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BMJ Supportive & Palliative Care Jun 2020To review literature relating to evidence, context and facilitation to describe knowledge translation in paediatric palliative care. Paediatric palliative care requires...
OBJECTIVES
To review literature relating to evidence, context and facilitation to describe knowledge translation in paediatric palliative care. Paediatric palliative care requires competences including both paediatric specialists as well as services that are developed for this purpose, and there is a need to facilitate paediatric palliative care knowledge translation. Promoting Action on Research Implementation in the Health Services (PARiHS) is a framework for knowledge translation, which highlights the relationships between evidence, context and facilitation. PARiHS framework has been revised and updated in a new version called i-PARiHS.
METHODS
The electronic databases AgeLine, CINAHL, The Cochrane Library, PsycINFO, PubMed and Scopus were searched. Papers included were limited to English and Swedish publications and restricted to publications dated between 1993 and August 2019. All types of observational and experimental studies using any research design were included.
RESULTS AND CONCLUSIONS
Thirty-eight articles were included and there was a common vision about how and when palliative care should be offered to children. The i-PARiHS was used as a lens to describe the knowledge translation in paediatric palliative care. Symptom relief was the most commonly described evidence-based strategy, and the hospital environment was the most commonly described context. Different types of education were the most commonly used strategies to facilitate knowledge translation. The results mainly focused on increasing knowledge of palliative care in paediatric care. To sum up, the results report strategies to achieve knowledge translation of paediatric palliative care, and these can be interpreted as a guideline for how this process can be facilitated.
TRIAL REGISTRATION NUMBER
CRD42018100663.
Topics: Child; Female; Health Services Research; Humans; Male; Palliative Care; Pediatrics; Translational Research, Biomedical
PubMed: 31836595
DOI: 10.1136/bmjspcare-2019-001934 -
BMJ Supportive & Palliative Care Jun 2023One of the barriers to the integration of palliative care within the process of patient care and treatment is the lack of awareness of patients about palliative care. In...
BACKGROUND
One of the barriers to the integration of palliative care within the process of patient care and treatment is the lack of awareness of patients about palliative care. In order to develop efficient resources to improve patient awareness, comprehensive information is required to determine the specific aspects of palliative care where a paucity of evidence on patient awareness exists. This review aims to synthesise evidence from previous studies in order to provide a comprehensive information set about the current state of patient awareness of palliative care.
METHODS
In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Magiran, Scientific Information Database(SID) and Islamic Science Citation (ISC) were searched to identify articles published between 2000 and 2021 that considered patients' awareness of palliative care.
RESULTS
Of the 5347 articles found, 22 studies were retained after quality evaluation; three full-text articles were excluded. Nineteen articles are included in this review. More than half of the patients did not have any information about palliative care or hospice care. Some patients accurately defined hospice care and palliative care; other patients had misunderstandings about palliative care. Patients had limited information about pastoral care, social care and bereavement care. Patients' awareness about individuals or centres providing palliative care or hospice care was limited. Video presentation and distribution of information at the community level indicated that this method would be beneficial in increasing the awareness.
CONCLUSION
The review points to the need for patient education programmes and interventional studies to increase patients' awareness.
Topics: Humans; Palliative Care; Hospice Care; Hospice and Palliative Care Nursing; Patients
PubMed: 34635546
DOI: 10.1136/bmjspcare-2021-003072 -
Public Health May 2021Palliative care education (PCE) is an important public health approach to palliative care and is crucial to improving its utilisation. The present study aims to develop...
BACKGROUND
Palliative care education (PCE) is an important public health approach to palliative care and is crucial to improving its utilisation. The present study aims to develop a comprehensive understanding of PCE and its effectiveness.
METHOD
A systematic review approach, including narrative synthesis, was used to review qualitative and quantitative studies published in the English language between January 1969 and January 2019, focussing on PCE programs.
RESULTS
Thirty-nine research studies were included in the systematic review. The target audience of the included studies were mostly healthcare professionals, followed by family caregivers. Definitions of death and palliative care, symptom management and communication were leading themes in the reviewed PCE programs. The educational resources used in PCE programs were mainly self-developed teaching materials, with some programs utilising eLearning resources. The included PCE programs were effective in improving knowledge, attitude and confidence in palliative care and the satisfaction of participant learning experience.
CONCLUSION
PCE is a useful tool to improve knowledge of, confidence in and attitudes towards palliative care amongst healthcare professionals and carers. To make palliative care a public health issue, PCE should be expanded to the public and policy-makers.
