citation statements)

References 23 publications

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“…"[I had] a patient that was living at home with her husband and she was falling all the time and was back and forth into the hospi-tal…It was almost to the point where I was [considering] calling Adult Protective Services because the husband really couldn't take care of her… But palliative care wasn't involved in that, and sometimes I think most people consider palliative care for cancer patients or patients in a lot of pain, but I think that palliative care could have been beneficial for this patient." (PCP- 14) Interviewees reported that providers across different settings could help identify palliative care needs for patients by drawing on each provider's unique perspective. That is, participants explained that each provider has access to different cues that palliative care may be needed based on their setting and relationship to the patient.…”

Section: Providers Across Settings Can Identify Palliative Care Needsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…13 Additionally, solutions to address these challenges often focus on support for individual or specialist providers, such as oncologists, rather than improving coordination and information sharing across settings and providers. 3,[14][15][16] To guide development and future pilot testing of a model to identify and address unmet palliative care needs among older adult HHC patients and their family caregivers across multiple settings, we conducted a qualitative descriptive study that addresses the following questions: (1) how can a coordinated multi-setting (i.e., inpatient, primary care, HHC) approach improve the early identification of palliative care needs, and ( 2) what is the best way to overcome existing communication challenges to facilitate these conversations?…”

Section: Introductionmentioning

confidence: 99%

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Palliative Care across Settings: Perspectives from Inpatient, Primary Care, and Home Health Care Providers and Staff

Tietbohl

Dafoe

Jordan

et al. 2023

Am J Hosp Palliat Care

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Background Early introduction of palliative care can improve patient-centered outcomes for older adults with complex medical conditions. However, identifying the need for and introducing palliative care with patients and caregivers is often difficult. We aim to identify how and why a multi-setting approach to palliative care discussions may improve the identification of palliative care needs and how to facilitate these conversations. Methods Descriptive qualitative study to inform the development and future pilot testing of a model to improve recognition of, and support for, unmet palliative care needs in home health care (HHC). Thematic analysis of semi-structured interviews with providers across inpatient (n = 11), primary care (n = 17), and HHC settings (n = 10). Results Four key themes emerged: 1) providers across settings can identify palliative care needs using their unique perspectives of the patient’s care, 2) identifying palliative care needs is challenging due to infrequent communication and lack of shared information between providers, 3) importance of identifying a clinical lead of patient care who will direct palliative care discussions (primary care provider), and 4) importance of identifying a care coordination lead (HHC) to bridge communication among multi-setting providers. These themes highlight a multi-setting approach that would improve the frequency and quality of palliative care discussions. Conclusions A lack of structured communication across settings is a major barrier to introducing and providing palliative care. A novel model that improves communication and coordination of palliative care across HHC, inpatient and primary care providers may facilitate identifying and addressing palliative care needs in medically complex older adults.

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Section: Providers Across Settings Can Identify Palliative Care Needsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Palliative Care across Settings: Perspectives from Inpatient, Primary Care, and Home Health Care Providers and Staff

Tietbohl

Dafoe

Jordan

et al. 2023

Am J Hosp Palliat Care

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“…Gynecological cancers have characteristics of high morbidity, high mortality, and recurrence. 11 , 12 Moreover, rational use of some technical methods to study the spatial distribution of gynecological cancer and identify areas with high incidence of gynecological cancer can help improve the efficiency of early screening. In particular, the late treatment of gynecological cancer is not effective.…”

Section: Introductionmentioning

confidence: 99%

<p>Application of GIS Spatial Analysis and Scanning Statistics in the Gynecological Cancer Clustering Pattern and Risk Screening: A Case Study in Northern Jiangxi Province, China</p>

