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Medicinal cannabis - has it found a place in palliative care? 药用大麻——它在姑息治疗中找到了一席之地吗?
IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-05 eCollection Date: 2024-01-01 DOI: 10.1177/26323524241273491
Janet R Hardy
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引用次数: 0
Palliative care in policy documents for adults with cancer and non-cancer diseases with potential palliative care needs: a document analysis. 有潜在姑息治疗需求的成人癌症和非癌症疾病政策文件中的姑息治疗:一项文件分析。
IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-03 eCollection Date: 2024-01-01 DOI: 10.1177/26323524241296145
Anna O'Sullivan, Linnéa Carling, Joakim Öhlén, Stina Nyblom, Anneli Ozanne, Ragnhild Hedman, Carl-Johan Fürst, Cecilia Larsdotter

Background: The inclusion of palliative care in policy has been encouraged internationally, and gradually implemented, including in Sweden. Care should be driven by policy; hence, examining how palliative care is included in national policy documents is paramount.

Objectives: This study aimed to examine how palliative care is included in national disease-specific policy documents for adults with chronic conditions, cancer and non-cancer, with potential palliative care needs.

Design: Document analysis.

Methods: A document analysis of Swedish policy documents for different disease-specific groups with severe chronic conditions, cancer and non-cancer, was performed. In total, 96 documents were analysed.

Results: How palliative care was included in the policy documents varied from mentioning the term without explanation to detailed discussion regarding palliative care practice. Such discussion encompassed several conceptualisations of palliative care: defined through authorities' definitions; as care of dying persons; integrated with disease-specific care and treatment; limited to disease-specific medical treatments or based on detail regarding certain key elements of palliative care such as specialised palliative care and end-of-life conversations.

Conclusion: There may be large variations in how palliative care is conceptualised in national disease-specific policy documents, as disclosed by this analysis of the Swedish case. Limiting palliative care to disease-specific medical treatments (most commonly palliative oncological treatments) or the care of dying persons limits its scope in ways contrary to current evidence supporting early integrated palliative care. The lack of palliative care recommendations adapted for each specific diagnosis indicates a gap in policy. To promote equal access to palliative care regardless of patients' diseases or medical conditions, the importance of how palliative care is included in national policy documents needs to be further acknowledged and discussed - with palliative care consistently included in such documents.

背景:国际上鼓励将姑息治疗纳入政策,并逐步实施,包括在瑞典。护理应由政策驱动;因此,研究如何将姑息治疗纳入国家政策文件至关重要。目的:本研究旨在探讨如何将姑息治疗纳入具有潜在姑息治疗需求的成人慢性病、癌症和非癌症患者的国家疾病特定政策文件。设计:文档分析。方法:对瑞典针对不同疾病特异性人群(癌症和非癌症)的政策文件进行文献分析。总共分析了96份文件。结果:姑息治疗纳入政策文件的方式各不相同,从提及姑息治疗一词而不作解释到对姑息治疗实践进行详细讨论。这样的讨论包含了姑息治疗的几个概念:通过当局的定义来定义;照顾垂死的人;结合特定疾病的护理和治疗;仅限于特定疾病的医学治疗或基于姑息治疗的某些关键要素的细节,如专门的姑息治疗和临终对话。结论:正如对瑞典病例的分析所揭示的那样,在国家疾病特定政策文件中如何概念化姑息治疗可能存在很大差异。将姑息治疗局限于特定疾病的医学治疗(最常见的是姑息性肿瘤治疗)或临终者的护理,限制了其范围,与目前支持早期综合姑息治疗的证据相反。缺乏针对每种具体诊断的姑息治疗建议表明政策存在差距。为了促进平等获得姑息治疗,无论患者的疾病或医疗状况如何,需要进一步承认和讨论如何将姑息治疗纳入国家政策文件的重要性,并始终将姑息治疗纳入此类文件。
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引用次数: 0
Focusing on life rather than illness: the lived experience of children with life-threatening and life-limiting conditions-a qualitative study. 关注生命而不是疾病:有生命威胁和生命限制条件的儿童的生活经历——一项定性研究。
IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-29 eCollection Date: 2024-01-01 DOI: 10.1177/26323524241301431
Trine Brun Kittelsen, Charlotte Castor, Anja Lee, Lisbeth Gravdal Kvarme, Anette Winger

Background: The perspectives of children with life-threatening or life-limiting (LT/LL) conditions have predominantly been conveyed through their parents rather than heard from the children themselves. Despite an increase in studies focusing on children's perspectives in pediatric palliative care, this research remains limited, particularly in including children who are unable to express themselves orally.

