-
Patient Education and Counseling Aug 2022The present mixed-method systematic review identifies facilitators and barriers in palliative care communication among health professionals and older people. (Review)
Review
OBJECTIVES
The present mixed-method systematic review identifies facilitators and barriers in palliative care communication among health professionals and older people.
METHODS
The review process was conducted by three reviewers who searched studies in four different databases (January 2009-January 2022), exploring experiences of communication among health professionals and older people without cognitive impairments. Relevant articles were quality assessed with a standardized tool.
RESULTS
Twenty-eight articles were included and the following 5 clusters were identified: 1) training and education for health professionals, 2) team working and coordination among health professionals, 3) communication skills, 4) time and availability, 5) emotional, cultural and psychological factors. The articles highlighted the need for greater preparation of health professionals around the management of palliative care communication with older people.
CONCLUSION
Palliative care communication among health professionals and older people are characterized by several challenges. However, there are facilitating aspects that may be considered to improve the quality of communication.
PRACTICE IMPLICATIONS
Facilitators are promising approaches to support health professionals in providing high-quality palliative care communication to older people, developing a person-centred practice. Facilitators include palliative care training and educational opportunities for health professionals, like ELNEC Geriatric Curriculum, permitting them to develop specific competences in communication and aging.
Topics: Aged; Communication; Curriculum; Health Personnel; Hospice and Palliative Care Nursing; Humans; Palliative Care
PubMed: 35459530
DOI: 10.1016/j.pec.2022.04.003 -
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 -
Palliative Medicine Feb 2017Homeless individuals have a high prevalence of multiple chronic comorbidities and early mortality compared to the general population. They also experience significant... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Homeless individuals have a high prevalence of multiple chronic comorbidities and early mortality compared to the general population. They also experience significant barriers to access and stigmatization in the healthcare system. Providing advance care planning, palliative care, and end-of-life care for this underserved population is an important health issue.
AIM
To summarize and evaluate the evidence surrounding advance care planning, palliative care, and end-of-life care interventions for homeless persons.
DESIGN
A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
DATA SOURCES
Articles from MEDLINE, EMBASE, CINAHL, PsycINFO, Social Work Abstracts, Cochrane Library, Web of Science, and PubMed databases were searched through 13 June 2015. Peer-reviewed studies that implemented advance care planning, palliative care, and end-of-life care interventions for homeless populations were included. Data from studies were independently extracted by two investigators using pre-specified criteria, and quality was assessed using modified Cochrane and Critical Appraisal Skills Programme tools.
RESULTS
Six articles met inclusion criteria. Two studies were randomized controlled trials involving advance directive completion. Two cohort studies investigated the costs of a shelter-based palliative care intervention and predictors for completing advance directives. These studies were rated low to fair quality. Two qualitative studies explored the interface between harm-reduction services and end-of-life care and the conditions for providing palliative care for homeless persons in a support home.
CONCLUSION
The effectiveness of advance care planning, palliative care, and end-of-life care interventions for homeless individuals is uncertain. High-quality studies of interventions that reflect the unique and complex circumstances of homeless populations and investigate patient-related outcomes, caregiver burden, and cost-effectiveness are needed.
Topics: Advance Care Planning; Health Care Costs; Health Services Accessibility; Ill-Housed Persons; Humans; Palliative Care; Terminal Care
PubMed: 27260169
DOI: 10.1177/0269216316649334 -
The American Journal of Hospice &... Aug 2023To describe the use of tele-palliative care in patients with advanced disease and assess its effectiveness on quality of life (QOL), symptom burden and other outcomes...
To describe the use of tele-palliative care in patients with advanced disease and assess its effectiveness on quality of life (QOL), symptom burden and other outcomes for patients and their caregivers. We searched for randomised controlled trials to assess the outcomes of tele-palliative care on patients with advanced disease and their caregivers. Eight databases were searched for studies published in Chinese or English from inception to November 27, 2021. Data from the included trials were extracted independently by 2 reviewers and evaluated independently for methodological quality using the Cochrane Collaboration's tool. A narrative synthesis of the results of all trials was performed. Thirty trials were included ultimately with more than one half of the studies were moderate to high quality, including, which involved 19 665 patients and 1153 caregivers. Results from 10/15 included trials (reporting patient QOL), 5/14 trials (reporting patient symptoms), 1/3 trials (reporting survival), 8/13 trials (reporting patient mood), 3/6 trials (reporting ACP related indicators), 3/7 trials (reporting resource utilization) showed statistically significant between tele-palliative care and control care groups. Of 30 trials, 8 measured caregiver outcomes, 1/4 trials (reporting caregiver QOL) showed statistically significant, and results from 3/3 trials (reporting caregiver mood), 3/4 trials (reporting caregiver burden) showed benefit in at least 1 domain at 1 or more time points. This systematic review suggests that although tele-palliative care can improve patient physical, patient and caregiver psychological health outcomes to some extent, there is still a lack of sufficient evidence to substantiate its application effects. Moreever, regional and cultural characteristics should also be taken into account when tele-palliative care interventions are carried out.
