-
Journal of the American Association of... Nov 2023Burnout among health care professionals contributes to high job turnover. Within the United States, burnout among specialty palliative care (PC) providers will...
BACKGROUND
Burnout among health care professionals contributes to high job turnover. Within the United States, burnout among specialty palliative care (PC) providers will accentuate provider shortage problems.
OBJECTIVES
This systematic review was conducted to answer the question "what is known about burnout among specialty PC providers practicing in the United States?" More specifically, it was designed to identify the rate of burnout and factors that influence or mitigate it among PC nurse practitioners (NPs), physician assistants (PA), and physicians and to inform future research.
DATA SOURCES
An electronic literature search of studies conducted in the United States between 2012 and September 2022 was completed in Embase, PubMed, CINAHL, and PsycINFO.
CONCLUSIONS
Analysis of 14 studies showed that there are five primary themes related to burnout among PC providers: (1) the rate of burnout, (2) the physical, psychological, and clinical manifestations of burnout, (3) predictors of burnout, (4) factors of resiliency, and (5) interventions piloted to decrease burnout. The majority of studies have delineated the physician role but have failed to determine the rate and factors of burnout among PC NPs and PAs.
IMPLICATIONS FOR PRACTICE
As NPs and PAs are integral to the PC provider workforce, future research should be designed to understand more clearly how burnout affects these two PC roles to inform efforts to sustain the PC workforce.
Topics: Humans; United States; Palliative Care; Nurse Practitioners; Burnout, Professional; Workforce; Physicians; Physician Assistants
PubMed: 37395681
DOI: 10.1097/JXX.0000000000000912 -
BMC Palliative Care Mar 2024Children with life-threatening and life-limiting conditions can experience high levels of suffering due to multiple distressing symptoms that result in poor quality of...
BACKGROUND
Children with life-threatening and life-limiting conditions can experience high levels of suffering due to multiple distressing symptoms that result in poor quality of life and increase risk of long-term distress in their family members. High quality symptom treatment is needed for all these children and their families, even more so at the end-of-life. In this paper, we provide evidence-based recommendations for symptom treatment in paediatric palliative patients to optimize care.
METHODS
A multidisciplinary panel of 56 experts in paediatric palliative care and nine (bereaved) parents was established to develop recommendations on symptom treatment in paediatric palliative care including anxiety and depression, delirium, dyspnoea, haematological symptoms, coughing, skin complaints, nausea and vomiting, neurological symptoms, pain, death rattle, fatigue, paediatric palliative sedation and forgoing hydration and nutrition. Recommendations were based on evidence from a systematic literature search, additional literature sources (such as guidelines), clinical expertise, and patient and family values. We used the GRADE methodology for appraisal of evidence. Parents were included in the guideline panel to ensure the representation of patient and family values.
RESULTS
We included a total of 18 studies that reported on the effects of specific (non) pharmacological interventions to treat symptoms in paediatric palliative care. A few of these interventions showed significant improvement in symptom relief. This evidence could only (partly) answer eight out of 27 clinical questions. We included 29 guidelines and two textbooks as additional literature to deal with lack of evidence. In total, we formulated 221 recommendations on symptom treatment in paediatric palliative care based on evidence, additional literature, clinical expertise, and patient and family values.
CONCLUSION
Even though available evidence on symptom-related paediatric palliative care interventions has increased, there still is a paucity of evidence in paediatric palliative care. We urge for international multidisciplinary multi-institutional collaboration to perform high-quality research and contribute to the optimization of symptom relief in palliative care for all children worldwide.
Topics: Humans; Child; Palliative Care; Quality of Life; Terminal Care; Pain; Family
PubMed: 38481215
DOI: 10.1186/s12904-024-01367-w -
Patient Education and Counseling Oct 2023The aim of this study was to systematically review and synthesize the literature on patients' perceptions of hope in palliative care. (Review)
Review
OBJECTIVE
The aim of this study was to systematically review and synthesize the literature on patients' perceptions of hope in palliative care.
METHODS
PubMed, Scopus, SocINDEX, Cochrane, and Web of Science were screened against the eligibility criteria. After familiarization with the data and conduction of the coding process, studies were thematically analyzed using Braun and Clarke's methodology. The research question guiding our analysis was: what is said about hope from patients in PC?
RESULTS
The database searches yielded 24 eligible studies. Three main themes emerged from the studies: Hope beliefs (encompassing patients' understanding of hope and characteristics assigned to it), Hope functions (including the role that hope plays for patients) and Hope work (highlighting aspects that in patients' perspective cultivate hope).
CONCLUSION
This review emphasizes the importance of acknowledging patients' understanding of hope, its role, and the efforts required to sustain it. In particular, it suggests that hope serves as a valuable strategy, fostering meaningful personal relationships towards end of life.