Objective: This study seeks to address gaps in existing knowledge, especially the limited inclusion of children's perspectives and the exclusion of children with communicative and cognitive disabilities. The aim of this study was to explore the lived experiences of children living with LT/LL conditions.

Design: The study has a qualitative, hermeneutic phenomenological design inspired by van Manen's phenomenology of practice.

Methods: Twelve children with cancer or genetic conditions participated. Due to the children's varying cognitive and communicative abilities, multiple data collection methods were employed to capture the children's perspectives, including interviews, interactions, descriptions of the children's non-verbal expressions, and an adapted photo elicitation method. Data were analyzed using thematic analysis.

Results: The findings showed that the children's attention revolved around life rather than illness. The analysis revealed the presence of three themes: wanting to engage in life, being dependent on familiar relations, and the importance of cherished items.

Conclusion: Professionals across various levels within pediatric palliative care should acknowledge children's desire to engage in life despite serious illness and facilitate participation. Practices should be implemented to support children's agencies and expressions of what is important to them. This recognition can guide care plans and interventions at all levels of pediatric palliative care when a child is living with an LT/LL condition. The study emphasizes that children with LT/LL conditions are children first and foremost, with a fundamental need to participate in meaningful activity, just like any other child.

背景:对危及生命或限制生命(LT/LL)的儿童的看法主要是通过他们的父母传达,而不是从孩子自己那里听到的。尽管关注儿童在儿童姑息治疗中的观点的研究有所增加,但这项研究仍然有限,特别是在包括无法口头表达自己的儿童方面。目的:本研究旨在解决现有知识的差距,特别是对儿童观点的有限纳入和对交流和认知障碍儿童的排斥。本研究的目的是探讨生活在LT/LL条件下的儿童的生活经历。设计:该研究具有定性的、解释学的现象学设计,灵感来自范·马南的实践现象学。方法:12名患有癌症或遗传疾病的儿童参与研究。由于儿童的认知和沟通能力不同,我们采用了多种数据收集方法来捕捉儿童的观点,包括访谈,互动,描述儿童的非语言表达,以及适应的照片启发法。数据采用专题分析进行分析。结果:研究结果表明,孩子们的注意力集中在生活上,而不是疾病上。分析揭示了三个主题的存在:想要参与生活,依赖熟悉的关系,以及珍惜物品的重要性。结论:在儿童姑息治疗中,各级专业人员应该承认儿童在身患重病的情况下参与生活的愿望,并促进其参与。应当采取措施,支持儿童机构和对他们来说重要的东西的表达。当儿童患有LT/LL疾病时,这种认识可以指导各级儿科姑息治疗的护理计划和干预措施。该研究强调,患有LT/LL疾病的儿童首先是儿童,与其他儿童一样,他们有参与有意义活动的基本需求。
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引用次数: 0
Financial cost of end-of-life cancer care in palliative care units (PCUs) and non-PCUs in Iran: insights from low- and middle-income countries. 伊朗姑息治疗单位和非姑息治疗单位临终癌症治疗的财务成本:来自低收入和中等收入国家的见解
IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-28 eCollection Date: 2024-01-01 DOI: 10.1177/26323524241299819
Ali Darrudi, Amir Hossein Poupak, Rajabali Darroudi, Nasrin Sargazi, Kazem Zendehdel, Libby Sallnow, Ali Ghanbari Motlagh, Mamak Tahmasebi, Azin Nahvijou

Background: End-of-life care for patients with advanced cancer can impose a significant financial burden. However, data on the economic impact of end-of-life care in low- and middle-income countries are limited.

Objective: This study aims to compare the costs associated with palliative care units (PCUs) and non-PCU settings for cancer patients in Iran.

Design: We designed a retrospective study at the largest hospital in the country.

