PROGRESS IN PALLIATIVE CARE最新文献

{"title":"Widening the conversation: Paramedic involvement in interprofessional care","authors":"D. Long, B. Lord","doi":"10.1080/09699260.2021.1890976","DOIUrl":"https://doi.org/10.1080/09699260.2021.1890976","url":null,"abstract":"In this special issue of Progress in Palliative Care we explore the nexus between palliative care and paramedicine by presenting important initiatives being undertaken in Australia, New Zealand, the United Kingdom, and Canada to improve access to care. In each of the settings described, paramedics are regulated or registered health care professionals working in health settings that include ambulance or emergency medical services. Paramedics within these regions can be rapidly deployed to provide urgent health care to the entire population of the areas they serve, including areas that are not served by out of hours specialist palliative care. We know that paramedics are involved in care for patients who may be experiencing a health crisis related to a life-limiting condition, and that the call to the emergency service may arise from distressing symptoms such as pain, agitation, respiratory distress, and nausea. Although paramedics can provide symptom relief, paramedic practice has traditionally focussed on the assessment and management of acute injury and illness rather than chronic illness and the care of patients and their carers, particularly at end of life. Previous research found that paramedics perceived that limited exposure to palliative education, lack of practice guidelines that address the needs of palliative care patients, and limited referral options and 24-hour access to specialist advice inhibit their ability to provide safe and effective care for patients in their home, particularly at the end of life. 1 In countries such as Australia, these barriers to care in the community result in most calls relating to a palliative crisis being transferred by ambulance to an emergency department. 2 The contributions to this special issue describe initiatives that involve paramedics and ambulance services planning for care that may include a broader range of management options than the default option of transport to a hospital. It is recognised that patients may experience illness or injury that is unrelated to their palliative condition, and that health emergencies associated with a life-limiting illness may require hospital admission. However, where the patient expresses a preference for care at home or has an advance care directive that describes this preference, every opportunity should be explored to pursue the universal maxim of person-centred care. In order to achieve this Carter and colleagues present the outcome of a national collaborative initiative in Canada that aims to support paramedics in the provision of care in the home, and develop mechanisms to share patient goals of care with other members of the multi-disciplinary healthcare team to ensure that the patient’s wishes are respected. Murphy-Jones and colleagues describe two case reports of UK ambulance service improvement programmes that involved collaboration with a specialist palliative care service to support paramedics and identify appropriate alternatives to hospital conve","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1890976","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48404160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a paramedic approach to palliative emergencies","authors":"J. Helmer, L. Baranowski, R. Armour, J. Tallon, David M. Williscroft, Michelle Brittain","doi":"10.1080/09699260.2020.1852656","DOIUrl":"https://doi.org/10.1080/09699260.2020.1852656","url":null,"abstract":"Emergency health services (EHS) have experienced a steady increase in demand from palliative patients accessing 9-1-1 during times of acute crisis, although the majority of these patients do not wish for conveyance to hospital following paramedic treatment. To address this demand, and to provide patients with the right care, the first time, the British Columbia Emergency Health Service (BCEHS) introduced the province’s first Assess, See, Treat and Refer (ASTaR) Clinical Pathway. This alternative model of care is intended to improve patient-oriented care by providing care for patients in their own home and reducing the requirement for conveyance to the emergency department, thus reducing the requirement for hospitalization. Launched in June 2019, the ASTaR Pathway includes the early recognition of patients with palliative needs accessing 9-1-1, the use of secondary triage services and the automatic notification and referral of non-conveyed patients to primary healthcare teams for patient follow-up. The following commentary outlines the early integration of the ASTaR Palliative Clinical Pathway into the BCEHS paramedic approach to palliative patient care.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2020.1852656","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41952796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infusing the palliative into paramedicine: Inter-professional collaboration to improve the end of life care response of UK ambulance services","authors":"Georgina Murphy-Jones, D. Laverty, J. Stonehouse","doi":"10.1080/09699260.2021.1879348","DOIUrl":"https://doi.org/10.1080/09699260.2021.1879348","url":null,"abstract":"Paramedics frequently encounter patients requiring palliative and end of life care. This is anticipated to increase with an ageing UK population, a strengthening preference for care and death to occur in the home, alongside pressurized community services. Nationally education is lacking and despite localized efforts of improvement, widespread change within ambulance services to advance the quality of care for this patient group has been slow to emerge. This paper describes two UK ambulance service improvement programmes that have sought to address this need. South Western Ambulance Service NHS Foundation Trust and London Ambulance Service NHS Trust collaborated with a nationally renowned charity, Macmillan Cancer Support, to create innovative programmes of change. Both services targeted data exploration, valued inter-professional learning and effectively engaged local stakeholders. Experience demonstrates the need for collaboration with specialist palliative care and dependence on community services to access support and alternatives to hospital conveyance. This paper considers the future for end of life care leadership in UK ambulance services and the development of specialist paramedic roles. While the future of an alliance of paramedicine and palliative care is yet to be fully realized, our work exhibits the significant progress made by UK ambulance services.