PRACTICE IMPLICATIONS
In order to address communication challenges in clinical practice, a potential fruitful strategy for nurturing hope could involve engaging family and friends in hope interventions facilitated by healthcare professionals.
Topics: Humans; Palliative Care; Patients; Narration; Hospice and Palliative Care Nursing; Perception
PubMed: 37413808
DOI: 10.1016/j.pec.2023.107879 -
Enfermeria Intensiva 2023Patients in palliative care are found in different places where care is provided, including the intensive care environment with important role of the nursing staff. (Review)
Review
CONTEXT
Patients in palliative care are found in different places where care is provided, including the intensive care environment with important role of the nursing staff.
OBJECTIVE
The aim of this systematic review was to answer the following question: which nursing interventions are aimed to the palliative care patients who are in the intensive care unit (ICU).
DATA SOURCES
US National Library of Medicine (PUBMED), Virtual Health Library (BVS), SciELO, The Cochrane Library (Cochrane) and Lilacs databases were used.
DATA EXTRACTION
After applying inclusion and exclusion criteria in accordance with the PRISMA method, a total of 36 entries published between 2010 and 2020 were used.
DATA ANALYSIS
The records extracted were analyzed from a qualitative approach, so no statistical analysis was carried out.
RESULTS
The findings demonstrated that the interventions that focus on promoting the patient's autonomy and respect their needs on ICU involves effective communication, promoting shared decision with patient and family, individualize care for each patient including the family on the daily care and decisions, maintaining basic nursing care as hygiene and comfort and encouraging self-care, as well as the involvement of nursing palliative care specialists the care is important. Other interventions included promoting a continuing education program for the nursing staff and other professionals involved in caring for patients in palliative care at ICU.
CONCLUSION
This review highlighted the need for specific nursing interventions aimed at palliative care patients at ICU to promote patient autonomy and the focus on patient needs, always sharing decisions with the patient and family. However, it showed that there is a need for the continuous training of the nursing staff because factors such as the nurses' lack of technical-scientific knowledge and, concomitantly, the absence of a standardized and specific intervention model linked to a bureaucratic system, make it difficult to carry out a specialized care for this type of patient.
Topics: United States; Humans; Palliative Care; Intensive Care Units; Critical Care; Nursing Staff; Hospice and Palliative Care Nursing
PubMed: 37684063
DOI: 10.1016/j.enfie.2023.08.008 -
Palliative Medicine Apr 2024Shared decision-making is a key element of person-centred care and promoted as the favoured model in preference-sensitive decision-making. Limitations to implementation... (Review)
Review
BACKGROUND
Shared decision-making is a key element of person-centred care and promoted as the favoured model in preference-sensitive decision-making. Limitations to implementation have been observed, and barriers and limitations, both generally and in the palliative setting, have been highlighted. More knowledge about the process of shared decision-making in palliative cancer care would assist in addressing these limitations.
AIM
To identify and synthesise qualitative data on how people with cancer, informal carers and healthcare professionals experience and perceive shared decision-making in palliative cancer care.
DESIGN
A systematic review and metasynthesis of qualitative studies. We analysed data using inductive thematic analysis.
DATA SOURCES
We searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus) from inception until June 2023, supplemented by backward searches.
RESULTS
We identified and included 23 studies, reported in 26 papers. Our analysis produced four analytical themes; (1) Overwhelming situation of 'no choice', (2) Processes vary depending on the timings and nature of the decisions involved, (3) Patient-physician dyad is central to decision-making, with surrounding support and (4) Level of involvement depends on interactions between individuals and systems.
CONCLUSION
Shared decision-making in palliative cancer care is a complex process of many decisions in a challenging, multifaceted and evolving situation where equipoise and choice are limited. Implications for practice: Implementing shared decision-making in clinical practice requires (1) clarifying conceptual confusion, (2) including members of the interprofessional team in the shared decision-making process and (3) adapting the approach to the ambiguous, existential situations which arise in palliative cancer care.
Topics: Humans; Physician-Patient Relations; Health Personnel; Caregivers; Palliative Care; Decision Making; Neoplasms
PubMed: 38481012
DOI: 10.1177/02692163241238384 -
Worldviews on Evidence-based Nursing Oct 2023The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented disruption to healthcare delivery worldwide. The use of telehealth practices rapidly expanded... (Review)
Review
BACKGROUND
The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented disruption to healthcare delivery worldwide. The use of telehealth practices rapidly expanded during the pandemic, while its application in palliative care remains a conflicted issue.
AIMS
The aims of this study were to evaluate users' reports of their satisfaction with telehealth palliative care during COVID-19 and to identify facilitators and barriers to telehealth implementation in palliative care during COVID-19.