Methods: We conducted a comprehensive evaluation of hospitalization costs and care service delivery for 150 patients in the final 5 days of life, who were admitted to the largest hospital complex in Iran. All costs were adjusted based on the 2018 USD exchange rate.

Results: Among the 150 patients included in the study, 56 (37%) were admitted to the PCU. The average total treatment cost during the final 5 days of life was three times higher in general wards compared to PCUs. In non-PCU settings, the total cost of care during this period amounted to $2873, while in PCU settings, it was $909.63.

Conclusion: The establishment of PCUs within tertiary hospitals and the provision of palliative consultation services to patients with advanced cancer can yield significant benefits, even when resources are limited.

背景:晚期癌症患者的临终关怀会带来巨大的经济负担。然而,关于低收入和中等收入国家临终关怀的经济影响的数据有限。目的:本研究旨在比较伊朗癌症患者与姑息治疗单位(pcu)和非pcu设置相关的成本。设计:我们在国内最大的医院设计了一项回顾性研究。方法:我们对伊朗最大的综合医院收治的150例患者在生命最后5天的住院费用和护理服务提供进行了综合评估。所有费用均根据2018年美元汇率进行调整。结果:纳入研究的150例患者中,56例(37%)入住PCU。普通病房在生命最后5天的平均总治疗费用是icu的3倍。在非PCU设置中,在此期间的护理总费用为2873美元,而在PCU设置中,则为909.63美元。结论:在资源有限的情况下,在三级医院建立pcu,为晚期癌症患者提供姑息咨询服务,可以产生显著的效益。
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引用次数: 0
Optimizing palliative care education nationwide: a practice example from The Netherlands. 在全国范围内优化姑息关怀教育:荷兰的实践范例。
IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-20 eCollection Date: 2024-01-01 DOI: 10.1177/26323524241298288
Ingrid van Zuilekom, Jojanneke Thiesen-van Staveren, Marijke Dericks-Issing, Marieke van den Brand, Harmieke van Os-Medendorp, Suzanne Metselaar

Background: Every healthcare professional (HCP) in the Netherlands is expected to provide palliative care based on their initial education. This requires national consensus and clarity on the quality and goals of palliative care education and accessible education opportunities nationwide. These requirements were not met in the Netherlands, posing a major obstacle to improving the organization and delivery of palliative care. Therefore, a program, Optimizing Education and Training in Palliative Care (O2PZ), was established to improve palliative care education on a national level.

Objectives: The main task of the O2PZ program from 2018 to 2021 was to implement and improve palliative care education in initial education for nursing and medical professionals. The program's ultimate goal was that every HCP be sufficiently educated to provide high-quality generalist palliative care.

Design: The O2PZ program consists of four projects to improve and consolidate generalist palliative care education nationwide.

Methods: All projects used a participatory approach, that is, participatory development, implementation, and co-creation with stakeholders, mainly HCPs and education developers. Appreciative inquiry was used to assess, improve, and integrate existing local palliative care education initiatives.

Results: (1) Establishment of an Education Framework for palliative care for all HCPs, including an interprofessional collaboration model; (2) optimization of palliative care education in the (initial) curricula of vocational education institutions and (applied) universities; (3) establishment of an online platform to disseminate materials to improve palliative care education; and (4) installment of seven regional palliative care education hubs, of which one hub was devoted to pediatric palliative care, as well as one national hub.

Discussion: We discuss some lessons learned and challenges in accomplishing the goals of the O2PZ program in 2018-2021 and address how these challenges were dealt with. We maintain that co-creation with stakeholders at policy, organizational, and operational levels, as well as ongoing communication and collaboration, is essential to consolidating and implementing results.

Conclusion: Over the past 4 years, we have improved generalist palliative care education nationwide for all HCPs through four projects in which we collaborated closely with stakeholders. This has resulted in more attention to and implementation of palliative care in education, a national Education Framework for palliative care, including an interprofessional collaboration model, an online platform for palliative care education, and palliative care education hubs covering all regions of the Netherlands.

