-
Journal of Hospice and Palliative... Jun 2022Severe and persistent mental illnesses refer to a group of psychiatric disorders causing severe dysfunction in patients and include diagnoses such as schizophrenia,...
Severe and persistent mental illnesses refer to a group of psychiatric disorders causing severe dysfunction in patients and include diagnoses such as schizophrenia, bipolar disorder, and major depression. Patients with severe and persistent mental illnesses have a complex symptomatology and face complicated medical disparities creating a difficult care process and reduced quality of life. Palliative care, a holistic approach to care that aims to reduce symptoms and stress of illness in persons living with chronic diagnoses, is appropriate within this population to address the complexity of care needs but is currently underutilized. The purpose of this review was to systematically review the literature to determine what is currently known about palliative care utilization in the severe and persistently mentally ill population. The databases systematically searched include PubMed, Cumulative Index for Nursing and Allied Health Literature, PsycINFO, and MEDLINE, to find all articles relevant to the research question. Keywords include "palliative care," "end-of-life care," and "severe and persistent mental illness," including all subsets. Literature was reviewed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The results of this systematic review helped synthesize current information about this developing topic to inform clinicians on how to best integrate palliative care to this population.
Topics: Hospice and Palliative Care Nursing; Humans; Mental Disorders; Palliative Care; Quality of Life; Terminal Care
PubMed: 35285463
DOI: 10.1097/NJH.0000000000000855 -
Journal of the American Medical... May 2020Despite recommendations to integrate palliative care into nursing home care, little is known about the most effective ways to meet this goal. (Review)
Review
BACKGROUND
Despite recommendations to integrate palliative care into nursing home care, little is known about the most effective ways to meet this goal.
OBJECTIVE
To examine the characteristics and effectiveness of nursing home interventions that incorporated multiple palliative care domains (eg, physical aspects of care-symptom management, and ethical aspects-advance care planning).
DESIGN
Systematic review.
METHODS
We searched MEDLINE via PubMed, Embase, CINAHL, and Cochrane Library's CENTRAL from inception through January 2019. We included all randomized and nonrandomized trials that compared palliative care to usual care and an active comparator. We assessed the type of intervention, outcomes, and the risk of bias.
RESULTS
We screened 1167 records for eligibility and included 13 articles. Most interventions focused on staff education and training strategies and on implementing a palliative care team. Many interventions integrated advance care planning initiatives into the intervention. We found that palliative care interventions in nursing homes may enhance palliative care practices, including processes to assess and manage pain and symptoms. However, inconsistent outcomes and high or unclear risk of bias among most studies requires results to be interpreted with caution.
CONCLUSIONS AND IMPLICATIONS
Heterogeneity in methodology, findings, and study bias within the existing literature revealed limited evidence for nursing home palliative care interventions. Findings from a small group of diverse clinical trials suggest that interventions enhanced nursing home palliative care and improved symptom assessment and management processes.
Topics: Advance Care Planning; Humans; Nursing Homes; Palliative Care; Symptom Assessment
PubMed: 31924556
DOI: 10.1016/j.jamda.2019.11.015 -
Revista Paulista de Pediatria : Orgao... 2022To perform a systematic review of the health economic evidence on the care of children and adolescents with complex clinical conditions, comparing groups included and...
OBJECTIVE
To perform a systematic review of the health economic evidence on the care of children and adolescents with complex clinical conditions, comparing groups included and not included (control group) in palliative care at the end of life.
DATA SOURCE
The seven databases searched were PubMed, Embase, Web of Science, Cochrane Library, Virtual Health Library-Latin American and Caribbean Health Sciences Literature (VHL-LILACS), EBSCOhost, and Paediatric Economic Database Evaluation, following recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, from January 1979 to November 2020. The review included studies of patients under 18 years of age with complex clinical conditions that compared a palliative care group with a control group. The economic outcomes analyzed were length and place of stay at the end of life (home, hospice, ward, intensive care unit, emergency room), diagnostic and therapeutic procedures performed, and health-related costs. The exclusion criteria were: studies without a matched control group, conference/congress abstracts, letters to the editor, editorials, comments, qualitative studies, narrative reviews, studies with ten or fewer participants in each group, articles published in languages other than English, Portuguese, or Spanish.
