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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 -
Asian Pacific Journal of Cancer... Sep 2022The current study aims to review, appraise, and synthesize the available studies and recommend the significant clinical implications for healthcare professionals to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The current study aims to review, appraise, and synthesize the available studies and recommend the significant clinical implications for healthcare professionals to understand the existing findings of palliative care experience among patients with hematology malignancy.
METHODS
After excluding the registered or ongoing systematic reviews in the PROSPERO database regarding the lived experience of palliative care among patients with HM, our systematic review and meta-analysis protocol was registered in PROSPERO [CRD42021270311]. A search for published articles in English between January 2000 and December 2020 was conducted among different electronic databases using PRISMA guidelines 2020. Meta-synthesis was accomplished using the JBI meta-aggregation method to synthesize the findings. The implemented approach involved all qualitative research and mixed-method studies that included a qualitative part.
RESULTS
This review contained eight studies which led to 25 codes and seven categories. Finally, three synthesized themes were developed: (1) Approaching the end of life among patients with Hematology Malignancy, (2) submission and surrender of patients with Hematology Malignancy during their terminal stage, and (3) Entrance to the palliative care world. Therefore, realizing the importance of palliative care services to patients with Hematology Malignancy by providing evidence-based education and timely referral is crucial.
CONCLUSION
There was a substantial increase in the HMs rate with late referral to palliative care services. The results of this review may draw attention to some issues reported by patients with Hematology Malignancy. Scaling up palliative care services for those patients is essential to minimize end-of-life suffering and the long-term impact of inadequate palliative care for patients with Hematology Malignancy.
Topics: Health Personnel; Hematologic Neoplasms; Humans; Neoplasms; Palliative Care; Qualitative Research
PubMed: 36172649
DOI: 10.31557/APJCP.2022.23.9.2881 -
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 -
BMJ Supportive & Palliative Care Dec 2022Palliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing...
BACKGROUND
Palliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing international movement to embed palliative care education in medical student and junior doctor education. To date there has been no review of the literature concerning the views and experiences of junior doctors delivering this care.
AIM
To review the published literature between 2000 and 2019 concerning junior doctors' experience of palliative and end-of-life care.
METHODS
Systematic literature review and narrative synthesis.
RESULTS
A search of six databases identified 7191 titles; 34 papers met the inclusion criteria, with a further 5 identified from reference searching. Data were extracted into a review-specific extraction sheet and a narrative synthesis undertaken. Three key themes were identified: (1) 'Significance of death and dying': all papers found that junior doctors care for many patients approaching the end of life, and this often causes emotional distress and can leave persisting memories for many years afterwards; (2) 'Thrown in at the deep end': junior doctors feel unprepared and unsupported in providing palliative and end-of-life care; and (3) 'Addressing the gaps': junior doctors often experience a medical culture of disengagement towards dying patients and varying attitudes of senior doctors. Subsequently they have to learn the skills needed through seeking their own opportunities.
CONCLUSION
Medical education needs to change in order to better prepare and support junior doctors for their role in caring for dying patients. This education needs to focus on their knowledge, skills and attitudes.
Topics: Humans; Palliative Care; Qualitative Research; Terminal Care; Medical Staff, Hospital; Hospice Care
PubMed: 31722983
DOI: 10.1136/bmjspcare-2019-001954 -
Journal of Palliative Medicine Mar 2020Investigators have tested interventions delivered by specialty palliative care (SPC) clinicians, or by clinicians without palliative care specialization (primary...
Investigators have tested interventions delivered by specialty palliative care (SPC) clinicians, or by clinicians without palliative care specialization (primary palliative care, PPC). To compare the characteristics and outcomes of randomized clinical trials (RCTs) of SPC and PPC interventions. Systematic review secondary analysis. RCTs of palliative care interventions. Interventions were classified SPC if delivered by palliative care board-certified or subspecialty trained clinicians, or those with extensive clinical experience; all others were PPC. We abstracted data for each intervention: delivery setting, delivery clinicians, outcomes measured, trial results, and Cochrane's Risk of Bias. We conducted narrative synthesis for quality of life, symptom burden, and survival. Of 43 RCTs, 27 tested SPC and 16 tested PPC interventions. SPC interventions were more comprehensive (4.2 elements of palliative care vs. 3.1 in PPC, = 0.02). SPC interventions were delivered in inpatient (44%) or outpatient settings (52%) by specialty physicians (44%) and nurses (44%); PPC interventions were delivered in inpatient (38%) and home settings (38%) by nurses (75%). PPC trials were more often of high risk of bias than SPC trials. Improvements were demonstrated on quality of life by SPC and PPC trials and on physical symptoms by SPC trials. Compared to PPC, SPC interventions were more comprehensive, were more often delivered in clinical settings, and demonstrated stronger evidence for improving physical symptoms. In the face of SPC workforce limitations, PPC interventions should be tested in more trials with low risk of bias, and may effectively meet some palliative care needs.