背景:在荷兰,每一位医疗保健专业人员(HCP)都应根据其初始教育提供姑息关怀服务。这需要就姑息关怀教育的质量和目标达成全国性共识和明确规定,并在全国范围内提供可获得的教育机会。荷兰并没有达到这些要求,这对改善姑息关怀的组织和提供构成了重大障碍。因此,荷兰制定了一项名为 "优化姑息关怀教育与培训"(Optimizing Education and Training in Palliative Care,O2PZ)的计划,以改善全国范围内的姑息关怀教育:2018年至2021年,O2PZ计划的主要任务是在护理和医疗专业人员的初始教育中实施并改进姑息关怀教育。该计划的最终目标是让每一位卫生保健人员都能接受充分的教育,以提供高质量的全科姑息关怀:O2PZ计划由四个项目组成,旨在改善和巩固全国范围内的全科姑息关怀教育:所有项目均采用参与式方法,即参与式开发、实施,以及与利益相关者(主要是姑息关怀医生和教育开发人员)共同创造。采用欣赏式探究来评估、改进和整合当地现有的姑息关怀教育项目。结果:(1) 为所有卫生保健人员建立了姑息关怀教育框架,包括跨专业合作模式;(2) 优化了职业教育机构和(应用型)大学(初始)课程中的姑息关怀教育;(3) 建立了一个在线平台,用于传播改善姑息关怀教育的材料;(4) 建立了七个地区姑息关怀教育中心,其中一个中心专门针对儿童姑息关怀,还有一个国家中心:我们讨论了在 2018-2021 年实现 O2PZ 计划目标过程中的一些经验教训和挑战,并阐述了如何应对这些挑战。我们坚持认为,与政策、组织和业务层面的利益相关方共同创造,以及持续的沟通与合作,对于巩固和落实成果至关重要:在过去的 4 年中,我们通过与利益相关者密切合作的四个项目,在全国范围内改善了针对所有医护人员的姑息关怀通才教育。这使得姑息关怀在教育中得到了更多的关注和实施,建立了包括跨专业合作模式在内的国家姑息关怀教育框架、姑息关怀教育在线平台以及覆盖荷兰所有地区的姑息关怀教育中心。
{"title":"Optimizing palliative care education nationwide: a practice example from The Netherlands.","authors":"Ingrid van Zuilekom, Jojanneke Thiesen-van Staveren, Marijke Dericks-Issing, Marieke van den Brand, Harmieke van Os-Medendorp, Suzanne Metselaar","doi":"10.1177/26323524241298288","DOIUrl":"10.1177/26323524241298288","url":null,"abstract":"<p><strong>Background: </strong>Every healthcare professional (HCP) in the Netherlands is expected to provide palliative care based on their initial education. This requires national consensus and clarity on the quality and goals of palliative care education and accessible education opportunities nationwide. These requirements were not met in the Netherlands, posing a major obstacle to improving the organization and delivery of palliative care. Therefore, a program, Optimizing Education and Training in Palliative Care (O<sup>2</sup>PZ), was established to improve palliative care education on a national level.</p><p><strong>Objectives: </strong>The main task of the O<sup>2</sup>PZ program from 2018 to 2021 was to implement and improve palliative care education in initial education for nursing and medical professionals. The program's ultimate goal was that every HCP be sufficiently educated to provide high-quality generalist palliative care.</p><p><strong>Design: </strong>The O<sup>2</sup>PZ program consists of four projects to improve and consolidate generalist palliative care education nationwide.</p><p><strong>Methods: </strong>All projects used a participatory approach, that is, participatory development, implementation, and co-creation with stakeholders, mainly HCPs and education developers. Appreciative inquiry was used to assess, improve, and integrate existing local palliative care education initiatives.</p><p><strong>Results: </strong>(1) Establishment of an Education Framework for palliative care for all HCPs, including an interprofessional collaboration model; (2) optimization of palliative care education in the (initial) curricula of vocational education institutions and (applied) universities; (3) establishment of an online platform to disseminate materials to improve palliative care education; and (4) installment of seven regional palliative care education hubs, of which one hub was devoted to pediatric palliative care, as well as one national hub.</p><p><strong>Discussion: </strong>We discuss some lessons learned and challenges in accomplishing the goals of the O<sup>2</sup>PZ program in 2018-2021 and address how these challenges were dealt with. We maintain that co-creation with stakeholders at policy, organizational, and operational levels, as well as ongoing communication and collaboration, is essential to consolidating and implementing results.</p><p><strong>Conclusion: </strong>Over the past 4 years, we have improved generalist palliative care education nationwide for all HCPs through four projects in which we collaborated closely with stakeholders. This has resulted in more attention to and implementation of palliative care in education, a national Education Framework for palliative care, including an interprofessional collaboration model, an online platform for palliative care education, and palliative care education hubs covering all regions of the Netherlands.</p>","PeriodicalId":36693,"journal":{"name":"Palliative Care and Social Practice","volume":"18 ","pages":"26323524241298288"},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Integrating patient-centred and tumour-centred cancer care: the EU-MyPath implementation project offers an innovative digital solution with care pathways. 整合以患者为中心和以肿瘤为中心的癌症护理:欧盟--MyPath 实施项目为护理路径提供了创新的数字化解决方案。
IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-19 eCollection Date: 2024-01-01 DOI: 10.1177/26323524241296143
Anne-Lore Scherrens, An Jacobs, Kim Beernaert, Koen Pardon, Eveline Raemdonck, Marie Fallon, Kathrin Cresswell, Nusa Faric, Robin Williams, Tonje Lundeby, Marianne J Hjermstad, Luc Deliens, Stein Kaasa