Topics: Caregivers; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Palliative Care; Program Evaluation
PubMed: 33873061
DOI: 10.1016/j.puhe.2021.02.033 -
Journal of Palliative Medicine Feb 2022Peripheral artery disease (PAD) encompasses conditions with poor outcome and severe suffering, both mentally and physically, yet utilization and research into... (Review)
Review
Peripheral artery disease (PAD) encompasses conditions with poor outcome and severe suffering, both mentally and physically, yet utilization and research into palliative care interventions remain sparse. The purpose of this study is to identify existing evidence on palliative care intervention for chronic limb threatening ischaemia (CLTI) and abdominal aortic aneurysm (AAA). We conducted a PROSPERO-registered systematic review of studies published between 1991 and 2020 in which people with PAD received palliative care interventions and at least one patient outcome was recorded. For the purpose of this study, a palliative care intervention was defined as one which aims primarily to reduce negative impact of PAD on patients' and/or caregivers' physical, emotional, psychological, social, or spiritual condition. A total of 8 studies involving 87,024 patients met the inclusion criteria (4 cohort studies and 4 cross-sectional studies). Methodological quality ranged from low to moderate. The small number of studies and study heterogeneity precluded meta-analysis. Regarding our primary outcomes, only two articles recorded patient-reported outcomes. Five articles found an association between palliative care and reduction in health care utilization, a secondary outcome of the study. Most of the studies reported that palliative care was likely underused. Only two of the studies included non-hospital patients. Despite high mortality and morbidity associated with PAD, evidence of the effectiveness of palliative care in this group of patients is lacking. There are only a handful of articles on palliative care for people with PAD, and the majority are small, methodologically flawed and lack meaningful patient-reported outcomes. High-quality research of palliative care interventions in patients with PAD is urgently needed to better understand the impact of palliative care on quality of end of life and to develop and evaluate service-level interventions.
Topics: Cohort Studies; Cross-Sectional Studies; Humans; Palliative Care; Peripheral Arterial Disease
PubMed: 34860585
DOI: 10.1089/jpm.2021.0393 -
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 -
BMJ Supportive & Palliative Care Dec 2021Prognostic disclosure is an important component of communication in palliative care. Disclosing information on poor prognosis may affect quality of life (QoL) of... (Review)
Review
INTRODUCTION
Prognostic disclosure is an important component of communication in palliative care. Disclosing information on poor prognosis may affect quality of life (QoL) of palliative care patients. However, the effects of prognostic disclosure on QoL across different cultures and countries are unclear.
OBJECTIVE
To review the effects of prognostic disclosure on QoL of palliative care patients.
METHODS
A systematic review was conducted across seven databases (AMED, CINAHL plus, Cochrane Library, Medline (via the PubMed interface), Embase, Scopus and Web of Science). All primary studies, of any design, that explored the effects of prognostic disclosure on QoL of adult palliative care patients were eligible.
RESULTS
A total of 1926 records were screened for eligibility. Twenty-five articles were included (11 cross-sectional, 10 cohort, 3 mixed methods and 1 qualitative study). Studies were conducted in 11 countries. Five studies reported the sources of prognostic disclosure, while 20 studies did not. Emotional QoL was the most reported domain among the studies. The effects of prognostic disclosure on emotional aspects, overall QoL and other domains, including symptoms, physical functions, role functions, social functions and cognitive functions, were inconsistent.
CONCLUSIONS
The effects of prognostic disclosure on QoL across cultures and countries are inconsistent. Cultural differences are not sufficient to explain the effects. Future research is needed to explore the association between prognostic disclosure and QoL, and develop tools to support clinicians to share prognostic information in the most sensitive and supportive way.
Topics: Adult; Cross-Sectional Studies; Disclosure; Humans; Palliative Care; Prognosis; Quality of Life
PubMed: 33257406
DOI: 10.1136/bmjspcare-2020-002460 -
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 -
Respiratory Medicine 2023Chronic respiratory diseases represent a significant burden of disease globally, with high morbidity and mortality. Individuals living with these conditions, as well as... (Review)
Review
INTRODUCTION
Chronic respiratory diseases represent a significant burden of disease globally, with high morbidity and mortality. Individuals living with these conditions, as well as their families, face considerable physical, emotional and social challenges. Palliative care might be a valuable approach to address their complex needs, but evidence to prove this is still scarce.
OBJECTIVES
This systematic review aimed to study the effectiveness of palliative care interventions in health-related outcomes (quality of life, symptom control, symptom burden, psychological well-being, advance care planning, use of health services, and survival) in chronic respiratory patients.
METHODS
Pubmed, Cochrane and Web of Science were searched for trials published in the last 10 years, comparing palliative care interventions to usual care, in patients with chronic respiratory diseases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.
RESULTS
Eight studies were included, seven randomized controlled trials and one cluster-controlled trial; the former with moderate risk of bias and the latter with high risk of bias. Findings revealed that palliative interventions improve breathlessness control and advance care planning. There were no significant differences for the other outcomes.
CONCLUSIONS
Palliative care appears to have a beneficial effect on breathlessness, one of the most distressing symptoms in patients suffering from chronic respiratory diseases and allows for advanced care planning. Additional research, with more robust trials, is needed to draw further conclusions about other health-related outcomes.
Topics: Humans; Palliative Care; Quality of Life; Advance Care Planning; Dyspnea; Anxiety
PubMed: 37717791
DOI: 10.1016/j.rmed.2023.107411