DATA SYNTHESIS
Out of the 518 articles identified, 4 met the inclusion criteria. We found evidence of direct economic benefits, such as reduced health costs, indirect savings, and protection of patients from undergoing invasive procedures, surgeries, and costly therapies, which cause greater suffering at the end of life. Therefore, participating in a palliative care program saved financial and technological resources, besides increasing the frequency of deaths at home and improving the quality of life.
CONCLUSIONS
Public and private policies to promote palliative care represent better efficiency when allocating available health care resources.
Topics: Adolescent; Child; Cost-Benefit Analysis; Death; Humans; Palliative Care; Quality of Life
PubMed: 35019011
DOI: 10.1590/1984-0462/2022/40/2021002 -
Journal of Applied Research in... Nov 2017Paediatric palliative care is a nuanced area of practice with additional complexities in the context of intellectual disability. There is currently minimal research to... (Review)
Review
BACKGROUND
Paediatric palliative care is a nuanced area of practice with additional complexities in the context of intellectual disability. There is currently minimal research to guide clinicians working in this challenging area of care.
METHOD
This study describes the complex care of children with life-limiting conditions and intellectual disability by means of a literature synthesis and commentary with "best-practice" guide.
RESULTS
As few articles concerning children with intellectual disability and palliative care needs were identified by formal systematic review, our expert consensus group has drawn from the paediatric palliative, oncology and adult intellectual disability literature to highlight common clinical challenges encountered in the day-to-day care of children with intellectual disability and life-limiting conditions.
CONCLUSION
A longitudinal child- and family-centred approach is key to ensuring best-practice care for families of children with life-limiting conditions and intellectual disability. As highlighted by the great absence of literature addressing this important patient population, further research in this area is urgently required.
Topics: Child; Humans; Intellectual Disability; Palliative Care; Pediatrics; Quality of Life
PubMed: 28836319
DOI: 10.1111/jar.12389 -
Complementary Therapies in Clinical... May 2021Animal assisted interventions (AAI) have been used in different contexts including oncology/palliative care and can improve mood, quality of life and wellness. The goal... (Review)
Review
INTRODUCTION
Animal assisted interventions (AAI) have been used in different contexts including oncology/palliative care and can improve mood, quality of life and wellness. The goal of this review was to evaluate studies about AAI and its effects on oncological/palliative care patients.
METHODS
The search was conducted on PubMed, Scopus and Lilacs databases. The inclusion criteria were original articles that measured quantitatively the health-related outcomes of an AAI on oncological/palliative care patients.
RESULTS
Ten studies fulfilled the inclusion criteria. Benefits related to the AAI were described. Mood, pain perception and quality of life seemed to be the variables that had improvement with the intervention. Due to the small sample sizes/heterogeneous methodologies, additional analyses could not be performed.
CONCLUSIONS
AAI can be an important tool for improving psychosocial/physiological parameters in cancer/palliative care patients. Further well designed studies are needed to provide a better knowledge of the AAI benefits in this setting.
Topics: Animals; Humans; Palliative Care; Quality of Life
PubMed: 33691267
DOI: 10.1016/j.ctcp.2021.101347 -
Journal of Palliative Medicine Aug 2014Hospice and palliative care are underutilized among patients at the end of their lives despite evidence that they improve patient satisfaction and reduce costs. (Review)
Review
BACKGROUND
Hospice and palliative care are underutilized among patients at the end of their lives despite evidence that they improve patient satisfaction and reduce costs.
OBJECTIVE
To synthesize evidence regarding interventions to increase hospice referral/enrollment.
DESIGN AND MEASUREMENTS
We conducted a systematic review of the literature and selected studies that evaluated interventions aimed at increasing hospice use. We performed a MEDLINE search (1979 to April 2013) supplemented by manual searches of bibliographies of key articles. Study design, quality criteria, population, interventions, and outcomes for each study were extracted. The main outcome evaluated was hospice referral/enrollment.