Cancer is one of the leading causes of mortality, with new cases expected to rise. Medical advances increase cure rates and prolong patient lives, but survivorship involves high symptom burden, loss of function and emotional distress. Improving patient-centred care (PCC) and quality of life throughout the care process is essential. Key to this improvement are systematic use of patient-reported outcome measures (PROMs) and patient-centred care pathways (PCCPs). Despite established benefits, current cancer care focuses on tumour-centred care approaches often neglecting the patient perspective. Evidence-based PCC guidelines fail to be routinely incorporated into clinical practices. The Horizon 2020-funded European MyPath project aims to address these gaps by developing, implementing and evaluating digital PCCPs with PROMs. MyPath will be tailored to enhance the organisational contexts of cancer centres across Europe through the application of implementation science strategies. This paper describes the current state of applying PCC in routine cancer care and presents a forward-looking perspective on how the MyPath project can successfully adopt and implement digital PROMs across countries. A literature search was conducted to provide the state-of-the art.

癌症是导致死亡的主要原因之一,预计新发病例还会增加。医疗技术的进步提高了治愈率,延长了患者的生命,但患者的生存期涉及到高症状负担、功能丧失和情绪困扰。在整个护理过程中,改善以患者为中心的护理(PCC)和生活质量至关重要。改善的关键在于系统地使用患者报告的结果测量(PROMs)和以患者为中心的护理路径(PCCPs)。尽管已经证实了以患者为中心的护理路径的益处,但目前的癌症护理主要集中在以肿瘤为中心的护理方法上,往往忽视了患者的观点。以证据为基础的患者为中心护理路径指南未能被常规纳入临床实践。由地平线 2020 项目资助的欧洲 MyPath 项目旨在通过开发、实施和评估带有 PROMs 的数字化 PCCP 来弥补这些不足。MyPath 项目将通过应用实施科学策略来改善欧洲癌症中心的组织环境。本文介绍了在常规癌症治疗中应用 PCC 的现状,并就 MyPath 项目如何在各国成功采用和实施数字化 PROM 提出了前瞻性观点。我们进行了文献检索,以了解最新进展。
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引用次数: 0
The Professional Guest: conceptualizing home visits in palliative care settings. 专业访客:姑息关怀环境中家访的概念化。
IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-17 eCollection Date: 2024-01-01 DOI: 10.1177/26323524241293821
Ron Sabar, Inbal Halevi Hochwald, Moran Weiss, Gila Yakov

Background: Home-based palliative care is a growing trend, necessitating a deeper understanding of the unique challenges faced by professional staff members in this setting. The shift to home-based care has been driven by advances in technology, changing demographics, and a move toward more patient-centered approaches. As a care setting, the home environment offers distinct characteristics, presenting both advantages and drawbacks for patients and healthcare providers.

Objectives: This study aims to explore the experiences and perceptions of professional staff members providing palliative care in patients' homes.

Design: A qualitative descriptive study.