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1879348","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41402625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dealing with dying – progressing paramedics’ role in grief support","authors":"C. Cameron, Tyne M. Lunn, C. Lanos, A. Batt","doi":"10.1080/09699260.2020.1856634","DOIUrl":"https://doi.org/10.1080/09699260.2020.1856634","url":null,"abstract":"Abstract Paramedics are frequently present at the death of patients and are in a position to provide grief support to family members who are suddenly bereaved, but existing education and system resources have failed to provide paramedics with the necessary tools to do so. Although the literature emphasizes the importance of providing grief training from initial education, through clinical placements and into continuing professional development opportunities, the current state across all health professions is a patchwork of elective, brief, and siloed opportunities. With new interprofessional partnerships developing between paramedicine and palliative care, there is a unique opportunity to better prepare paramedics to adequately participate in the death and dying process and address developing competency in grief support in a more strategic and integrated manner. We suggest employing a multi-faceted approach, focused on recruitment, initial and continuing education, and continued support in clinical practice. Importantly, paramedics will require support from interprofessional colleagues in palliative, grief and bereavement care to provide expertise in educational programs, clinical placements, and support at the patient's bedside. Now is the time to address grief support across the full continuum of paramedic practice to ensure paramedics are competent to support recently bereaved families.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2020.1856634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46501214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of ambulance services in reducing the gaps in access to end-of-life care: from conversations to policy","authors":"B. Pekarsky, Amy E. Seymour-Walsh, Catherine Wright, Mathew Hooper, Colleen Carter","doi":"10.1080/09699260.2020.1871174","DOIUrl":"https://doi.org/10.1080/09699260.2020.1871174","url":null,"abstract":"Reducing the gap between the need for and access to effective and best practice care at the end-of-life is a goal of the Australian palliative care sector. Largely absent from the suite of plans, strategies and frameworks that map Australia’s path to quality end-of-life care for all patients isPalliatiev CAre Australia the role of ambulance services. Instead, patients’ need for these services tends to be characterized as an undesirable consequence of an under-resourced palliative care sector and no longer necessary when the sector is fully resourced. We hypothesize that one reason for this characterization is that the ambulance and palliative care sectors have fundamentally different perspectives of end-of-life care. We conclude that further if the palliative care sector were to partner with ambulance services, the gap between the need for and access to end-of-life care would be reduced more rapidly and cost effectively.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2020.1871174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44094024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A national collaborative to spread and scale paramedics providing palliative care in Canada: Breaking down silos is essential to success","authors":"A. Carter, M. Arab, C. Cameron, M. Harrison, Charlotte Pooler, Ian McEwan, M. Austin, J. Helmer, Gurkan Ozel, Jessica Heathcote, N. Reardon, Elizabeth Anderson, M. Carey, R. S. Moxam, S. Crick","doi":"10.1080/09699260.2020.1871173","DOIUrl":"https://doi.org/10.1080/09699260.2020.1871173","url":null,"abstract":"A national collaborative has been launched in Canada to spread and scale up the Paramedics Providing Palliative Care model. This builds on the knowledge that paramedics in the 9-1-1 (emergency/unscheduled) and scheduled models of care are both historically and currently asked by the public to provide urgent symptom relief within the context of a palliative approach, and that approximately 40% of dying people visit the emergency department in the last two weeks of life despite 70% wishing to die at home. A model of care including a palliative care clinical practice guideline or protocol, specific training, and a mechanism for sharing of goals of care, has been proven to improve the palliative and end of life experience for patients with palliative care needs and their families. It increases the comfort and confidence of paramedics and has benefits to the broader health system. Meaningful and very broad stakeholder engagement and inter-sectoral collaboration is absolutely essential to the success of this innovative approach to care.