PROGRESS IN PALLIATIVE CARE最新文献

{"title":"Community paramedicine to support palliative care","authors":"A. Rosa, M. Dissanayake, D. Carter, S. Sibbald","doi":"10.1080/09699260.2021.1912690","DOIUrl":"https://doi.org/10.1080/09699260.2021.1912690","url":null,"abstract":"Objective This commentary describes community paramedicine (CP) and the potentiality of an expanded scope of practice to provide home-based palliative care. Background The prevalence of individuals desiring palliative care within their home is growing, requiring the provision of high-quality care. CP is a novel approach to delivering care, allowing paramedics to provide community-based, non-urgent care as well as crisis and symptom management within the home. The need for home-based palliative care at earlier stages of the disease trajectory will be essential for the growing older adult population. Community-based models of care are essential in alleviating health systems burden by reducing emergency department visits and over-reliance on primary care. Methods A rapid review was conducted to determine current scope of practice and geographical coverage of CP programming, as well as a broader literature search describing current roles. Discussion An expanded scope of CP practice that provides palliative care has immense potential in alleviating health system burden while simultaneously improving patient health outcomes. Pilot CP palliative care programs in Alberta, Nova Scotia and Prince Edward Island have demonstrated the benefits of community paramedics providing palliative care through reduced emergency department visits and improved patient satisfaction. Community paramedics are well equipped to provide high-quality palliative care earlier within the patient’s disease trajectory and support the patient and caregiver through remote patient monitoring.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"11 - 15"},"PeriodicalIF":1.7,"publicationDate":"2021-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1912690","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42795275","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":"Survival following palliative percutaneous nephrostomy tube insertion in patients with malignant ureteric obstruction: Validating a prognostic model","authors":"B. Gunawan, K. Foster, J. Hardy, P. Good","doi":"10.1080/09699260.2021.1905145","DOIUrl":"https://doi.org/10.1080/09699260.2021.1905145","url":null,"abstract":"Background and Aims Malignant ureteric obstruction (MUO) is a life-threatening complication of advanced cancer associated with short survival. Percutaneous nephrostomy (PCN) is a commonly employed technique to decompress MUO. Prognostic models have been developed to identify patients with poor outcomes. This study aimed to validate and update the recent model by Alawneh et al. [Alawneh A, Tuqan W, Innabi A, et al. Clinical Factors Associated With a Short Survival Time After Percutaneous Nephrostomy for Ureteric Obstruction in Cancer Patients: An Updated Model. J Pain Symptom Manag 2016;51(2):255–261]. Methods A retrospective analysis was performed on patients who received PCN for MUO over a 10-year period. Clinical and demographic details were recorded. Patients were stratified into prognostic groups and survival was described using the Kaplan-Meier method. Association between prognostic group, individual variables and mortality was investigated. Results 29 patients had received PCN for MUO. When stratified by Alawneh prognostic group, survival was 0.9 months (0 risk factors), 8.4 months (1 factor), 3.4 months (2 factors) and 4.1 months (3 factors). No statistical association was identified between prognostic group and mortality risk (Hazard Ratio [HR] 0.92; p = 0.72). The only variable associated with increased mortality was pre-nephrostomy haemoglobin <100 g/L (HR 2.6; p = 0.037). Conclusion Survival with MUO remains short, despite advances in supportive care and PCN. This study was unable to either validate or update the prognostic model, due to limited numbers. Further research with prospective studies is recommended.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"21 - 28"},"PeriodicalIF":1.7,"publicationDate":"2021-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1905145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49150918","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 prevalence and types of advance care planning use in patients with advanced cancer: A retrospective single-centre perspective, Australia","authors":"Arron Veltre, A. Broadbent, J. Sanmugarajah, Amy Marshall, M. Hamiduzzaman","doi":"10.1080/09699260.2022.2152989","DOIUrl":"https://doi.org/10.1080/09699260.2022.2152989","url":null,"abstract":"Objectives: In Australia participation rate in Advance Care Directives is 14%, and research is limited on Advance Care Planning (ACP) invitations and uptake among the patients with advanced cancer (PwAC). This study identifies the prevalence and types of documented ACP discussions in PwAC who died within two or four weeks of receiving chemotherapy. Design: A retrospective audit was conducted. Statistical analysis was calculated in SPSS. Difference in ACP invitation and utilization between three groups [control, <2-weeks, and –4 weeks] was measured by Kruskal–Wallis and Chi-square (or Fisher-Exact) tests. Post-hoc follow-up pair-wise comparisons were performed. Adjusted prevalence ratios were estimated using two logistic regression models. Setting: This study was conducted in XXX Coast University Hospital, Australia. Participants: The records of 339 patients were examined and 320 patients were found eligible. Results: Of the 320 PwAC [male: 55%; median age: 65 years], 227 (71%) received ACP invitation, and among the invited patients, 89% used Acute Resuscitation Plan; 54% used Enduring Power-of-Attorney; and 20% completed Advance Health Directives. From 7.5% [n = 24] of the patients who received chemotherapy in their last 2-weeks of life, 42% had not received an ACP invitation, 29% didn’t have Acute Resuscitation Plan and only 4% completed Advance Health Directives. There were significant differences among Control, <2-weeks, and 2–4 weeks groups in completing Acute Resuscitation Plan (P = 0.003) and Advance Health Directives (P = 0.045). A significant difference was also observed between control and <2-weeks groups in number of days since Acute Resuscitation Plan used. Completing an Acute Resuscitation Plan was associated with a lower risk of dying within two-weeks of chemotherapy (OR = 0.246; P = 0.008). Conclusions: Low rates of ACP invitation and use in PwAC, especially who received chemotherapy in 2-weeks of dying confirm a need for embedding and regularly revisiting ACP framework in cancer care and educating staff, patients, and their family caregivers to increase uptake.