METHODS
A systematic search of the literature, including studies between January 2020 and June 2022, was conducted using PubMed, MEDLINE, CINAHL Plus, Embase, and Google Scholar. Empirical studies of telehealth in palliative care during COVID-19 were included.
RESULTS
A total of 18 studies were included in the review, of which nine were outpatient consultations, four were family meetings, two were remote volunteering programs, two were inpatient care, and one was a residential care home needs assessment. The satisfaction rates were high (66%-99%) among patients and family members who participated in telehealth consultations, but the satisfaction with family meetings was mixed. Compared with their clients, healthcare professionals were less likely to assess telehealth as satisfactory. The authors identified four barriers and four facilitators. The barriers were technological challenges, lack of nonverbal communication, ethical concerns, and limitations for clinical practice. The facilitators were accessibility and convenience, visual cues, facilitation and training, and family engagement.
LINKING EVIDENCE TO ACTION
This systematic mixed studies review suggests that current evidence supports the feasibility of telehealth implementation in palliative care for outpatient consultations and routine follow-up appointments. This review also identified facilitators and barriers to telehealth in palliative care, and the findings can inform the implementation of future palliative care services. Future attention should be paid to the effectiveness of telehealth implementation in palliative care patients.
PubMed: 36942832
DOI: 10.1111/wvn.12637 -
Journal of Advanced Nursing Nov 2023To map evidence on the nature and extent of use of nurse-led palliative care models in low- and middle-income countries serving adults with life-limiting conditions. (Review)
Review
AIMS
To map evidence on the nature and extent of use of nurse-led palliative care models in low- and middle-income countries serving adults with life-limiting conditions.
DESIGN
A scoping review of the literature was undertaken.
DATA SOURCES
A systematic search was performed from database inception to March 2022 in: Medline, EMBASE, CINAHL, Wiley Cochrane Library, SCOPUS, Web of Science, SciELO and Global Health. Main search terms included: Nurse-led AND Palliative care AND Low-and middle-income countries. Grey literature was searched from Proquest Dissertations and Theses Global, the World Health Organization and selected palliative care websites. We searched the reference list of included articles for additional studies.
REVIEW METHODS
We used the framework by Arksey and O'Malley and the PRISMA-ScR guidelines. Titles and abstracts were screened by one reviewer and full text by two reviewers. Thematic analysis was used to synthesize data and results are presented descriptively using themes and categories.
RESULTS
Eighteen studies were included, with majority from Sub-Saharan Africa (10/20). Three nurse-led palliative care models emerged: nurse-led empowering care, nurse-led symptom control and nurse-led multicomponent palliative care. They served particularly cancer and HIV patients and were delivered in person or by telehealth care. Reported outcomes were adherence to therapy, improved self-care ability, improved quality of life and increased access to palliative.
CONCLUSIONS
The use of nurse-led palliative care in low- and middle-income countries is in its developing stages and seems feasible. Nursing roles in in low- and middle-income countries need to be expanded by developing advanced practice nurses and nurse practitioner programmes, with palliative care content. More impact evaluation studies on the use of nurse-led palliative care models in these countries are needed.
IMPACT
This review highlights nurse-led care models that can enhance access and quality of life of patients with life-limiting conditions in low- and middle-income countries.
Topics: Adult; Humans; Palliative Care; Developing Countries; HIV Infections; Quality of Life; Nurse's Role
PubMed: 36965072
DOI: 10.1111/jan.15646 -
BMC Medicine Oct 2023Breastfeeding has long been associated with numerous benefits for both mothers and infants. While some observational studies have explored the relationship between... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Breastfeeding has long been associated with numerous benefits for both mothers and infants. While some observational studies have explored the relationship between breastfeeding and mental health outcomes in mothers and children, a systematic review of the available evidence is lacking. The purpose of this study is to systematically evaluate the association between breastfeeding and mental health disorders in mothers and children.
METHODS
We systematically searched MEDLINE and EMBASE from inception to June 2, 2023. The inclusion criteria consisted of all studies evaluating links between breastfeeding and development of mental health disorders in children and mothers. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) while grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of evidence. A random-effects meta-analysis was used if possible, to estimate the odds ratio for the association between breastfeeding and mental health outcomes. The Mantel-Haenszel method was utilised for pooling ORs across studies. Study heterogeneity was assessed using the I statistic.
RESULTS
Our review identified twenty-one original study. Of these, 18 focused on the association between breastfeeding and child health, assessing depressive disorders, schizophrenia, anxiety disorders, eating disorders and borderline personality disorder. Three studies evaluated the associations between breastfeeding and maternal mental health disorders. Three studies looking at outcomes in children showed no significant association between breastfeeding and occurrence of schizophrenia later in life (OR 0.98; 95% CI 0.57-1.71; I = 29%). For depressive disorders (5 studies) and anxiety disorders (3 studies), we found conflicting evidence with some studies showing a small protective effect while others found no effect. The GRADE certainty for all these findings was very low due to multiple limitations. Three studies looking at association between breastfeeding and maternal mental health, were too heterogeneous to draw any firm conclusions.
