Pub Date : 2022-02-12DOI: 10.1080/09699260.2022.2035186
Jason Mills
The field of Public Health Palliative Care (PHPC) has grown significantly over the past 20 years, since the inception of health-promoting palliative care. While much has been developed and refined in terms of theoretical basis and practice methods, there is an increasing need to consider the research agenda and methods employed to evaluate outcomes and strengthen the evidence base for public health approaches to palliative and end-of-life care. In particular, promoting the participation of underserved and vulnerable populations and understanding the influence of power structures on their representation in research is imperative. Depending on congruence between epistemological orientation, methodological choices, and options in operationalisation, there is scope to complement traditional research methodologies with new public health approaches that are participatory and directly informed by communities’ lived experience, expressed needs, and aspirations for care. Community-based participatory research (CBPR) represents a prime example, and has been applied to the PHPC model of compassionate communities (referred to as ‘caring communities’ in German-speaking countries). In this context, Wegleitner and Schuchter 2 argue that an ecological health-promotion framework for action must be complemented by social experiential learning processes arising from the collective experiences and wisdom of community members. This and CBPR are consistent with recent literature on reimagining palliative care access through partnerships and community participation. Given the public health benefits of community development and relevance of intersectionality as a transformational paradigm to understand complexities and address power relations within a settings-based social model of health, recommendations have been made to include the prioritisation of active research involvement by patients and the wider public (outside of clinical contexts). Outside of this PHPC context, CBPR has been used to address inequities in access to palliative care and promote social justice for historically excluded groups; however, participatory engagement between clinical services and community groups alone—although helpful —may not be sustainable where it is not supported by societal infrastructure and broader policies that transcend diversity across communities to engage common participation from everyday citizens. Indeed, a wellknown challenge relating to CBPR has been to ground it in a relevant social movement theoretical model for change. Based on the WHO Healthy Cities model, the Compassionate Cities movement is an example of a civic programme that has been implemented across cities worldwide. The Compassionate City Charter also forms a key component of Abel and colleagues’ new essentials public health model of palliative care, encapsulating: (1) Civic programmes; (2) Compassionate Communities; (3) Generalist Palliative Care; and (4) Specialist Palliative Care. Thus CBPR can usefully
{"title":"Community-based participatory research and Public Health Palliative Care","authors":"Jason Mills","doi":"10.1080/09699260.2022.2035186","DOIUrl":"https://doi.org/10.1080/09699260.2022.2035186","url":null,"abstract":"The field of Public Health Palliative Care (PHPC) has grown significantly over the past 20 years, since the inception of health-promoting palliative care. While much has been developed and refined in terms of theoretical basis and practice methods, there is an increasing need to consider the research agenda and methods employed to evaluate outcomes and strengthen the evidence base for public health approaches to palliative and end-of-life care. In particular, promoting the participation of underserved and vulnerable populations and understanding the influence of power structures on their representation in research is imperative. Depending on congruence between epistemological orientation, methodological choices, and options in operationalisation, there is scope to complement traditional research methodologies with new public health approaches that are participatory and directly informed by communities’ lived experience, expressed needs, and aspirations for care. Community-based participatory research (CBPR) represents a prime example, and has been applied to the PHPC model of compassionate communities (referred to as ‘caring communities’ in German-speaking countries). In this context, Wegleitner and Schuchter 2 argue that an ecological health-promotion framework for action must be complemented by social experiential learning processes arising from the collective experiences and wisdom of community members. This and CBPR are consistent with recent literature on reimagining palliative care access through partnerships and community participation. Given the public health benefits of community development and relevance of intersectionality as a transformational paradigm to understand complexities and address power relations within a settings-based social model of health, recommendations have been made to include the prioritisation of active research involvement by