Palliative Care and Social Practice最新文献

{"title":"Focusing on life rather than illness: the lived experience of children with life-threatening and life-limiting conditions-a qualitative study.","authors":"Trine Brun Kittelsen, Charlotte Castor, Anja Lee, Lisbeth Gravdal Kvarme, Anette Winger","doi":"10.1177/26323524241301431","DOIUrl":"https://doi.org/10.1177/26323524241301431","url":null,"abstract":"<p><strong>Background: </strong>The perspectives of children with life-threatening or life-limiting (LT/LL) conditions have predominantly been conveyed through their parents rather than heard from the children themselves. Despite an increase in studies focusing on children's perspectives in pediatric palliative care, this research remains limited, particularly in including children who are unable to express themselves orally.</p><p><strong>Objective: </strong>This study seeks to address gaps in existing knowledge, especially the limited inclusion of children's perspectives and the exclusion of children with communicative and cognitive disabilities. The aim of this study was to explore the lived experiences of children living with LT/LL conditions.</p><p><strong>Design: </strong>The study has a qualitative, hermeneutic phenomenological design inspired by van Manen's phenomenology of practice.</p><p><strong>Methods: </strong>Twelve children with cancer or genetic conditions participated. Due to the children's varying cognitive and communicative abilities, multiple data collection methods were employed to capture the children's perspectives, including interviews, interactions, descriptions of the children's non-verbal expressions, and an adapted photo elicitation method. Data were analyzed using thematic analysis.</p><p><strong>Results: </strong>The findings showed that the children's attention revolved around life rather than illness. The analysis revealed the presence of three themes: wanting to engage in life, being dependent on familiar relations, and the importance of cherished items.</p><p><strong>Conclusion: </strong>Professionals across various levels within pediatric palliative care should acknowledge children's desire to engage in life despite serious illness and facilitate participation. Practices should be implemented to support children's agencies and expressions of what is important to them. This recognition can guide care plans and interventions at all levels of pediatric palliative care when a child is living with an LT/LL condition. The study emphasizes that children with LT/LL conditions are children first and foremost, with a fundamental need to participate in meaningful activity, just like any other child.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241301431"},"PeriodicalIF":2.7,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial cost of end-of-life cancer care in palliative care units (PCUs) and non-PCUs in Iran: insights from low- and middle-income countries.","authors":"Ali Darrudi, Amir Hossein Poupak, Rajabali Darroudi, Nasrin Sargazi, Kazem Zendehdel, Libby Sallnow, Ali Ghanbari Motlagh, Mamak Tahmasebi, Azin Nahvijou","doi":"10.1177/26323524241299819","DOIUrl":"https://doi.org/10.1177/26323524241299819","url":null,"abstract":"<p><strong>Background: </strong>End-of-life care for patients with advanced cancer can impose a significant financial burden. However, data on the economic impact of end-of-life care in low- and middle-income countries are limited.</p><p><strong>Objective: </strong>This study aims to compare the costs associated with palliative care units (PCUs) and non-PCU settings for cancer patients in Iran.</p><p><strong>Design: </strong>We designed a retrospective study at the largest hospital in the country.</p><p><strong>Methods: </strong>We conducted a comprehensive evaluation of hospitalization costs and care service delivery for 150 patients in the final 5 days of life, who were admitted to the largest hospital complex in Iran. All costs were adjusted based on the 2018 USD exchange rate.</p><p><strong>Results: </strong>Among the 150 patients included in the study, 56 (37%) were admitted to the PCU. The average total treatment cost during the final 5 days of life was three times higher in general wards compared to PCUs. In non-PCU settings, the total cost of care during this period amounted to $2873, while in PCU settings, it was $909.63.</p><p><strong>Conclusion: </strong>The establishment of PCUs within tertiary hospitals and the provision of palliative consultation services to patients with advanced cancer can yield significant benefits, even when resources are limited.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241299819"},"PeriodicalIF":2.