Methods: Qualitative study with 36 home-based hospice professionals using questionnaires and interviews. Thematic analysis identified key themes in staff experiences and challenges.

Results: The central theme of "The Professional Guest" highlights the hybrid identity and boundary role professional staff members must navigate, being both medical professionals and guests in the patient's domain. Four sub-themes emerged: (1) Observing and Applying, emphasizing the conscious scanning of the home environment to build trust and tailor care plans; (2) Asking for Permission, respecting the patient's territory and adapting to their norms; (3) Expecting the Unexpected, maintaining flexibility and improvising in unfamiliar situations; and (4) Preparing the Ground for Your Absence, equipping patients and families with comprehensive self-care guidance during professional staff members' absences.

Conclusion: The "Professional Guest" phenomenon captures the complexities of providing care in patient's homes, necessitating a delicate balance between professionalism and personal vulnerability. Specialized training programs and policies should be developed to support professional staff members in navigating this hybrid identity and effectively negotiating the boundaries between professional and personal spheres.

背景:居家姑息关怀是一种日益增长的趋势,因此有必要深入了解专业工作人员在这种环境中所面临的独特挑战。向居家姑息关怀转变的动力来自于技术的进步、人口结构的变化以及更加以病人为中心的护理方式。作为一种护理环境,家庭环境具有鲜明的特点,对患者和医疗服务提供者来说既有利也有弊:本研究旨在探讨在患者家中提供姑息关怀的专业人员的经验和看法:设计:描述性定性研究:方法:对 36 名居家安宁疗护专业人员进行定性研究,采用问卷调查和访谈的方式。主题分析确定了员工经验和挑战中的关键主题:结果:"专业客人 "这一中心主题突出了专业工作人员必须驾驭的混合身份和边界角色,他们既是医疗专业人员,又是病人领域的客人。四个次主题分别是:(1)观察和应用,强调有意识地扫描家庭环境,以建立信任并定制护理计划;(2)请求允许,尊重患者的领地并适应他们的规范;(3)期待意外,在不熟悉的情况下保持灵活性并随机应变;以及(4)为你的缺席做好准备,在专业人员缺席期间为患者和家属提供全面的自我护理指导:专业客人 "现象反映了在病人家中提供护理服务的复杂性,需要在专业性和个人脆弱性之间取得微妙的平衡。应制定专门的培训计划和政策,支持专业人员驾驭这种混合身份,并有效协商专业领域与个人领域之间的界限。
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引用次数: 0
Medical influence: what does success look like? 医疗影响力:成功是什么样的?
IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-12 eCollection Date: 2024-01-01 DOI: 10.1177/26323524241297695
Diane Wintz, Kelly Wright, Kathryn B Schaffer

Background: Social media influencers have revolutionized information, gaining viewers, retention, and interest with short videos. Medical teams could potentially benefit from this medium for educating patients. Defining success in this endeavor remains unclear.

Objective: We are a surgeon-nurse team that sought to promote our messages on social media to gain viewers and interest in our website.

Design: An educational podcast focusing on end-of-life discussions was linked to social media platforms, including Instagram and TikTok, to gain views on our website.

Methods: Eleven podcast episodes were produced and published over a 3-month period, between November 2023 and January 2024. The podcast episodes were promoted to "similar clients" based on internal algorithms by a podcast streaming service, Spotify. The promotion provided by Spotify and website views were compared to responses evident by other social media posts.

Results: After 3 months of publishing podcast episodes on Spotify, with free publicity, our podcast gained 10,400 promotions, 486 listeners, 49 followers, and approximately 1200 random website views. In comparison, the podcast content garnered more than 50,000 video clip views on TikTok and Instagram, after funding these brief video promotions. TikTok and Instagram both charged $20 or more per promotion. Paid promotion opportunities resulted in no website visits or podcast followers.

Conclusion: Our own experience with social media promotion was inadequate in generating interest in our content. The authors would encourage other teams to be strategic with paid promotions and to consider engaging a marketing expert to improve the potential for mass interest in content and promotional efficiency. Additionally, based on these findings, the authors would appreciate more transparency in the algorithms behind successful promotions to better understand "what success looks like" for medical messaging.