patients and the wider public (outside of clinical contexts). Outside of this PHPC context, CBPR has been used to address inequities in access to palliative care and promote social justice for historically excluded groups; however, participatory engagement between clinical services and community groups alone—although helpful —may not be sustainable where it is not supported by societal infrastructure and broader policies that transcend diversity across communities to engage common participation from everyday citizens. Indeed, a wellknown challenge relating to CBPR has been to ground it in a relevant social movement theoretical model for change. Based on the WHO Healthy Cities model, the Compassionate Cities movement is an example of a civic programme that has been implemented across cities worldwide. The Compassionate City Charter also forms a key component of Abel and colleagues’ new essentials public health model of palliative care, encapsulating: (1) Civic programmes; (2) Compassionate Communities; (3) Generalist Palliative Care; and (4) Specialist Palliative Care. Thus CBPR can usefully ","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"67 - 68"},"PeriodicalIF":1.7,"publicationDate":"2022-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48675982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-20DOI: 10.1080/09699260.2021.2021371
D. Rawlings, L. Miller-Lewis, J. Tieman
A Dying2learn Massive Open Online Course (MOOC) was held in 2020 with the aim of bringing the community together to talk about death and dying, with participants undertaking activities, contributing comments, and sharing thoughts and feelings. An activity was posed for participants within a compassionate communities’ framework related to the Death Doula role. As we were interested in the views regarding the Death Doula role by those without a professional background in healthcare. We extracted comments from this cohort of course participants (n = 147) and analysed them in NVivo. Eight themes were subsequently generated: (1) It is new to me, and I have no experience with one, (2) I have heard of it, and I have met one, (3) There is a place for it, but what about the role of family and friends, (4) Death doula training, finding the role interesting and wanting to know more, (5) Creating community, supporting the dying and helping loved ones, (6) I am one, I do this informally, or I want to be one, (7) The name, the industry, paying someone (8) Providing an alternative and recognising similar roles. The Dying2Learn community MOOC participants felt that there was value in having a supportive role such as a Death Doula and that it had importance for individuals and society. It was also apparent that the Death Doula role generated considerable interest from participants.
{"title":"‘It’s like a wedding planner’: Dying2Learn Massive Open Online Course participants views of the Death Doula role","authors":"D. Rawlings, L. Miller-Lewis, J. Tieman","doi":"10.1080/09699260.2021.2021371","DOIUrl":"https://doi.org/10.1080/09699260.2021.2021371","url":null,"abstract":"A Dying2learn Massive Open Online Course (MOOC) was held in 2020 with the aim of bringing the community together to talk about death and dying, with participants undertaking activities, contributing comments, and sharing thoughts and feelings. An activity was posed for participants within a compassionate communities’ framework related to the Death Doula role. As we were interested in the views regarding the Death Doula role by those without a professional background in healthcare. We extracted comments from this cohort of course participants (n = 147) and analysed them in NVivo. Eight themes were subsequently generated: (1) It is new to me, and I have no experience with one, (2) I have heard of it, and I have met one, (3) There is a place for it, but what about the role of family and friends, (4) Death doula training, finding the role interesting and wanting to know more, (5) Creating community, supporting the dying and helping loved ones, (6) I am one, I do this informally, or I want to be one, (7) The name, the industry, paying someone (8) Providing an alternative and recognising similar roles. The Dying2Learn community MOOC participants felt that there was value in having a supportive role such as a Death Doula and that it had importance for individuals and society. It was also apparent that the Death Doula role generated considerable interest from participants.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"281 - 287"},"PeriodicalIF":1.7,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47575034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-02DOI: 10.1080/09699260.2022.2001140
A. C. M. Garcia, L. O. Maia