RESULTS
Our search strategy yielded 419 studies, of which only 6 met our eligibility criteria. Three studies included nursing home populations; 1 included home care patients, 1 targeted care managers, and 1 reported on heart failure patients. Three studies had a cohort design, 2 were pre-post, and only 1 was randomized. Two studies evaluated a process to identify eligible subjects. Two evaluated the impact of advance care planning programs and 2 only provided education. Interventions that only provided education showed a median increase in referral of 5% (2.8%-17%) while interventions that identified hospice candidates showed a median increase in hospice referral of 19.5 % (19%-20%).
CONCLUSIONS
Interventions of different levels of complexity can improve the use of hospice services among subjects with high mortality risk. An approach that allows the medical team to assess patients' treatment goals and that engages the treating physician seems to be the most successful one.
Topics: Cost Control; Hospice Care; Humans; Palliative Care; Patient Satisfaction; Quality Improvement; Referral and Consultation
PubMed: 25000384
DOI: 10.1089/jpm.2013.0503 -
Journal of Palliative Medicine Jan 2017To systematically characterize interventions and effectiveness of palliative care for advanced heart failure (HF) patients. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically characterize interventions and effectiveness of palliative care for advanced heart failure (HF) patients.
BACKGROUND
Patients with advanced heart failure experience a high burden of distressing symptoms and diminished quality of life. Palliative care expertise with symptom management and healthcare decision-making benefits HF patients.
METHODS
A systematic PubMed search was conducted from inception to June 2016 for studies of palliative care interventions for HF patients. Studies of humans with a HF diagnosis who underwent a palliative care intervention were included. Data were extracted on study design, participant characteristics, intervention components, and in three groups of outcomes: patient-centered outcomes, quality-of-death outcomes, and resource utilization. Study characteristics were examined to determine if meta-analysis was possible.
RESULTS
The fifteen identified studies varied in design (prospective, n = 10; retrospective, n = 5). Studies enrolled older patients, but greater variability was found for race, sex, and marital status. A majority of studies measuring patient-centered outcomes demonstrated improvements including quality of life and satisfaction. Quality-of-death outcomes were mixed with a majority of studies reporting clarification of care preferences, but less improvement in death at home and hospice enrollment. A meta-analysis in three studies found that home-based palliative care consults in HF patients lower the risk of rehospitalization by 42% (RR = 0.58; 95% Confidence Interval 0.44, 0.77).
DISCUSSION
Available evidence suggests that home and team-based palliative interventions for HF patients improve patient-centered outcomes, documentation of preferences, and utilization. Increased high quality studies will aid the determination of the most effective palliative care approaches for the HF population.
Topics: Adult; Aged; Aged, 80 and over; Decision Making; Female; Heart Failure; Humans; Male; Middle Aged; Palliative Care; Prospective Studies; Quality of Life; Retrospective Studies
PubMed: 27912043
DOI: 10.1089/jpm.2016.0330 -
Journal of Pain and Symptom Management Mar 2021There is rapidly increasing need for palliative care in Greater China because of rapidly aging populations. (Review)
Review
CONTEXT
There is rapidly increasing need for palliative care in Greater China because of rapidly aging populations.
OBJECTIVES
This study aimed to systematically review and appraise evidence for palliative care needs, models of care, interventions, and outcomes in Greater China.
METHODS
Four databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) were searched, with hand searching of local journals and databases. Narrative synthesis was applied to the qualitative and quantitative evidence.
RESULTS
Nineteen qualitative studies and 47 quantitative studies were retained. With respect to care needs, nine themes were synthesized: pain control, reduced aggressive end-of-life care, truth telling, physical, emotional, and spiritual supports, and achieving preferred place of care/death. Informal caregivers expressed their needs for education and burden reduction. Health care professionals called for training and national policy support. Twenty-four studies evaluated interventions, mostly among patients with advanced cancer. Positive effects were suggested for improvements in quality of life, pain, anxiety and depression, readmission rate, and costs. Models of care evaluated were mostly specialist palliative care delivered in various settings (hospitals, residential care, and home). Outcome measures used were grouped into six categories of construct: quality of life, pain, physical assessment, psychospiritual assessment, quality of care, and implementation assessment. Limited rigorous randomized controlled trials are available to document intervention outcomes, and some problems (such as high attrition rates) reduced the strength of the evidence.