背景:社交媒体上的 "有影响力的人 "为信息带来了革命性的变化,他们通过短视频赢得了观众、留存率和兴趣。医疗团队有可能从这种教育患者的媒介中获益。但成功的定义尚不明确:我们是一个外科医生护士团队,希望在社交媒体上推广我们的信息,以获得观众并对我们的网站产生兴趣:设计:将以生命末期讨论为重点的教育播客与社交媒体平台(包括 Instagram 和 TikTok)相链接,以获得我们网站的浏览量:方法:在 2023 年 11 月至 2024 年 1 月的 3 个月期间,制作并发布了 11 集播客。播客流媒体服务商 Spotify 根据内部算法将这些播客推广给 "类似客户"。将 Spotify 提供的推广和网站浏览量与其他社交媒体帖子的明显反应进行了比较:在 Spotify 上发布播客剧集并进行免费宣传 3 个月后,我们的播客获得了 10,400 次推广、486 位听众、49 位追随者和大约 1200 次随机网站浏览量。相比之下,在资助了这些简短的视频推广后,播客内容在 TikTok 和 Instagram 上获得了 50,000 多次视频剪辑浏览量。TikTok 和 Instagram 的每次推广费用都在 20 美元以上。付费推广机会没有带来任何网站访问量或播客追随者:我们在社交媒体推广方面的经验不足以引起人们对我们内容的兴趣。作者鼓励其他团队对付费推广采取战略性态度,并考虑聘请营销专家来提高大众对内容的兴趣潜力和推广效率。此外,基于这些发现,作者希望成功推广背后的算法更加透明,以便更好地了解医疗信息 "成功的样子"。
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引用次数: 0
Palliative care consultation in the last week of life and associated factors: a cross-sectional general population study. 生命最后一周的姑息关怀咨询及相关因素:一项普通人群横断面研究。
IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-08 eCollection Date: 2024-01-01 DOI: 10.1177/26323524241293818
Susanna Böling, Hanna Gyllensten, My Engström, Emma Lundberg, Johan Berlin, Joakim Öhlén

Background: Knowledge of access to palliative care services, such as palliative care consultation teams, is crucial to identify areas of improvement for policy and practice. Research on general populations spanning all disease groups and multiple healthcare contexts is needed.

Objective: The objective was to investigate the sociodemographic, disease- and care-related, and care structure-related factors associated with palliative care consultations for adult patients in the last week of life.

Design: Cross-sectional, general population-level study based on linked Swedish national public authority registers and a national palliative care quality register.

Methods: The study population included all adult patients deceased in Sweden between 2013 and 2019 and registered in the Swedish Register of Palliative Care, with an anticipated death, and not enrolled in specialised palliative care. Multivariable logistic regression analyses to investigate association with palliative care consultations.

Results: In total, 8.2% of the 265,129 participants had received a palliative care consultation in the last week of life. The main multivariable analysis (Model 1) showed that those dying from neoplasms were more likely to receive a palliative care consultation (odds ratio (OR) 8.55, 95% CI 8.15-8.98) than those dying from circulatory diseases. Palliative care consultation was more likely with an increasing number of symptoms (OR 1.35, CI 1.32-1.37). Patients of old age and patients deceased in hospitals were less likely to receive a palliative care consultation. Moreover, factors such as educational attainment, healthcare region, living in a single-person household, and year of death were also associated with a palliative care consultation in the last week of life.

Conclusion: Our findings show inequities in access to palliative care consultations in the last week of life. Considering changes to policy and clinical practice is motivated.