The healthcare field and society at large are witnessing a resurgence of interest in the effects and applications of psychedelic therapies in a wide range of settings. In the 1950s and 1960s, research was conducted to explore different applications for psychedelics, such as lysergic acid diethylamide (LSD) and mescaline, in the healthcare setting. However, psychedelic research was dramatically reduced in the 1970s due to regulatory, political, and social issues. With the resumption of studies involving psychedelics mostly since the 2000s, several studies have been conducted in order to investigate the therapeutic potential of these substances, including in patients with serious diseases. Psychedelics, formerly known as ‘hallucinogens,’ are substances that elicit changes in perception, cognition, emotion and may also evoke peak or mystical experiences. Based on their pharmacological profiles, psychedelics can be classified into four classes: 1) classic psychedelics (serotonin 2A receptor agonists, e.g., LSD, psilocybin, dimethyltryptamine [DMT], mescaline); 2) empathogens or entactogens (mixed serotonin and dopamine reuptake inhibitors and releasers such as methylenedioxymethamphetamine [MDMA]); 3) dissociative anaesthetic agents (glutamate receptors antagonists such as ketamine); and 4) atypical psychedelics (diverse mechanisms of action, e.g., ibogaine, tetrahydrocannabinol [THC], salvinorin A). Most of these compounds are found – or are similar to chemical compounds found – in plants or fungi that have been used for millennia in traditional spiritual or folk healing rituals. Primarily in the fields of hospice and palliative care, assisted psychedelic therapies have been investigated as a potential novel therapeutic modality due to preliminary evidence suggesting their profound impact on psychological, existential, and spiritual outcomes in patients with serious diseases. Results indicate that psychedelic experiences, in a controlled setting, can catalyze psychological processes associated with illness and fear of death, promoting therapeutic effects that impact the physical, mental, and spiritual spheres – thus representing a possible therapeutic tool for providing care to critically ill patients. In a recent interview, Dr. Anthony Bossis, clinical psychologist and clinical assistant professor of psychiatry at New York University School of Medicine, a scientist working in the field of palliative care and psychedelic therapies, states that one of the insights that many psychedelic research volunteers shared is that by turning emotionally toward fear and feelings regarding their death, they often felt less anxiety, more compassion, love for themselves and others, and nurtured new insights. While it can be a challenging experience, by turning to grief, they spoke of experiencing greater acceptance and openness to the mystery of death. In doing so, they reported being able to live more wholeheartedly in the present moment. Taken together, these pot
{"title":"The therapeutic potential of psychedelic substances in Hospice and Palliative Care","authors":"A. C. M. Garcia, L. O. Maia","doi":"10.1080/09699260.2022.2001140","DOIUrl":"https://doi.org/10.1080/09699260.2022.2001140","url":null,"abstract":"The healthcare field and society at large are witnessing a resurgence of interest in the effects and applications of psychedelic therapies in a wide range of settings. In the 1950s and 1960s, research was conducted to explore different applications for psychedelics, such as lysergic acid diethylamide (LSD) and mescaline, in the healthcare setting. However, psychedelic research was dramatically reduced in the 1970s due to regulatory, political, and social issues. With the resumption of studies involving psychedelics mostly since the 2000s, several studies have been conducted in order to investigate the therapeutic potential of these substances, including in patients with serious diseases. Psychedelics, formerly known as ‘hallucinogens,’ are substances that elicit changes in perception, cognition, emotion and may also evoke peak or mystical experiences. Based on their pharmacological profiles, psychedelics can be classified into four classes: 1) classic psychedelics (serotonin 2A receptor agonists, e.g., LSD, psilocybin, dimethyltryptamine [DMT], mescaline); 2) empathogens or entactogens (mixed serotonin and dopamine reuptake inhibitors and releasers such as methylenedioxymethamphetamine [MDMA]); 3) dissociative anaesthetic agents (glutamate receptors antagonists such as ketamine); and 4) atypical psychedelics (diverse mechanisms of action, e.g., ibogaine, tetrahydrocannabinol [THC], salvinorin A). Most of these compounds are found – or are similar to chemical compounds found – in plants or fungi that have been used for millennia in traditional spiritual or folk healing rituals. Primarily in the fields of hospice and palliative care, assisted psychedelic therapies have been investigated as a potential novel therapeutic modality due to preliminary evidence suggesting their profound impact on psychological, existential, and spiritual outcomes in patients with serious diseases. Results indicate that psychedelic experiences, in a controlled setting, can catalyze psychological processes associated with illness and fear of death, promoting therapeutic effects that impact the physical, mental, and spiritual spheres – thus representing a possible therapeutic tool for providing care to critically ill patients. In a recent interview, Dr. Anthony Bossis, clinical psychologist and clinical assistant professor of psychiatry at New York University