CONCLUSION
Palliative care services within Greater China should pay more attention to management of nonmalignant disease and to integration into primary services. Policy support is key to establishing culturally appropriate person-centered services.
Topics: Caregivers; China; Humans; Palliative Care; Quality of Life; Terminal Care
PubMed: 32916261
DOI: 10.1016/j.jpainsymman.2020.08.040 -
Journal of Pain and Symptom Management May 2023Interprofessional education (IPE) involving palliative and end-of-life content benefits learners by addressing interprofessional and palliative care (PC) competency... (Review)
Review
CONTEXT
Interprofessional education (IPE) involving palliative and end-of-life content benefits learners by addressing interprofessional and palliative care (PC) competency needs.
OBJECTIVES
A synthesis of educational approaches promoting interprofessional PC in academic and clinical settings would address research gaps and promote effective teaching.
METHODS
A systematic review of interprofessional PC educational studies was conducted to summarize current approaches in PC IPE and to appraise teaching and research methods. Characteristics of excellence in interprofessional PC education established by Donesky et al. served as a framework for evaluating studies in this systematic review.
RESULTS
A total of 39 articles met inclusion criteria for this review. Learners from medicine and nursing were the most included professions. University programs represented most studies, and evaluation methods demonstrated achievement of mostly self-reported outcomes like learner attitude and self-efficacy. While the effect of interprofessional collaboration on patient outcomes is well-documented, the effect of IPE on PC delivery is not. Although content spanned all interprofessional and PC domains, few studies addressed cultural aspects and fewer addressed well-being for the care provider.
CONCLUSION
In light of the current healthcare landscape, there is an imminent need to address culture and provider well-being more directly through interprofessional PC education. Education and research must also move beyond university programs into health systems to support the professional development of clinicians for systems integration, sustainability, and impact on patient outcomes. Future evaluation of interprofessional PC education would be strengthened by multisite studies, randomized controlled trials, and repeated measures looking at outcomes over time.
Topics: Humans; Palliative Care; Interprofessional Education; Hospice and Palliative Care Nursing; Education, Nursing
PubMed: 36736863
DOI: 10.1016/j.jpainsymman.2023.01.022 -
Journal of Pain and Symptom Management Apr 2017Families of persons with dementia continue to report unmet needs during end of life (EOL). Strategies to improve care and quality of life for persons with dementia... (Review)
Review
CONTEXT
Families of persons with dementia continue to report unmet needs during end of life (EOL). Strategies to improve care and quality of life for persons with dementia include development of clinical practice guidelines (CPGs) and an integrative palliative approach.
OBJECTIVES
We aimed to assess palliative care content in dementia CPGs to identify the presence or limitations of recommendations and discussion pertaining to common issues or domains affected by illness as described by the Canadian Hospice Palliative Care Association "Square of Care."
DESIGN
A systematic review of databases and gray literature was conducted for recent CPGs. Guidelines meeting inclusion criteria were evaluated using the Appraisal of Guidelines for Research and Evaluation II instrument. Quality CPGs were analyzed through organizational template analysis using illness domains described by the "Canadian Hospice Palliative Care Association Model." The study protocol is registered at PROSPERO (CRD 42015025369).
RESULTS
Eleven CPGs were selected and analyzed from 3779 citations. Nine guidelines demonstrated the maximum level of content regarding physical, psychological, and social care. Conversely, spiritual care was either absent (three) or minimal (three) in CPGs. Six CPGs did not address loss or grief, and seven CPGs did not address or had minimal content regarding EOL care.
CONCLUSIONS
The lack of content surrounding grief represents a gap for this population at high risk for complicated grief and chronic sorrow. Results of this review require attention by CPG developers and researchers to develop evidence-based recommendations surrounding spiritual care, EOL, and grief.
Topics: Dementia; Humans; Palliative Care; Practice Guidelines as Topic; Terminal Care
PubMed: 28063859
DOI: 10.1016/j.jpainsymman.2016.10.368