Wan¹,

Wang²,

Deng³

2020

RMHP

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Objective The incidence of gynecological cancer is high in China, and the effects of related treatments and preventive measures need to be improved. Methods This study uses GIS spatial analysis methods and a scanning statistical analysis to study the major gynecological cancers in northern Jiangxi Province from 2016 to 2018. Results The incidence and spatial pattern of cervical cancer, ovarian cancer, and uterine cancer had agglomeration characteristics and changes during the study period. The gynecological cancer had a spatial autocorrelation and agglomeration in its spatial pattern. The Moran’s Index of the overall gynecological cancer incidence rate was 0.289 (p = 0.005). Ripley’s L(d) function showed that the agglomeration radius was between 51.40 and 52.82 km. The results of the kernel density estimation showed that the cases of gynecological cancer were concentrated in the central and northeastern areas of the study area. The overall county-level incidence of gynecological cancer varied from 0.26 to 11.14 per 100,000. The results of the gravity center analysis showed that the spatial distribution of the gravity center point of gynecological cancer had moved toward the east during the past three years. The results of a hotspot analysis showed that there were five hotspot areas that had gynecological cancers. The most likely clusters of gynecological cancer at the county level in northern Jiangxi Province were distributed in the adjacent areas of Jiujiang, Yichun, and Nanchang, with a relative risk of 1.85. Conclusion The research shows that GIS can display the distribution of cancer cases and can use spatial analysis methods and scanning statistical techniques to obtain key areas of cancer incidence. These results can provide data and key areas for the formulation of regional public health policies and provide recommendations for cancer screening and the rational allocation of health resources.

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“…3 Disruption of these attachments can lead to negative consequences, such as perceptions of abandonment, 4 which has implications for quality EOL cancer care, including serving as a deterrent to enrollment in palliative care programs, potentially affecting advanced care planning discussions, and causing shock and distress from lack of closure of this valued relationship. [4][5][6][7][8][9][10] Relationships between the patient and HCP may be affected not only by the termination of the relationship but also by negative changes in the relationship near EOL, including rushed visits and poor communication or miscommunication. [10][11][12][13] Stanley 11(p936) has characterized these negative changes as "emotional abandonment."…”

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confidence: 99%

A Qualitative Descriptive Study of Nurse-Patient Relationships Near End of Life

et al. 2023

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Background The end of life (EOL) period represents a challenging time for patients with cancer as they face disruptions in their relationships with their oncology healthcare providers (HCPs) when moving toward hospice care. Poor communication and severed or altered relationships in physician-patient relationships have been shown to occur near EOL, leading to perceptions of abandonment and other negative consequences for quality EOL care. Little is known, however, about nurse-patient relationships near EOL in the cancer setting. Objective The purpose of this qualitative descriptive study was to describe the relationships between patients with cancer and their cancer nurses near EOL. Methods A qualitative descriptive methodology was used via semistructured interviews. A total of 9 participants with advanced cancer were enrolled in and completed the study. Data analysis occurred through qualitative content analysis. Results The overarching theme woven throughout the narratives was “Good Communication Fosters Nurse-Patient Relationships.” Three additional themes emerged from this main theme: 1) “Valuing Professionalism in the Relationship,” 2) “Embracing Personhood in the Relationship,” and 3) “An Unimaginable Termination.” Conclusion Patients with cancer continued to perceive good communication and strong relationships with their cancer nurses even as EOL approached. Themes consistent with negative alterations in these relationships or perceptions of abandonment were not identified. Implication for Practice Cancer nurses can foster nurse-patient relationships through patient-centered communication techniques. Spending adequate time engaging with patients as individuals is also recommended. Perhaps most importantly, nurse-patient relationships should continue to be supported as EOL approaches.

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Strategies for Introducing Outpatient Specialty Palliative Care in Gynecologic Oncology

Abstract: Gynecologic oncologists have developed strategies for introducing palliative care services to alleviate patient concerns. These strategies provide groundwork for developing system-wide best practice approaches to the presentation of palliative care referral.

Cited by 21 publications

References 23 publications

Palliative Care across Settings: Perspectives from Inpatient, Primary Care, and Home Health Care Providers and Staff

Palliative Care across Settings: Perspectives from Inpatient, Primary Care, and Home Health Care Providers and Staff

<p>Application of GIS Spatial Analysis and Scanning Statistics in the Gynecological Cancer Clustering Pattern and Risk Screening: A Case Study in Northern Jiangxi Province, China</p>

A Qualitative Descriptive Study of Nurse-Patient Relationships Near End of Life

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