School of Medicine, a scientist working in the field of palliative care and psychedelic therapies, states that one of the insights that many psychedelic research volunteers shared is that by turning emotionally toward fear and feelings regarding their death, they often felt less anxiety, more compassion, love for themselves and others, and nurtured new insights. While it can be a challenging experience, by turning to grief, they spoke of experiencing greater acceptance and openness to the mystery of death. In doing so, they reported being able to live more wholeheartedly in the present moment. Taken together, these pot","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"1 - 3"},"PeriodicalIF":1.7,"publicationDate":"2022-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45347202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.1080/09699260.2021.1988311
Madelena Arnone, Lynn Grandmaison Dumond, N. Yazdani, Rayan El-Baroudi, Annie Pouliot, S. Modanloo
Abstract This study aimed to explore grandparents’ experiences of grief after the death of a grandchild, their perception of socially supportive behavior as well as their satisfaction with a bereavement support care. A six-session bereavement support group was implemented, followed by a cross-sectional survey with open-ended questions. The death happened mostly in the last 2 years (26, 90%). The findings revealed the presence of grief (mean score of 67, SD 13) and existing perception of socially supportive behaviors (mean score of 79, SD 23) after participation in the bereavement group. The thematic analysis showed three themes of ‘We are feeling it; There are ways to heal and return to a different normal; We want to help our family’. This study adds to the existing literature about the experience of grandparents coping with grief, explores some of their challenges, and needs after the death of a grandchild.
{"title":"Evaluation of a grandparent bereavement support group in a Pediatric Palliative Care Hospice","authors":"Madelena Arnone, Lynn Grandmaison Dumond, N. Yazdani, Rayan El-Baroudi, Annie Pouliot, S. Modanloo","doi":"10.1080/09699260.2021.1988311","DOIUrl":"https://doi.org/10.1080/09699260.2021.1988311","url":null,"abstract":"Abstract This study aimed to explore grandparents’ experiences of grief after the death of a grandchild, their perception of socially supportive behavior as well as their satisfaction with a bereavement support care. A six-session bereavement support group was implemented, followed by a cross-sectional survey with open-ended questions. The death happened mostly in the last 2 years (26, 90%). The findings revealed the presence of grief (mean score of 67, SD 13) and existing perception of socially supportive behaviors (mean score of 79, SD 23) after participation in the bereavement group. The thematic analysis showed three themes of ‘We are feeling it; There are ways to heal and return to a different normal; We want to help our family’. This study adds to the existing literature about the experience of grandparents coping with grief, explores some of their challenges, and needs after the death of a grandchild.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"75 - 82"},"PeriodicalIF":1.7,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47830427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-08DOI: 10.1080/09699260.2021.2005756
Abbey Frame, J. B. Grant, E. Layard, Brett Scholz, E. Law, K. Ranse, I. Mitchell, M. Chapman
End-of-life care involves treatment and support offered to terminally ill individuals and their caregivers. Effective communication and decision-making, illness and symptom management, relationship with doctors, characteristics of the health care team, and the involvement and needs of caregivers have all been proposed to contribute to the quality of the end-of-life experience. This study sought to establish bereaved caregivers’ experiences of the quality of the elements of end-of-life care delivered to their loved ones. Bereaved caregivers who had lost a loved one who was cared for in an acute care University-affiliated hospital, with 670 beds, located in the Australian Capital Territory during the previous 6−12 months (N=91), were surveyed using a modified version of the Canadian Health Care Evaluation Project questionnaire. The findings indicated that the bereaved caregivers were generally very satisfied with their loved one’s end-of-life care. The age of the caregiver, the preferred location of death for both patient and caregiver, if death was expected, and religious affiliation were associated with satisfaction of the end-of-life care delivered. Key areas for improvement of end-of-life care included factors related to the relationships between doctors and those receiving care, characteristics of the health care team, illness management, communication and decision-making, and the involvement of caregivers. These findings have significant implications for this hospital and those seeking to improve outcomes in end-of-life care settings more widely, by providing baseline data on caregiver-evaluated care quality and identifying high-priority areas for targeted intervention.