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing palliative care education nationwide: a practice example from The Netherlands.","authors":"Ingrid van Zuilekom, Jojanneke Thiesen-van Staveren, Marijke Dericks-Issing, Marieke van den Brand, Harmieke van Os-Medendorp, Suzanne Metselaar","doi":"10.1177/26323524241298288","DOIUrl":"10.1177/26323524241298288","url":null,"abstract":"<p><strong>Background: </strong>Every healthcare professional (HCP) in the Netherlands is expected to provide palliative care based on their initial education. This requires national consensus and clarity on the quality and goals of palliative care education and accessible education opportunities nationwide. These requirements were not met in the Netherlands, posing a major obstacle to improving the organization and delivery of palliative care. Therefore, a program, Optimizing Education and Training in Palliative Care (O²PZ), was established to improve palliative care education on a national level.</p><p><strong>Objectives: </strong>The main task of the O²PZ program from 2018 to 2021 was to implement and improve palliative care education in initial education for nursing and medical professionals. The program's ultimate goal was that every HCP be sufficiently educated to provide high-quality generalist palliative care.</p><p><strong>Design: </strong>The O²PZ program consists of four projects to improve and consolidate generalist palliative care education nationwide.</p><p><strong>Methods: </strong>All projects used a participatory approach, that is, participatory development, implementation, and co-creation with stakeholders, mainly HCPs and education developers. Appreciative inquiry was used to assess, improve, and integrate existing local palliative care education initiatives.</p><p><strong>Results: </strong>(1) Establishment of an Education Framework for palliative care for all HCPs, including an interprofessional collaboration model; (2) optimization of palliative care education in the (initial) curricula of vocational education institutions and (applied) universities; (3) establishment of an online platform to disseminate materials to improve palliative care education; and (4) installment of seven regional palliative care education hubs, of which one hub was devoted to pediatric palliative care, as well as one national hub.</p><p><strong>Discussion: </strong>We discuss some lessons learned and challenges in accomplishing the goals of the O²PZ program in 2018-2021 and address how these challenges were dealt with. We maintain that co-creation with stakeholders at policy, organizational, and operational levels, as well as ongoing communication and collaboration, is essential to consolidating and implementing results.</p><p><strong>Conclusion: </strong>Over the past 4 years, we have improved generalist palliative care education nationwide for all HCPs through four projects in which we collaborated closely with stakeholders. This has resulted in more attention to and implementation of palliative care in education, a national Education Framework for palliative care, including an interprofessional collaboration model, an online platform for palliative care education, and palliative care education hubs covering all regions of the Netherlands.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241298288"},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating patient-centred and tumour-centred cancer care: the EU-MyPath implementation project offers an innovative digital solution with care pathways.","authors":"Anne-Lore Scherrens, An Jacobs, Kim Beernaert, Koen Pardon, Eveline Raemdonck, Marie Fallon, Kathrin Cresswell, Nusa Faric, Robin Williams, Tonje Lundeby, Marianne J Hjermstad, Luc Deliens, Stein Kaasa","doi":"10.1177/26323524241296143","DOIUrl":"10.1177/26323524241296143","url":null,"abstract":"<p><p>Cancer is one of the leading causes of mortality, with new cases expected to rise. Medical advances increase cure rates and prolong patient lives, but survivorship involves high symptom burden, loss of function and emotional distress. Improving patient-centred care (PCC) and quality of life throughout the care process is essential. Key to this improvement are systematic use of patient-reported outcome measures (PROMs) and patient-centred care pathways (PCCPs). Despite established benefits, current cancer care focuses on tumour-centred care approaches often neglecting the patient perspective. Evidence-based PCC guidelines fail to be routinely incorporated into clinical practices. The Horizon 2020-funded European MyPath project aims to address these gaps by developing, implementing and evaluating digital PCCPs with PROMs. MyPath will be tailored to enhance the organisational contexts of cancer centres across Europe through the application of implementation science strategies. This paper describes the current state of applying PCC in routine cancer care and presents a forward-looking perspective on how the MyPath project can successfully adopt and implement digital PROMs across countries. A literature search was conducted to provide the state-of-the art.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241296143"},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Professional Guest: conceptualizing home visits in palliative care settings.","authors":"Ron Sabar, Inbal Halevi Hochwald, Moran Weiss, Gila Yakov","doi":"10.1177/26323524241293821","DOIUrl":"10.1177/26323524241293821","url":null,"abstract":"<p><strong>Background: </strong>Home-based palliative care is a growing trend, necessitating a deeper understanding of the unique challenges faced by professional staff members in this setting. The shift to home-based care has been driven by advances in technology, changing demographics, and a move toward more patient-centered approaches. As a care setting, the home environment offers distinct characteristics, presenting both advantages and drawbacks for patients and healthcare providers.