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Supportive Care in Cancer : Official... Jul 2021Pediatric palliative care (PC) is an evolving field and involves a comprehensive approach to care of children with cancer. The goal of this paper was to explore how...
PURPOSE
Pediatric palliative care (PC) is an evolving field and involves a comprehensive approach to care of children with cancer. The goal of this paper was to explore how pediatric oncologists define, interpret, and practice pediatric palliative care in their clinical settings.
METHODS
The study used the grounded theory approach to data collection and analysis. Twenty-one pediatric oncologists from six pediatric cancer centers across Israel were interviewed. Data was analyzed using line-by-line coding.
RESULTS
The analysis resulted in a four-tiered conceptual model. This model included the following categories: (1) ill-defined concept; (2) philosophies of palliative care; (3) trajectory of palliative care; and (4) palliative care treatment goals.
CONCLUSION
The findings illustrate the current conceptualizations of pediatric palliative care among the pediatric oncology community in Israel. The conceptual model documents their understanding of pediatric palliative care as a philosophical approach and the challenges they face in differentiating between palliative care and standard pediatric oncology care. Pediatric palliative care is a highly needed and valued sub-specialty. The findings from this study highlight the importance for its continued development in Israel, as it can reduce the suffering of children and their families. Concurrently, pediatric oncologists need to have more resources and access to explicit knowledge of the conceptual and practical aspects of both primary and specialized pediatric palliative care.
Topics: Adult; Aged; Concept Formation; Female; Humans; Male; Middle Aged; Oncologists; Palliative Care
PubMed: 33392772
DOI: 10.1007/s00520-020-05959-z -
Clinical Oncology (Royal College of... Nov 2020The advent of new cancer therapies, alongside expected growth and ageing of the population, better survival rates and associated costs of care, is uncovering a need to... (Review)
Review
The advent of new cancer therapies, alongside expected growth and ageing of the population, better survival rates and associated costs of care, is uncovering a need to more clearly define and integrate supportive care services across the whole spectrum of the disease. The current focus of cancer care is on initial diagnosis and treatment, and end of life care. The Multinational Association of Supportive Care in Cancer defines supportive care as 'the prevention and management of the adverse effects of cancer and its treatment'. This encompasses the entire cancer journey, and necessitates involvement and integration of most clinical specialties. Optimal supportive care can assist in accurate diagnosis and management, and ultimately improve outcomes. A national strategy to implement supportive care is needed to acknowledge evolving oncology practice, changing disease patterns and the changing patient demographic.
Topics: Humans; Medical Oncology; Neoplasms; Palliative Care
PubMed: 32814649
DOI: 10.1016/j.clon.2020.07.020 -
Annals of Palliative Medicine Jul 2019Radiotherapy has been used to palliate cancer symptoms since shortly after the time that X rays were discovered late in the 1800's. The 20th century witnessed... (Review)
Review
Radiotherapy has been used to palliate cancer symptoms since shortly after the time that X rays were discovered late in the 1800's. The 20th century witnessed improvements in treatment planning and delivery that permitted radiotherapy to serve as a successful, timely, and cost-efficient palliative intervention. Palliative radiation oncology has risen to the level of its own subspecialty, as evidenced by the formation of palliative radiation oncology clinical services and dedicated palliative radiotherapy guidelines, while additional changes have begun to alter the very definition and goals of palliative radiotherapy. Local treatment may now be offered with dual goals of symptom relief and the potential for increased disease-free or overall survival. While these new directions show great promise, novel strategies must be formulated to manage the increased complexity, workload, and cost of these approaches.
Topics: Age Factors; Cancer Pain; History, 20th Century; Humans; Insurance, Health, Reimbursement; Life Expectancy; Neoplasms; Palliative Care; Patient Care Planning; Tomography, X-Ray Computed
PubMed: 30943739
DOI: 10.21037/apm.2019.03.02 -
Annals of Palliative Medicine Nov 2023The delivery of comprehensive cancer care within a progressively intricate healthcare environment requires oncology providers to become well-versed in the integration of... (Review)
Review
The delivery of comprehensive cancer care within a progressively intricate healthcare environment requires oncology providers to become well-versed in the integration of palliative care (PC). Moreover, as healthcare professionals are urged to prioritize the individual preferences of patients and their families who confront life-limiting illnesses, it has become evident that oncology patients and their families have identified their psychosocial care needs as multifaceted and distinct, calling for specialized attention from care providers. Nevertheless, this is a skill that can be acquired through learning and practice. The landscape of PC is rapidly changing, with paradigm shifting studies highlighting the importance of early concurrent palliative and oncology inpatient and outpatient care for those with new advanced cancer diagnosis. Early concurrent care can notably improve quality of life (QoL), symptom control, patient and caregiver satisfaction, reduce costs and even improve survival. There is no longer a question of if PC should be offered, but instead when referral should be completed, what is the optimal model for service delivery and what barriers are present to achieve concurrent care. Conceptual models have been identified for optimal integrated palliative and oncology care delivery. In order to provide the best integrated care however, multiple obstacles need to be overcome. This narrative review discusses the importance of early integrated oncology and PC for patients with advanced cancer diagnosis, as well as the barriers to the integration of these specialties and potential models for delivery.