{"title":"Bereaved caregivers’ satisfaction with end-of-life care","authors":"Abbey Frame, J. B. Grant, E. Layard, Brett Scholz, E. Law, K. Ranse, I. Mitchell, M. Chapman","doi":"10.1080/09699260.2021.2005756","DOIUrl":"https://doi.org/10.1080/09699260.2021.2005756","url":null,"abstract":"End-of-life care involves treatment and support offered to terminally ill individuals and their caregivers. Effective communication and decision-making, illness and symptom management, relationship with doctors, characteristics of the health care team, and the involvement and needs of caregivers have all been proposed to contribute to the quality of the end-of-life experience. This study sought to establish bereaved caregivers’ experiences of the quality of the elements of end-of-life care delivered to their loved ones. Bereaved caregivers who had lost a loved one who was cared for in an acute care University-affiliated hospital, with 670 beds, located in the Australian Capital Territory during the previous 6−12 months (N=91), were surveyed using a modified version of the Canadian Health Care Evaluation Project questionnaire. The findings indicated that the bereaved caregivers were generally very satisfied with their loved one’s end-of-life care. The age of the caregiver, the preferred location of death for both patient and caregiver, if death was expected, and religious affiliation were associated with satisfaction of the end-of-life care delivered. Key areas for improvement of end-of-life care included factors related to the relationships between doctors and those receiving care, characteristics of the health care team, illness management, communication and decision-making, and the involvement of caregivers. These findings have significant implications for this hospital and those seeking to improve outcomes in end-of-life care settings more widely, by providing baseline data on caregiver-evaluated care quality and identifying high-priority areas for targeted intervention.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"212 - 220"},"PeriodicalIF":1.7,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43193745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-01Epub Date: 2019-11-11DOI: 10.1177/1524838019882357
Danielle Stephens-Lewis, Amy Johnson, Alyson Huntley, Elizabeth Gilchrist, Mary McMurran, Juliet Henderson, Gene Feder, Louise M Howard, Gail Gilchrist
Introduction: Despite the high prevalence of intimate partner violence (IPV) perpetration by men who use substances, limited evidence exists about how best to reduce IPV among this group.
Method: A systematic narrative review with meta-analysis determined the effectiveness of interventions to reduce IPV by men who use substances. Inclusion criteria were randomized and nonrandomized controlled trials; adult heterosexual male IPV perpetrators where at least 60% of participants were alcohol and/or drug users; the intervention targeted IPV with or without targeting substance use (SU); outcomes included perpetrator and/or victim reports of IPV, SU, or both. Methodological quality was assessed.
Results: Nine trials (n = 1,014 men) were identified. Interventions were grouped into (1) integrated IPV and SU interventions (n = 5), (2) IPV interventions with adjunct SU interventions (n = 2), and (3) stand-alone IPV interventions (n = 2). Cognitive behavioral and motivational interviewing therapies were the most common approaches. Data from individual trials showed a reduction in SU outcomes in the short term (≤3months; n = 2 trials) and IPV perpetration at different time points (n = 3 trials) for interventions compared with treatment as usual (TAU). Meta-analysis with integrated IPV and SU interventions showed no difference in SU (n = 3 trials) or IPV outcomes (n = 4 trials) versus SU TAU.
Conclusions: Little evidence exists for effective interventions for male IPV perpetrators who use substances. Outcomes in integrated interventions were not superior to TAU in meta-analysis. Future trials should consider the nature of the relationship between IPV and SU in intervention design, duration of intervention, and type and timing of outcome measures. .