</p><p><strong>Objectives: </strong>This study aims to explore the experiences and perceptions of professional staff members providing palliative care in patients' homes.</p><p><strong>Design: </strong>A qualitative descriptive study.</p><p><strong>Methods: </strong>Qualitative study with 36 home-based hospice professionals using questionnaires and interviews. Thematic analysis identified key themes in staff experiences and challenges.</p><p><strong>Results: </strong>The central theme of \"The Professional Guest\" highlights the hybrid identity and boundary role professional staff members must navigate, being both medical professionals and guests in the patient's domain. Four sub-themes emerged: (1) Observing and Applying, emphasizing the conscious scanning of the home environment to build trust and tailor care plans; (2) Asking for Permission, respecting the patient's territory and adapting to their norms; (3) Expecting the Unexpected, maintaining flexibility and improvising in unfamiliar situations; and (4) Preparing the Ground for Your Absence, equipping patients and families with comprehensive self-care guidance during professional staff members' absences.</p><p><strong>Conclusion: </strong>The \"Professional Guest\" phenomenon captures the complexities of providing care in patient's homes, necessitating a delicate balance between professionalism and personal vulnerability. Specialized training programs and policies should be developed to support professional staff members in navigating this hybrid identity and effectively negotiating the boundaries between professional and personal spheres.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241293821"},"PeriodicalIF":2.7,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical influence: what does success look like?","authors":"Diane Wintz, Kelly Wright, Kathryn B Schaffer","doi":"10.1177/26323524241297695","DOIUrl":"10.1177/26323524241297695","url":null,"abstract":"<p><strong>Background: </strong>Social media influencers have revolutionized information, gaining viewers, retention, and interest with short videos. Medical teams could potentially benefit from this medium for educating patients. Defining success in this endeavor remains unclear.</p><p><strong>Objective: </strong>We are a surgeon-nurse team that sought to promote our messages on social media to gain viewers and interest in our website.</p><p><strong>Design: </strong>An educational podcast focusing on end-of-life discussions was linked to social media platforms, including <i>Instagram</i> and <i>TikTok</i>, to gain views on our website.</p><p><strong>Methods: </strong>Eleven podcast episodes were produced and published over a 3-month period, between November 2023 and January 2024. The podcast episodes were promoted to \"similar clients\" based on internal algorithms by a podcast streaming service, <i>Spotify</i>. The promotion provided by <i>Spotify</i> and website views were compared to responses evident by other social media posts.</p><p><strong>Results: </strong>After 3 months of publishing podcast episodes on <i>Spotify</i>, with free publicity, our podcast gained 10,400 promotions, 486 listeners, 49 followers, and approximately 1200 random website views. In comparison, the podcast content garnered more than 50,000 video clip views on <i>TikTok</i> and <i>Instagram</i>, after funding these brief video promotions. <i>TikTok</i> and <i>Instagram</i> both charged $20 or more per promotion. Paid promotion opportunities resulted in no website visits or podcast followers.</p><p><strong>Conclusion: </strong>Our own experience with social media promotion was inadequate in generating interest in our content. The authors would encourage other teams to be strategic with paid promotions and to consider engaging a marketing expert to improve the potential for mass interest in content and promotional efficiency. Additionally, based on these findings, the authors would appreciate more transparency in the algorithms behind successful promotions to better understand \"what success looks like\" for medical messaging.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241297695"},"PeriodicalIF":2.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative care consultation in the last week of life and associated factors: a cross-sectional general population study.","authors":"Susanna Böling, Hanna Gyllensten, My Engström, Emma Lundberg, Johan Berlin, Joakim Öhlén","doi":"10.1177/26323524241293818","DOIUrl":"https://doi.org/10.1177/26323524241293818","url":null,"abstract":"<p><strong>Background: </strong>Knowledge of access to palliative care services, such as palliative care consultation teams, is crucial to identify areas of improvement for policy and practice. Research on general populations spanning all disease groups and multiple healthcare contexts is needed.