Topics: Humans; Caregivers; Palliative Care; Quality of Life; Hospice and Palliative Care Nursing
PubMed: 36113129
DOI: 10.1177/10499091221123566 -
BMC Palliative Care Jan 2017Over the past decades there has been a significant increase in the number of published clinical trials in palliative care. However, empirical evidence suggests that... (Review)
Review
BACKGROUND
Over the past decades there has been a significant increase in the number of published clinical trials in palliative care. However, empirical evidence suggests that there are methodological problems in the design and conduct of studies, which raises questions about the validity and generalisability of the results and of the strength of the available evidence. We sought to evaluate the methodological characteristics and assess the quality of reporting of clinical trials in palliative care.
METHODS
We performed a systematic review of published clinical trials assessing therapeutic interventions in palliative care. Trials were identified using MEDLINE (from its inception to February 2015). We assessed methodological characteristics and describe the quality of reporting using the Cochrane Risk of Bias tool.
RESULTS
We retrieved 107 studies. The most common medical field studied was oncology, and 43.9% of trials evaluated pharmacological interventions. Symptom control and physical dimensions (e.g. intervention on pain, breathlessness, nausea) were the palliative care-specific issues most studied. We found under-reporting of key information in particular on random sequence generation, allocation concealment, and blinding.
CONCLUSIONS
While the number of clinical trials in palliative care has increased over time, methodological quality remains suboptimal. This compromises the quality of studies. Therefore, a greater effort is needed to enable the appropriate performance of future studies and increase the robustness of evidence-based medicine in this important field.
Topics: Clinical Trials as Topic; Data Accuracy; Humans; Medicine; Outcome and Process Assessment, Health Care; Palliative Care; Research Design; Sample Size; Surveys and Questionnaires
PubMed: 28122560
DOI: 10.1186/s12904-016-0181-9 -
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 -
PloS One 2016Prognostic accuracy in palliative care is valued by patients, carers, and healthcare professionals. Previous reviews suggest clinicians are inaccurate at survival... (Review)
Review
BACKGROUND
Prognostic accuracy in palliative care is valued by patients, carers, and healthcare professionals. Previous reviews suggest clinicians are inaccurate at survival estimates, but have only reported the accuracy of estimates on patients with a cancer diagnosis.
OBJECTIVES
To examine the accuracy of clinicians' estimates of survival and to determine if any clinical profession is better at doing so than another.
DATA SOURCES
MEDLINE, Embase, CINAHL, and the Cochrane Database of Systematic Reviews and Trials. All databases were searched from the start of the database up to June 2015. Reference lists of eligible articles were also checked.
INCLUSION CRITERIA
patients over 18, palliative population and setting, quantifiable estimate based on real patients, full publication written in English.
EXCLUSION CRITERIA
if the estimate was following an intervention, such as surgery, or the patient was artificially ventilated or in intensive care.
STUDY APPRAISAL AND SYNTHESIS METHODS
A quality assessment was completed with the QUIPS tool. Data on the reported accuracy of estimates and information about the clinicians were extracted. Studies were grouped by type of estimate: categorical (the clinician had a predetermined list of outcomes to choose from), continuous (open-ended estimate), or probabilistic (likelihood of surviving a particular time frame).
RESULTS
4,642 records were identified; 42 studies fully met the review criteria. Wide variation was shown with categorical estimates (range 23% to 78%) and continuous estimates ranged between an underestimate of 86 days to an overestimate of 93 days. The four papers which used probabilistic estimates tended to show greater accuracy (c-statistics of 0.74-0.78). Information available about the clinicians providing the estimates was limited. Overall, there was no clear "expert" subgroup of clinicians identified.
LIMITATIONS
High heterogeneity limited the analyses possible and prevented an overall accuracy being reported. Data were extracted using a standardised tool, by one reviewer, which could have introduced bias. Devising search terms for prognostic studies is challenging. Every attempt was made to devise search terms that were sufficiently sensitive to detect all prognostic studies; however, it remains possible that some studies were not identified.
CONCLUSION
Studies of prognostic accuracy in palliative care are heterogeneous, but the evidence suggests that clinicians' predictions are frequently inaccurate. No sub-group of clinicians was consistently shown to be more accurate than any other.
IMPLICATIONS OF KEY FINDINGS
Further research is needed to understand how clinical predictions are formulated and how their accuracy can be improved.
Topics: Algorithms; Humans; Palliative Care; Patient Comfort; Physicians; Probability; Prognosis; Survival; Treatment Outcome
PubMed: 27560380
DOI: 10.1371/journal.pone.0161407 -
Palliative Medicine Jul 2022The efficacy of virtual reality for people living with a terminal illness is unclear. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The efficacy of virtual reality for people living with a terminal illness is unclear.
AIM
To determine the feasibility and effectiveness of virtual reality use within a palliative care setting.
DESIGN
Systematic review and meta-analysis. PROSPERO (CRD42021240395).