背景:了解姑息关怀服务(如姑息关怀咨询团队)的可及性对于确定政策和实践的改进领域至关重要。需要对跨越所有疾病群体和多种医疗环境的普通人群进行研究:目的:调查与成年患者生命最后一周的姑息关怀咨询相关的社会人口学、疾病和护理相关以及护理结构相关因素:设计:基于瑞典国家公共机构登记簿和国家姑息治疗质量登记簿的横断面普通人群研究:研究人群包括2013年至2019年期间在瑞典死亡、在瑞典姑息治疗登记册上登记的所有成年患者,这些患者预计会死亡,且未参加专门的姑息治疗。通过多变量逻辑回归分析研究与姑息治疗咨询的关联:在 265 129 名参与者中,共有 8.2% 的人在生命的最后一周接受过姑息关怀咨询。主要的多变量分析(模型1)显示,与循环系统疾病患者相比,死于肿瘤的患者更有可能接受姑息关怀咨询(几率比(OR)8.55,95% CI 8.15-8.98)。症状越多,接受姑息治疗咨询的可能性越大(OR 1.35,CI 1.32-1.37)。老年患者和在医院去世的患者接受姑息治疗咨询的可能性较低。此外,教育程度、医疗保健地区、居住在单人家庭以及死亡年份等因素也与生命最后一周接受姑息关怀咨询有关:我们的研究结果表明,在生命的最后一周,获得姑息关怀咨询的机会并不平等。考虑改变政策和临床实践是有积极意义的。
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引用次数: 0
Using relational ethics to approach equity in palliative care. 在姑息关怀中运用关系伦理来实现公平。
IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-07 eCollection Date: 2024-01-01 DOI: 10.1177/26323524241293820
Kristina A Smith, Kelli Stajduhar

Evidence suggests that people experiencing inequities and who are highly marginalized (e.g., people impacted by racism, sexism, discrimination, stigma, mental illness, substance use issues, disability, and the effects of homelessness; also referred to as structurally vulnerable individuals) often die alone, in pain, and not receiving the care they need. Some research even points to highly marginalized people not feeling worthy of care. The need to consider equity in the context of palliative care has recently emerged but little attention has been paid to how ethical decision-making generally, and relational ethics, specifically, could provide guidance in the care of highly marginalized people who are on a palliative trajectory. Relational ethics offers a model of care and decision-making framework that emphasizes how clients, healthcare providers, and larger social structures are interwoven and acknowledge that structural conditions can position people to have less choice than others. Relational approaches in the context of palliative care for highly marginalized people have the potential to provide a lens to better support the delivery of equitable palliative care. This critical essay explores relational ethics as a way to approach equity in palliative care to support clients facing structural vulnerabilities. We discuss relational ethical considerations to approach collaborative partnerships between clients, healthcare providers, and the larger community with the goal of aligning care with clients' values. An ethical case for how a relational ethics approach might be used to promote equitable access to palliative care will be explored, highlighting how such approaches have the potential to better align client wishes with their needs and to ensure decision-making and care delivery is trauma-informed, harm reduction focused, and culturally respectful. Relational ethics can support social change in equity and palliative care by contributing ethically informed ways of caring for/with/about highly marginalized people.

有证据表明,遭受不公平待遇和高度边缘化的人(例如,受种族主义、性别歧视、歧视、污名化、精神疾病、药物使用问题、残疾和无家可归影响的人;也被称为结构脆弱的个人)往往是在痛苦中孤独地死去,得不到他们需要的护理。一些研究甚至指出,高度边缘化的人群认为自己不值得被照顾。在姑息关怀的背景下考虑公平性的必要性最近已经出现,但很少有人关注伦理决策,特别是关系伦理学,如何为处于姑息关怀轨迹上的高度边缘化人群的关怀提供指导。关系伦理学提供了一种护理模式和决策框架,强调客户、医疗服务提供者和更大的社会结构是如何相互交织在一起的,并承认结构性条件会使人们比其他人拥有更少的选择权。在为高度边缘化人群提供姑息关怀的背景下,关系方法有可能为更好地支持提供公平的姑息关怀提供一个视角。这篇批判性文章探讨了关系伦理学,将其作为姑息关怀中实现公平的一种方法,以支持面临结构性弱势的服务对象。我们讨论了在客户、医疗服务提供者和更大的社区之间建立合作关系的关系伦理考虑因素,目的是使关怀符合客户的价值观。我们将探讨如何利用关系伦理学方法来促进公平地获得姑息关怀的伦理案例,强调这种方法如何有可能更好地将客户的愿望与他们的需求结合起来,并确保决策和关怀服务是以创伤为基础的、以减少伤害为重点的,以及在文化上受到尊重的。关系伦理学可以支持公平和姑息关怀方面的社会变革,为关怀高度边缘化人群提供符合伦理的方式。
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引用次数: 0
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Palliative Care and Social Practice
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