</p><p><strong>Objective: </strong>The objective was to investigate the sociodemographic, disease- and care-related, and care structure-related factors associated with palliative care consultations for adult patients in the last week of life.</p><p><strong>Design: </strong>Cross-sectional, general population-level study based on linked Swedish national public authority registers and a national palliative care quality register.</p><p><strong>Methods: </strong>The study population included all adult patients deceased in Sweden between 2013 and 2019 and registered in the Swedish Register of Palliative Care, with an anticipated death, and not enrolled in specialised palliative care. Multivariable logistic regression analyses to investigate association with palliative care consultations.</p><p><strong>Results: </strong>In total, 8.2% of the 265,129 participants had received a palliative care consultation in the last week of life. The main multivariable analysis (Model 1) showed that those dying from neoplasms were more likely to receive a palliative care consultation (odds ratio (OR) 8.55, 95% CI 8.15-8.98) than those dying from circulatory diseases. Palliative care consultation was more likely with an increasing number of symptoms (OR 1.35, CI 1.32-1.37). Patients of old age and patients deceased in hospitals were less likely to receive a palliative care consultation. Moreover, factors such as educational attainment, healthcare region, living in a single-person household, and year of death were also associated with a palliative care consultation in the last week of life.</p><p><strong>Conclusion: </strong>Our findings show inequities in access to palliative care consultations in the last week of life. Considering changes to policy and clinical practice is motivated.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241293818"},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using relational ethics to approach equity in palliative care.","authors":"Kristina A Smith, Kelli Stajduhar","doi":"10.1177/26323524241293820","DOIUrl":"https://doi.org/10.1177/26323524241293820","url":null,"abstract":"<p><p>Evidence suggests that people experiencing inequities and who are highly marginalized (e.g., people impacted by racism, sexism, discrimination, stigma, mental illness, substance use issues, disability, and the effects of homelessness; also referred to as structurally vulnerable individuals) often die alone, in pain, and not receiving the care they need. Some research even points to highly marginalized people not feeling worthy of care. The need to consider equity in the context of palliative care has recently emerged but little attention has been paid to how ethical decision-making generally, and relational ethics, specifically, could provide guidance in the care of highly marginalized people who are on a palliative trajectory. Relational ethics offers a model of care and decision-making framework that emphasizes how clients, healthcare providers, and larger social structures are interwoven and acknowledge that structural conditions can position people to have less choice than others. Relational approaches in the context of palliative care for highly marginalized people have the potential to provide a lens to better support the delivery of equitable palliative care. This critical essay explores relational ethics as a way to approach equity in palliative care to support clients facing structural vulnerabilities. We discuss relational ethical considerations to approach collaborative partnerships between clients, healthcare providers, and the larger community with the goal of aligning care with clients' values. An ethical case for how a relational ethics approach might be used to promote equitable access to palliative care will be explored, highlighting how such approaches have the potential to better align client wishes with their needs and to ensure decision-making and care delivery is trauma-informed, harm reduction focused, and culturally respectful. Relational ethics can support social change in equity and palliative care by contributing ethically informed ways of caring for/with/about highly marginalized people.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241293820"},"PeriodicalIF":2.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fostering timely integrated palliative care in nursing homes through critical companionship: experiences from a Padi-Palli interventional study in France.","authors":"Emmanuel Bagaragaza, Benoite Umubyeyi, Danièle Leboul","doi":"10.1177/26323524241293819","DOIUrl":"10.1177/26323524241293819","url":null,"abstract":"<p><strong>Background: </strong>One of the fundamental pillars of integrating a palliative approach in nursing home care is increasing professional competencies and institutional capacity. However, conventional training designs have been proven to fall short of supporting this integration. This paper details the results of a practice development intervention that used critical companionship as a learning design to facilitate the integration of a palliative approach in the care of nursing home residents in France.