Topics: Humans; Palliative Care; Quality of Life; Neoplasms; Medical Oncology; Inpatients
PubMed: 37872127
DOI: 10.21037/apm-22-1154 -
BMC Palliative Care Jun 2024The number of people suffering from chronic diseases requiring palliative care (PC) is increasing rapidly. Therefore, PC teaching in undergraduate health science...
BACKGROUND
The number of people suffering from chronic diseases requiring palliative care (PC) is increasing rapidly. Therefore, PC teaching in undergraduate health science programs is necessary to improve primary PC based on international recommendations and available scientific evidence.
METHODS
A descriptive cross-sectional study was conducted. Active undergraduate medical and nursing programs that were approved by the Colombian Ministry of Education and integrated PC teaching into their curricula were included in the study. The total sample consisted of 48 programs: 31 nursing and 17 medical programs.
RESULTS
PC competencies are distributed throughout the curriculum in 41.67% of programs, in elective courses in 31.25%, and in mandatory courses in 27.08% of the programs. The average PC teaching hours is 81 for nursing and 57.6 for medicine. PC clinical rotations are not offered in 75% of the programs. For undergraduate nursing programs, the most frequent competencies taught are the definition and history of PC and identifying common symptoms associated with advanced disease. In undergraduate medicine, the most common competencies are pharmacological and non-pharmacological pain management and identification of PC needs.
CONCLUSIONS
PC teaching in undergraduate health science programs mainly addresses the conceptual and theoretical aspects of PC, which are part of the competencies present throughout the programs' curricula. Low availability of PC clinical rotations was identified. Future studies should assess whether the low availability of clinical rotations in PC limits the ability of students to develop the practical competencies necessary to provide quality PC.
TRIAL REGISTRATION
Not applicable.
Topics: Cross-Sectional Studies; Colombia; Humans; Education, Medical, Undergraduate; Palliative Care; Curriculum; Education, Nursing, Baccalaureate
PubMed: 38872162
DOI: 10.1186/s12904-024-01477-5 -
Social Science & Medicine (1982) Jul 2022The diffusion of palliative care has been rapid, yet uncertainty remains regarding palliative care's "active ingredients." The National Consensus Project Guidelines for...
The diffusion of palliative care has been rapid, yet uncertainty remains regarding palliative care's "active ingredients." The National Consensus Project Guidelines for Quality Palliative Care identified eight domains of palliative care. Despite these identified domains, when pressed to describe the specific maneuvers used in clinical encounters, palliative care providers acknowledge that "it's complex." The field of systems has been used to explain complexity across many different types of systems. Specifically, engineering systems develop a representation of a system that helps manage complexity to help humans better understand the system. Our goal was to develop a system model of what palliative care providers do such that the elements of the model can be described concretely and sequentially, aggregated to describe the high-level domains currently described by palliative care, and connected to the complexity described by providers and the literature. Our study design combined methodological elements from both qualitative research and systems engineering modeling. The model drew on participant observation and debriefing semi-structured interviews with interdisciplinary palliative care team members by a systems engineer. The setting was an interdisciplinary palliative care service in a US rural academic medical center. In the developed system model, we identified 59 functions provided to patients, families, non-palliative care provider(s), and palliative care provider(s). The high-level functions related to measurement, decision-making, and treatment address up to 8 states of an individual, including an overall holistic state, physical state, psychological state, spiritual state, cultural state, personal environment state, and clinical environment state. In contrast to previously described expert consensus domain-based descriptions of palliative care, this model more directly connects palliative care provider functions to emergent behaviors that may explain system-level mechanisms of action for palliative care. Thus, a systems modeling approach provides insights into the challenges surrounding the recurring question of what is in the palliative care "syringe."
Topics: Humans; Interdisciplinary Studies; Palliative Care; Qualitative Research; Rural Population; Syringes
PubMed: 35691210
DOI: 10.1016/j.socscimed.2022.115069 -
JNMA; Journal of the Nepal Medical... Aug 2022Nepal has witnessed demographic and epidemiological transition resulting in the shift from infectious diseases to non-communicable diseases as the major disease burden....
UNLABELLED
Nepal has witnessed demographic and epidemiological transition resulting in the shift from infectious diseases to non-communicable diseases as the major disease burden. Around 60% of mortalities and morbidities are attributable to non-communicable diseases of which the majority end with the need for palliative care services. The current palliative care services in Nepal are in the infancy stage compared with other services. Undignified dying is a challenging public health problem and as such requires a public health approach to address it with the involvement of all stakeholders. Recognizing the need for the end spectrum of non-communicable diseases patients, the Ministry of Health, Nepal recently introduced the policy to address the unmet need through the community-based palliative care program, a laudable initiation.