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"31 1","pages":"80 - 88"},"PeriodicalIF":1.7,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42309858","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 rollercoaster model of the bereaved caregiver","authors":"M. Moorhouse, M. O’Connor","doi":"10.1080/09699260.2021.1890927","DOIUrl":"https://doi.org/10.1080/09699260.2021.1890927","url":null,"abstract":"The grief associated with bereavement, while a natural response to loss, is usually a traumatic life event. The bereavement experience for a primary caregiver with the experience of caring for a loved one is complex, especially if this role has required them to relinquish aspects of their own life. The healing trajectory for the bereaved carer is often more complex than for many other bereavements, given the pre-death experience of caregiving. This paper describes the development of a bereavement model which arose from significant clinical experience of working with bereaved carers in a community palliative care environment. The model assists the bereaved carer in gaining insight into their experience and a focus for their psychological and emotional expression, thereby promoting adaptation to the transition and promoting a healthier grief trajectory.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"29 1","pages":"320 - 325"},"PeriodicalIF":1.7,"publicationDate":"2021-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1890927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43632689","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":"Lean in, don’t step back: The views and experiences of patients and carers with severe mental illness and incurable physical conditions on palliative and end of life care","authors":"J. Jerwood, G. Ward, D. Phimister, N. Holliday, J. Coad","doi":"10.1080/09699260.2021.1887589","DOIUrl":"https://doi.org/10.1080/09699260.2021.1887589","url":null,"abstract":"Background and Aim: People with severe mental illness (SMI) have a life expectancy of up to twenty years less than the general population and many live with incurable physical health conditions. Yet, they continue to experience barriers when trying to access palliative and end of life care (PEOLC). Little research has been carried out which includes the views and experiences of people with SMI, and this study presents first findings which include people with both SMI and an incurable condition and their carers. It aimed to seek their views, and those of their carers, on their experiences and expectations of accessing PEOLC and to understand how PEOLC for people with SMI could be improved. Methods: Semi-structured interviews were carried out with 8 participants (5 patient participants and 3 carer participants). Thematic analysis of the interview transcripts was undertaken. Findings: Four over-arching themes were developed. (1) Stigma and Prejudice – See Me, Not My Diagnosis (2) Hesitancy and Avoidance – Treading on Eggshells (3) Collaborators in Care – The Ignored Experts and (4) Connections – Leaning in, Not Stepping Back. Significance of Findings: This study presents the first accounts from the UK concerning experiences of PEOLC, barriers to access and how care can be improved, from the perspectives of patients with both a SMI and an incurable physical condition and their carers. The findings illuminate an under-researched area of clinical practice and contribute rich understandings to future service developments and innovations.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"29 1","pages":"255 - 263"},"PeriodicalIF":1.7,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1887589","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45593522","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":"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":"29 1","pages":"57 - 58"},"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":"Exploring paramedics’ intention to use a specialist palliative care telehealth service","authors":"H. S. James, A. Smith, E. Thomas, C. Snoswell, L. Caffery, H. Haydon","doi":"10.1080/09699260.2020.1852657","DOIUrl":"https://doi.org/10.1080/09699260.2020.1852657","url":null,"abstract":"A large proportion of expected deaths do not occur at home, despite often being the dying person’s preference. Paramedics play an integral role in hospital admissions when someone is close to death. As illness worsens, paramedics are often called and ascertain whether hospitalisation is appropriate. In a 12-month period, Ambulance Victoria (Australia) recorded 4348 palliative related callouts, 70% resulting in hospitalisation. Paramedics throughout the world recognise the need for extra palliative care training or support. One solution is a specialist palliative care support telehealth service from palliative specialists (usually in tertiary hospitals) to paramedics on call-outs to people with life-limiting illnesses. However, to maximise uptake and sustainability, it is prudent to examine factors that influence acceptance of such a service. In the current study, 112 paramedics employed by the Queensland Ambulance Service completed an online survey examining their Intention to Use the Specialist Palliative Care telehealth service as a function of the Technology Acceptance Model constructs (Perceived Usefulness, Perceived Ease of Use and Attitudes toward technology) and Palliative Care Self-Efficacy. After controlling for age, a hierarchical multiple regression analysis demonstrated the predictive utility of Perceived Usefulness and Attitudes. Palliative Care Self-efficacy did not add any significant variance to the model. This research highlights the importance of addressing paramedics’ perceptions regarding the telehealth service and its usefulness when implementing a similar service model.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"29 1","pages":"106 - 113"},"PeriodicalIF":1.7,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2020.1852657","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42747551","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":"29 1","pages":"72 - 75"},"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":"29 1","pages":"66 - 71"},"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":"29 1","pages":"91 - 97"},"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}