</p><p><strong>Objectives: </strong>This study aimed to explore the perceived outcomes of Padi-Palli critical companionship in supporting the integration of a palliative approach in the care of residents in nursing homes in France.</p><p><strong>Design: </strong>Qualitative multiple case study situated within a constructivist theoretic lens.</p><p><strong>Methods: </strong>This qualitative multiple case study is part of a larger interventional mixed-method study. Nurses with palliative care clinical expertise facilitated experiential learning with nursing home professionals for 10 months spread across three phases. At the end of the intervention, a purposive sampling method was used to select professionals from six nursing homes that participated, including leaders and critical companions. Focus groups and individual interviews were used to collect data between February 2023 and March 2024. Data analysis followed Braun and Clarke's reflexive thematic analysis.</p><p><strong>Results: </strong>Four interrelated themes explained how Padi-Palli critical companionship enhanced the palliative care competencies of professionals, improved nursing home palliative care practices, supported organisational practices for palliative care and facilitated collaborative learning at the bedside. The collaborative and co-creative principles that informed the delivery of the Padi-Palli critical companionship program facilitated a culture shift towards integrating a palliative approach in resident care at individual, team and organisational levels.</p><p><strong>Conclusion: </strong>Critical companionship offers an innovative practice development approach that can support the delivery of timely palliative care for residents in nursing homes.</p><p><strong>Trial registration: </strong>ID-RCB 2020-A01832-37.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241293819"},"PeriodicalIF":2.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience or perception: What healthcare providers need when using the Utrecht Symptom Diary-4 Dimensional, a mixed-methods study.","authors":"Tom Lormans, Everlien de Graaf, Carlo Leget, Saskia Teunissen","doi":"10.1177/26323524241281748","DOIUrl":"10.1177/26323524241281748","url":null,"abstract":"<p><strong>Background: </strong>The Utrecht Symptom Diary-4 Dimensional (USD-4D), an adaptation of the Edmonton Symptom Assessment System, supports healthcare providers (HCPs) in identifying, monitoring, and exploring multidimensional symptoms and needs of patients in the palliative phase. For the USD-4D to be optimally implemented in clinical palliative care, it is essential to know and understand the needs of HCPs when using it.</p><p><strong>Objective: </strong>To identify and interpret the needs of HCPs when using the USD-4D in clinical palliative care, operationalized as perceived facilitators and barriers.</p><p><strong>Design: </strong>An explanatory mixed-methods study with a sequential design.</p><p><strong>Methods: </strong>Data were collected between October 2019 and September 2020. In phase I, quantitative data were collected through a survey targeting Dutch HCPs working in palliative care. Facilitators were identified as items answered positively by ⩾80% of participants, while barriers were identified as items answered negatively by ⩾20% of participants. In phase II, these identified facilitators and barriers were explored in depth through mixed composition focus groups. The Capability-Opportunity-Motivation-Behavior (COM-B) model was utilized to contextualize and interpret the perceived facilitators and barriers.</p><p><strong>Results: </strong>A total of 122 HCPs completed the survey, with 95% of the respondents being women with a mean age of 48 years and 72% being nurses. Additionally, 53% of the respondents had no prior experience with the USD-4D. In phase II, 21 HCPs participated in focus groups. 95% of the participants were women with a mean age of 49 years and 67% being nurses. HCPs pinpointed facilitators primarily related to the potential benefits of the USD-4D for daily patient care. Conversely, the identified barriers included issues related to HCPs' behavior, knowledge gaps, uncertainty regarding their abilities and attitudes toward the USD-4D, and technical obstacles.</p><p><strong>Conclusion: </strong>Facilitators and barriers across all facets of the COM-B model were recognized, with a notable emphasis on motivational barriers. It should be acknowledged that facilitators and barriers can evolve throughout the implementation process, underscoring the importance of viewing implementation and integration as fluid and continuous endeavors. Facilitators and barriers are closely linked to HCPs' reflective capacities, emphasizing the need for tailored intervention strategies that align with different stages of USD-4D implementation.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241281748"},"PeriodicalIF":2.7,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}