KEYWORDS
community health care; Nepal; palliative care; public health.
Topics: Humans; Palliative Care; Public Health; Noncommunicable Diseases; Nepal
PubMed: 36705226
DOI: 10.31729/jnma.7255 -
Supportive Care in Cancer : Official... Jun 2024Many patients living beyond cancer experience significant unmet needs, although few of these patients are currently reviewed by specialist palliative care teams (SPCTs).... (Review)
Review
PURPOSE
Many patients living beyond cancer experience significant unmet needs, although few of these patients are currently reviewed by specialist palliative care teams (SPCTs). The aim of this narrative review was to explore the current and potential role of SPCTs in this cohort of patients.
METHODS
A search strategy was developed for Medline, and adapted for Embase, CINAHL, and PsycInfo. Additionally, websites of leading oncology, cancer survivorship, and specialist palliative care organisations were examined. The focus of the search was on individuals living beyond cancer rather than other groups of cancer survivors.
RESULTS
111 articles were retrieved from the search for full text review, and 101 other sources of information were identified after hand searching the reference lists of the full text articles, and the aforesaid websites. The themes of the review encompass the definition of palliative care/specialist palliative care, current models of specialist palliative care, core activities of SPCTs, relevant expertise of SPCTs, and potential barriers to change in relation to extending their support and expertise to individuals living beyond cancer. The review identified a paucity of evidence to support the role of SPCTs in the management of patients living beyond cancer.
CONCLUSIONS
Individuals living beyond cancer have many unmet needs, and specific services are required to manage these problems. Currently, there is limited evidence to support the role of specialist palliative care teams in the management of this cohort of people, and several potential barriers to greater involvement, including limited resources, and lack of relevant expertise.
Topics: Humans; Palliative Care; Cancer Survivors; Neoplasms; Patient Care Team
PubMed: 38842641
DOI: 10.1007/s00520-024-08598-w -
Journal of Clinical Nursing Jul 2023To describe the quality of information coming from previous care units to palliative care.
AIMS AND OBJECTIVES
To describe the quality of information coming from previous care units to palliative care.
BACKGROUND
Information quality is an interconnected concept that includes different dimensions and can be viewed from different perspectives. More knowledge is needed from a multi-professional perspective on the information quality coming to palliative care.
DESIGN
Descriptive qualitative study.
METHODS
Altogether 33 registered nurses, practical nurses, social workers and physicians working in palliative care were purposively selected to participate in thematic interviews. The research was carried out in six palliative care units in three hospital districts. The data were analysed by using deductive and inductive content analysis. The COREQ checklist was used.
RESULTS
Three main categories with thirteen categories were identified in connection with the deductive analysis based on the Clinical Information Quality framework: (1). Informativeness of information coming from previous care units to palliative care included accuracy, completeness, interpretability, plausibility, provenance and relevance. (2). Availability of information coming from previous care units to palliative care included accessibility, portability, security and timeliness. (3). Usability of information coming from previous care units to palliative care included conformance, consistency and maintainability. Each category is divided into sub-categories followed by narratives of their content.
CONCLUSIONS
This study provides new knowledge on the quality of information coming to palliative care from a multi-professional perspective. Professionals working in palliative care units highlight issues describing good information quality, but also point out quality issues and areas for improvement.
RELEVANCE TO CLINICAL PRACTICE
The results can guide the development of documentation practices and Health Information System development as well as be used in the generation of a new audit instrument of information quality.
Topics: Humans; Palliative Care; Hospice and Palliative Care Nursing; Qualitative Research; Physicians; Narration
PubMed: 35844084
DOI: 10.1111/jocn.16453 -
Revista Da Associacao Medica Brasileira... Jul 2019To estimate the human resources and services needed to meet the demand of the Brazilian population who would benefit from palliative care, based on the population growth...
OBJECTIVE
To estimate the human resources and services needed to meet the demand of the Brazilian population who would benefit from palliative care, based on the population growth projection for 2040.
METHODS
Population and mortality estimates and projections were obtained from the Brazilian Institute of Geography and Statistics. Service needs were estimated based on literature data.
RESULTS
The expected increase in the Brazilian population for 2000-2040 is 31.5%. The minimum estimate of patients with palliative care needs was 662,065 in 2000 and 1,166,279 in 2040. The staff required for each hundred thousand inhabitants would increase from 1,734 to 2,282, the number of doctors needed would increase from 4,470 to 6,274, and the number of nurses from 8,586 to 11,294, for the same period.
CONCLUSION
The definition of a national strategy predicting the increasing palliative care needs of the population is necessary. The expansion of the support network for chronic and non-transmissible diseases is necessary, but the training of existing human resources at all levels of attention to perform palliative actions can be a feasible alternative to minimize the suffering of the population.
Topics: Brazil; Female; Forecasting; Health Services Accessibility; Health Services Needs and Demand; Health Workforce; Humans; Male; Palliative Care; Time Factors
PubMed: 31340307
DOI: 10.1590/1806-9282.65.6.796