The Ethics of Prioritizing Access to Palliative Care: A Qualitative Study

Abstract

Palliative care services are increasingly required to consider issues of resource, management as demand for services increases. The processes of triage have been developed in health care as a means of balancing need and resources in an equitable and reproducible way. Objective: This article sought to explore ethical issues associated with prioritization decisions in palliative care. Methods: As part of a broader series of studies of triage in palliative care, this qualitative substudy was conducted via semi-structured focus groups and individual interviews. Transcripts were subjected to thematic analysis. Setting/Participants: Twenty health professionals working across disciplines (primary, specialist; medicine, nursing, and allied health), service types (inpatient, hospital liaison, and community), and locations (metropolitan and rural) in Victoria, Australia. Results: Four themes emerged from the data: (1) Clinicians understood the tension between maintaining service quality with the delivery of a compromised service that sought to respond to demand. (2) They were aware of the influences of relationships and responsibilities upon patient waiting list prioritization, and (3) reported a hierarchy of suffering with certain types of clinical problems viewed as more urgent than others, for example, pain being more urgent than existential distress. (4) Clinicians noted a lack of transparency around waiting lists as they currently exist. Conclusions: This study revealed key ethical decision-making issues associated with prioritizing access to palliative care services. Making explicit the processes and influences upon decisionmaking provides greater transparency of health-care utilization at the end of life.

Examining Barriers and Facilitators to Palliative Care Access in Rural Areas: A Scoping Review

“…Among clinicians, “…many, in general, are confused by the fact that palliative care and hospice are not the same thing.” 23 Their understanding of the role of PC varied due to different education and training opportunities. 18,21,23-26 Across studies, low competency in PC provision concerned many providers who were not specialized in PC. 22,24,25,27-31 Some regional providers, especially primary care providers, had feelings of geographic isolation and had encountered challenges consulting PC specialists when needed.…”

Práticas de cuidado hospitalares no final de vida: revisão integrativa

“…Quanto ao nível de evidência, destaca-se o nível VI, presente em 46 estudos (Anderson et al, 2011;Årestedt et al, 2018;Axelsson et al, 2018;Barnato et al, 2008;Beauverd et al, 2014;Bedell et al, 1986;Bélanger et al, 2014;Chang & Brass, 2014; W.-Y. S. Chou et al, 2017;Clarke et al, 2014;Cook et al, 1995Cook et al, , 1995De Bal et al, 2006;De Witt Jansen et al, 2017;DeMartino et al, 2017;Díez-Manglano et al, 2019;Farrington et al, 2014;Gilbar et al, 2019;Guardia-Mancilla et al, 2017;Hamano et al, 2018;Hiramoto et al, 2019;Kruser et al, 2017;Kryworuchko et al, 2016;Le & Watt, 2010;Liu et al, 2015;McIlvennan et al, 2017;Montagnini et al, 2018;Mori et al, 2019;Parpa et al, 2010;Penders et al, 2020;Philip et al, 2019;Piili et al, 2018;Pugh et al, 2009;Reid et al, 2015;L. Robijn et al, 2017;Lenzo Robijn et al, 2018;Robinson et al, 2007;Scott et al, 2018;Seale, 2010;Sellars et al, 2017;Steindal et al, 2015;Syed et al, 2017;…”

“…No final da vida, o controle de sintomas físicos são priorizados, principalmente nos pacientes oncológicos (Guardia-Mancilla et al, 2017;Philip et al, 2019). Médicos tem facilidade em estabelecer prognóstico quando a doença é oncológica e dificuldade com outras doenças crônicas (Díez-Manglano et al, 2019).…”

Using a validated case mix tool for use in the telephone-assisted triage of patients in a specialist palliative care community setting: a consecutive case series

“…This study builds on existing international evidence relating to the key elements of effective triage in palliative care-identifying physical suffering, imminent dying, psychological suffering and caregiver distress as key drivers of urgency. [13][14][15] These parameters are captured in the PCOC tool-PSS focuses on physical, psychological and caregiver distress, whereas terminal phase indicates proximity to death. Our study also showed that declining functional status can be added to the drivers of urgency of referral.…”