DATA SOURCES
Medline, Embase, AMED, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science were searched from inception to March 2021. Search terms included 'virtual reality' and 'palliative care'. Eligibility: (1) adult (>18 years old) with a terminal illness (2) at least one virtual reality session and (3) feasibility data and/or at least one patient outcome reported. The ROB-2 and ROBINS tools assessed risk of bias. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool assessed the quality of the evidence. Standardised mean differences (Hedges's ) were calculated from the pre- and post-data. A DerSimonian-Laird random effects model meta-analysis was conducted.
RESULTS
Eight studies were included, of which five were in the meta-analysis. All studies had at least some concern for risk of bias. Virtual reality statistically significantly improved pain ( = 0.0363), tiredness ( = 0.0030), drowsiness ( = 0.0051), shortness of breath ( = 0.0284), depression ( = 0.0091) and psychological well-being ( = 0.0201). The quality of the evidence was graded as very low due to small sample sizes, non-randomisation methods and a lack of a comparator arm.
CONCLUSIONS
Virtual reality in palliative care is feasible and acceptable. However, limited sample sizes and very low-quality studies mean that the efficacy of virtual reality needs further research.
Topics: Adolescent; Hospice and Palliative Care Nursing; Humans; Palliative Care; Technology
PubMed: 35635018
DOI: 10.1177/02692163221099584 -
Palliative & Supportive Care Oct 2020Advanced care planning (ACP) is central to patients' dignity and autonomy; however, in many countries it is underutilized. Studies that tested the effects of palliative...
OBJECTIVE
Advanced care planning (ACP) is central to patients' dignity and autonomy; however, in many countries it is underutilized. Studies that tested the effects of palliative care (PC) often included the rate of documented ACP as a secondary end point. We aimed to assess the contribution of PC to the rate of ACP among terminally ill patients by systematically reviewing relevant clinical trials.
METHOD
PUBMED and "Cochrane trials" databases were screened for clinical trials published until October 2017 that compared the addition of PC to standard treatment and that had ACP as a primary or a secondary end point. Studies were assessed for validity by three investigators using the Cochrane Collaboration tool and the ROBINS-I tool for randomized controlled trials (RCTs) and for cohort studies, respectively.
RESULTS
Twenty-six trials with 37,924 patients were included. Four were RCTs, nine were cohort studies, and 12 were cross-sectional studies. Randomized trials had the lowest risk of bias. There was a positive correlation between the addition of PC and ACP in 25 studies, among them four randomized trials.
SIGNIFICANCE OF RESULTS
In this systematic review, PC was associated with improvement in the rate of ACP. Understanding the significant effect of PC on the completion of ACP is an additional emphasis on the importance of this treatment among terminally ill patients.
Topics: Advance Care Planning; Correlation of Data; Humans; Palliative Care; Patient Acceptance of Health Care
PubMed: 31771672
DOI: 10.1017/S1478951519001068 -
BMC Psychiatry Apr 2019Increasing attention to palliative care for the general population has led to the development of various evidence-based or consensus-based tools and interventions....
BACKGROUND
Increasing attention to palliative care for the general population has led to the development of various evidence-based or consensus-based tools and interventions. However, specific tools and interventions are needed for people with severe mental illness (SMI) who have a life-threatening illness. The aim of this systematic review is to summarize the scientific evidence on tools and interventions in palliative care for this group.
METHODS
Systematic searches were done in the PubMed, Cochrane Library, CINAHL, PsycINFO and Embase databases, supplemented by reference tracking, searches on the internet with free text terms, and consultations with experts to identify relevant literature. Empirical studies with qualitative, quantitative or mixed-methods designs concerning tools and interventions for use in palliative care for people with SMI were included. Methodological quality was assessed using a critical appraisal instrument for heterogeneous study designs. Stepwise study selection and the assessment of methodological quality were done independently by two review authors.
RESULTS
Four studies were included, reporting on a total of two tools and one multi-component intervention. One study concerned a tool to identify the palliative phase in patients with SMI. This tool appeared to be usable only in people with SMI with a cancer diagnosis. Furthermore, two related studies focused on a tool to involve people with SMI in discussions about medical decisions at the end of life. This tool was assessed as feasible and usable in the target group. One other study concerned the Dutch national Care Standard for palliative care, including a multi-component intervention. The Palliative Care Standard also appeared to be feasible and usable in a mental healthcare setting, but required further tailoring to suit this specific setting. None of the included studies investigated the effects of the tools and interventions on quality of life or quality of care.
CONCLUSIONS
Studies of palliative care tools and interventions for people with SMI are scarce. The existent tools and intervention need further development and should be tailored to the care needs and settings of these people. Further research is needed on the feasibility, usability and effects of tools and interventions for palliative care for people with SMI.
Topics: Decision Making; Humans; Mental Disorders; Mental Health; Palliative Care; Quality of Life; Randomized Controlled Trials as Topic; Social Support
PubMed: 30943927
DOI: 10.1186/s12888-019-2078-7