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2020.1871173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42087239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staff stakeholder views on the role of UK paramedics in advance care planning for patients in their last year of life","authors":"L. Goodwin, Alyesha Proctor, K. Kirby, S. Black, L. Pocock, S. Richardson, J. Stonehouse, H. Taylor, S. Voss, J. Benger","doi":"10.1080/09699260.2021.1872140","DOIUrl":"https://doi.org/10.1080/09699260.2021.1872140","url":null,"abstract":"Background Early advance care planningh as clear benefits for patients approaching the end of their life, yet many of those attended by UK paramedics do not have this planning in place. Aims To explore staff stakeholder views on the role of UK paramedics in advance care planning, including the use of the Gold Standards Framework Proactive Identification Guidance for screening and referral of patients. Methods In-depth semi-structured telephone interviews with paramedics, general practitioners, Emergency Department and community doctors and nurses in the South West of England. Results Seventeen staff stakeholders participated. Four main themes were identified: a lack of advance care planning; variation across health conditions; a lack of joined-up care; poor-quality end of life conversations. Paramedic use of the Gold Standards Framework Proactive Identification Guidance to screen and refer patients for advance care planning was seen as feasible and acceptable, with perceived benefitssuch as identifying patients not accessing primary care, and the potential to reduce avoidable hospital admissions. Conclusions UK paramedics are well-placed toscreen and refer patients for advance care planning. Further research is needed to explore how this type of intervention might be developed to fit into a community-centred approach aimed at improving advance care planning.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1872140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45273360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bibliography","authors":"J. Gabbard, N. Pajewski, Kathryn, E. Callahan","doi":"10.1080/09699260.2021.1890364","DOIUrl":"https://doi.org/10.1080/09699260.2021.1890364","url":null,"abstract":"","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1890364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44035244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of palliative care referral in patients with advanced Non-Small Cell Lung Cancer: a retrospective cohort study","authors":"F. Binder, C. M. Ungaro, M. B. Bonella, Carlos Cafferata, D. Giunta, B. Ferreyro","doi":"10.1080/09699260.2021.1890914","DOIUrl":"https://doi.org/10.1080/09699260.2021.1890914","url":null,"abstract":"Introduction: Early palliative care referral is recommended for patients with Stage IV Non-Small Cell Lung Cancer (NSCLC) irrespective of the decision to administer cancer-directed therapies. Diagnosis-to-referral and referral-to-death intervals, proposed as measures of quality of care, are rarely reported in low-and-middle income settings. Objective: to estimate the 6-month cumulative incidence of palliative care referrals and the length of referral-to-death intervals among patients with Stage IV NSCLC at a teaching hospital in Argentina. Methods: Patients with Stage IV NSCLC diagnosed between 2012 and 2017 were followed up until December 2019. We retrieved the first contact with palliative care services and date of death from centralized Electronic Health Records. Cumulative incidence of palliative care referrals was estimated by fitting a Fine & Gray competing risks model. Results: Ninety-two patients were included. Median age was 71.5 years (IQR 63–79 years), 55% were women. Median survival time was 375 days (95% CI: 204–508 days). Considering death as a competing risk, the 6-month cumulative incidence of palliative care referrals was 37% (95% CI: 27% to 47%). Among referred patients, the median referral-to-death interval was 31 days. Discussion: Further research should focus on identifying and overcoming barriers to timely palliative care referrals in this population.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2021-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1890914","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46933343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Citizens appreciate talking about death and learning end-of-life care – a mixed-methods study on views and experiences of 5469 Last Aid Course participants","authors":"G. Bollig, Frans Brandt Kristensen, D. L. Wolff","doi":"10.1080/09699260.2021.1887590","DOIUrl":"https://doi.org/10.1080/09699260.2021.1887590","url":null,"abstract":"Background Most people would prefer to die at home. Engaging citizens in end-of-life care may contribute to making home death possible for more people. Aims To test the feasibility and acceptability of Last Aid Courses in different countries and to explore the views and experiences of participants with the course. Methods International multi-centre study with a questionnaire based mixed methods design. 408 Last Aid Courses were held in three different countries. Of 6014 course participants, 5469 participated in the study accounting for a response rate of 91%. Results The median age of participants was 56 years. 88% were female. 76% of participants rated the course “very good”. 99% would recommend it to others. Findings from the qualitative data revealed that participants found the atmosphere comfortable; instructors competent; appreciated the course format, duration, topics and discussions about life and death. Conclusions Last Aid Courses are both feasible and accepted by citizens from different countries. They have a huge potential to inform citizens and to encourage them to engage in care at home. Future research should investigate the long-term effects of the course on the ability and willingness of participants to provide end-of-life care and the impact on the number of home-deaths.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2021-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1887590","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43484973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}