Topics: Health Personnel; Hospice and Palliative Care Nursing; Humans; Palliative Care; Quality of Life; Specialization
PubMed: 31644399
DOI: 10.1089/jpm.2019.0349 -
Palliative Medicine Jun 2019Nursing homes are becoming a common site where delivering end-of-life care for older adults. They often represent the junction between the curative and the palliative...
BACKGROUND
Nursing homes are becoming a common site where delivering end-of-life care for older adults. They often represent the junction between the curative and the palliative phase.
AIM
To identify the elements that nursing home residents' family carers perceive as good end-of-life care and develop a conceptual model of good end-of-life care according to the family perspective.
DESIGN
Systematic review (PROSPERO no. 95581) with meta-aggregation method.
DATA SOURCES
Five electronic databases were searched from inception between April and May 2018. Published qualitative studies (and mixed-method designs) of end-of-life care experience of nursing home family carers whose relative was dead or at the end-of-life were included. No language or temporal limits were applied.
RESULTS
In all, 18 studies met inclusion criteria. A 'life crisis' often resulted in a changed need of care, and the transition towards palliative care was sustained by a 'patient-centered environment'. Family carers described good end-of-life care as providing resident basic care and spiritual support; recognizing and treating symptoms; assuring continuity in care; respecting resident's end-of-life wishes; offering environmental, emotional and psychosocial support; keeping family informed; promoting family understanding; and establishing a partnership with family carers by involving and guiding them in a shared decision-making. These elements improved the quality of end-of-life of both residents and their family, thus suggesting a common ground between good end-of-life care and palliative care.
CONCLUSION
The findings provide a family-driven framework to guide a sensitive and compassionate transition towards palliative care in nursing home.
Topics: Adult; Aged; Aged, 80 and over; Attitude to Death; Caregivers; Family; Female; Hospice Care; Humans; Male; Middle Aged; Nursing Homes; Palliative Care; Qualitative Research; Terminal Care
PubMed: 30969160
DOI: 10.1177/0269216319840275 -
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 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 -
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 -
Reviews on Recent Clinical Trials 2016To assess the role of early palliative care in patients with advanced oncologic and non-oncologic chronic diseases. (Review)
Review
BACKGROUND
To assess the role of early palliative care in patients with advanced oncologic and non-oncologic chronic diseases.
METHODS
A qualitative systematic review of literature was performed. All the randomized phase III trials comparing early, simultaneous palliative care and standard care in patients with advanced oncologic and non-oncologic diseases were considered eligible and included into the analysis. The outcomes were classified into 6 classes: quality of life, symptoms control, overall survival, quality of care, patients' and caregivers' satisfaction, and costs of the assistance.
RESULTS
Twelve papers reporting the data of 9 trials were considered eligible and included into the analysis. Two nonrandomized trials were also included into the selection because of the methods used by the authors. The early, simultaneous approach was reported to improve quality of life in two out of 7 papers, symptoms control in 1 out of 5 papers, overall survival in 2 out of 3 papers, quality of care in 5 out of 8 papers, patients' or caregivers' satisfaction in 3 out of 4 papers; and to reduce the costs of assistance in 2 out of 3 papers.
CONCLUSION
Early palliative care improves the main outcomes of the assistance in patients with advanced oncologic and non-oncologic chronic diseases. The available data are probably enough to consider early palliative cares a novel standard of care in these groups of patients.
Topics: Chronic Disease; Humans; Neoplasms; Palliative Care; Quality of Health Care
PubMed: 26464077
DOI: 10.2174/1574887110666151014141650