CONCLUSIONS
We found limited evidence to support a protective association between breastfeeding and the development of mental health disorders in children later in life. The data regarding the association between breastfeeding and maternal mental health beyond the postnatal period is also limited. The methodological limitations of the published literature prevent definitive conclusions, and further research is needed to better understand the relationship between breastfeeding and mental health in mothers and children.
Topics: Infant; Female; Child; Humans; Breast Feeding; Mothers; Mental Health; Anxiety Disorders; Feeding and Eating Disorders
PubMed: 37840122
DOI: 10.1186/s12916-023-03071-7 -
International Journal of Nursing Studies Jan 2024Dignity therapy is a psychotherapeutic intervention that is potentially effective in improving the well-being of patients receiving palliative care. However, the effects... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dignity therapy is a psychotherapeutic intervention that is potentially effective in improving the well-being of patients receiving palliative care. However, the effects of dignity therapy are not well-understood.
OBJECTIVE
We attempted to determine the effectiveness of dignity therapy in palliative patients to provide evidence that dignity therapy could be used in their care.
DESIGN
Systematic review.
PARTICIPANTS
The number of participants from all the studies was 1202 (intervention group, 619 patients; control group, 583 patients).
METHODS
The review was reported according to the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Relevant studies were collected with database searching of PubMed, Scopus, ScienceDirect, ProQuest Health & Medical Complete, CINAHL, and Psych Info databases from the inception of dignity therapy in 2002 to 2022. Literature was selected to identify trials of dignity therapy in patients with palliative care needs including cancer and non-cancer condition. Critical appraisal was performed independently by two reviewers to assess the relevance, reliability, and quality of the included studies. Two independent reviewers extracted data from all the studies. Data were synthesized using Review Manager version 4.5.
RESULTS
A total of 16 studies involving 1202 participants were included. Most studies were rated as medium quality (n = 10, 62.5 %). The results showed a significant difference between the dignity and control groups in dignity-related distress (MD = -3.54, 95 % CI: [-4.66, -2.42], p < 0.00001), hope (MD = 2.27, 95 % CI: [1.32, 3.22], p < 0.0001), and quality of life (SMD = 0.45, 95 % CI: [0.15, 1.14], p = 0.00). However, no significant difference was observed in depression (MD = -0.44, 95 % CI: [-1.09, 0.20], p = 0.18); anxiety (MD = -0.21, 95 % CI: [-1.68, 1.27], p = 0.78), and spiritual well-being (MD = 2.41, 95 % CI: [-0.82, 5.64], p = 0.14).
CONCLUSIONS
Dignity therapy was effective in improving dignity-related distress, quality of life, and levels of hope. A meta-analysis found no significant differences in patients' psychological or spiritual well-being. Differences in the providers of dignity therapy in the included studies may be the cause of the different findings regarding the varying effects of dignity therapy. Professional health workers need to be trained as dignity therapists to enhance the visibility of dignity therapy for patients.
REGISTRATION
CRD42022375319.
TWEETABLE ABSTRACT
Dignity therapy is an effective and promising intervention in palliative care.
Topics: Humans; Palliative Care; Quality of Life; Respect; Reproducibility of Results; Hospice and Palliative Care Nursing
PubMed: 37980718
DOI: 10.1016/j.ijnurstu.2023.104624 -
The American Journal of Hospice &... Aug 2023Telemedicine offers the opportunity to provide remote palliative care for patients to control symptoms and improve quality of life, even for patients with advanced...
Telemedicine offers the opportunity to provide remote palliative care for patients to control symptoms and improve quality of life, even for patients with advanced diseases. Establish a telemedicine model of rural palliative care for advanced cancer patients with difficulties in accessing standard care. This review comports with the minimum standards described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and uses the palliative care literature review iterative method (PALETTE) proposed by Zwakman et al in 2018. Three hundred, ninety-two articles were identified in PubMed and EMBASE databases and alternative search engines such as Google Scholar and OpenGrey. A telemedicine delivery model was developed for patients with limited access to standard care, which consists of identifying the candidate population, establishing the most convenient telemedicine modality, agreeing with patients and caregivers on palliative care needs, and evaluating the interventions effectiveness. Telemedicine is a revolutionary tool to provide palliative care to advanced cancer patients whose clinical condition or location prevent them from accessing conventional care.
Topics: Humans; Palliative Care; Quality of Life; Caregivers; Telemedicine; Neoplasms
PubMed: 36331174
DOI: 10.1177/10499091221130329