导言：尽管使用药物的男性实施亲密伴侣暴力（IPV）的发生率很高，但关于如何在这一群体中最好地减少 IPV 的证据却很有限：方法：通过荟萃分析进行系统性叙事回顾，确定了减少吸毒男性实施 IPV 的干预措施的有效性。纳入标准包括随机和非随机对照试验；成年异性恋男性 IPV 施暴者，其中至少 60% 的参与者是酒精和/或毒品使用者；干预措施针对 IPV，或不针对药物使用（SU）；结果包括施暴者和/或受害者报告的 IPV、SU 或两者。对方法学质量进行了评估：结果：共确定了九项试验（n = 1 014 名男性）。干预措施分为：（1）综合 IPV 和 SU 干预措施（5 项）；（2）IPV 干预措施与辅助 SU 干预措施（2 项）；（3）独立的 IPV 干预措施（2 项）。认知行为疗法和动机访谈疗法是最常见的方法。个别试验的数据显示，与常规治疗（TAU）相比，干预措施在短期内（≤3 个月；n = 2 项试验）降低了 SU 结果，在不同时间点（n = 3 项试验）降低了 IPV 施行率。综合 IPV 和 SU 干预的 Meta 分析表明，SU（n = 3 项试验）或 IPV 结果（n = 4 项试验）与 SU TAU 相比没有差异：对使用药物的男性 IPV 施暴者进行有效干预的证据很少。在荟萃分析中，综合干预的结果并不优于TAU。未来的试验应在干预设计、干预持续时间以及结果测量的类型和时间上考虑 IPV 和 SU 之间关系的性质。.
{"title":"Interventions to Reduce Intimate Partner Violence Perpetration by Men Who Use Substances: A Systematic Review and Meta-Analysis of Efficacy.","authors":"Danielle Stephens-Lewis, Amy Johnson, Alyson Huntley, Elizabeth Gilchrist, Mary McMurran, Juliet Henderson, Gene Feder, Louise M Howard, Gail Gilchrist","doi":"10.1177/1524838019882357","DOIUrl":"10.1177/1524838019882357","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the high prevalence of intimate partner violence (IPV) perpetration by men who use substances, limited evidence exists about how best to reduce IPV among this group.</p><p><strong>Method: </strong>A systematic narrative review with meta-analysis determined the effectiveness of interventions to reduce IPV by men who use substances. Inclusion criteria were randomized and nonrandomized controlled trials; adult heterosexual male IPV perpetrators where at least 60% of participants were alcohol and/or drug users; the intervention targeted IPV with or without targeting substance use (SU); outcomes included perpetrator and/or victim reports of IPV, SU, or both. Methodological quality was assessed.</p><p><strong>Results: </strong>Nine trials (<i>n</i> = 1,014 men) were identified. Interventions were grouped into (1) integrated IPV and SU interventions (<i>n</i> = 5), (2) IPV interventions with adjunct SU interventions (<i>n</i> = 2), and (3) stand-alone IPV interventions (<i>n</i> = 2). Cognitive behavioral and motivational interviewing therapies were the most common approaches. Data from individual trials showed a reduction in SU outcomes in the short term (≤3months; <i>n</i> = 2 trials) and IPV perpetration at different time points (<i>n</i> = 3 trials) for interventions compared with treatment as usual (TAU). Meta-analysis with integrated IPV and SU interventions showed no difference in SU (<i>n</i> = 3 trials) or IPV outcomes (<i>n</i> = 4 trials) versus SU TAU.</p><p><strong>Conclusions: </strong>Little evidence exists for effective interventions for male IPV perpetrators who use substances. Outcomes in integrated interventions were not superior to TAU in meta-analysis. Future trials should consider the nature of the relationship between IPV and SU in intervention design, duration of intervention, and type and timing of outcome measures. .</p>","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"1262-1278"},"PeriodicalIF":6.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84379695","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}
Pub Date : 2021-11-22DOI: 10.1080/09699260.2021.2000807
S. Karacsony, J. Martyn, J. Rosenberg, S. Andrews
Background and Aim The long-term care workforce is a significant provider of palliative care. The majority of older people being admitted to long-term care have palliative care needs and many are approaching end of life. The long-term care workforce comprises both registered health care professionals and unlicensed health care workers (UHCW) who provide most direct care. Studies that have examined palliative care competence in long-term care have focused on staff knowledge. However, it is also important to understand staff attitudes, beliefs, and values towards palliative care because these attributes influence behaviours related to care provision. The aim of the qualitative evidence synthesis is to identify and appraise the best available qualitative evidence on the attitudes, beliefs, and values of the long-term care workforce towards palliative care. Inclusion criteria The review will consider original research that reports qualitative findings of long-term care staff and their attitudes, beliefs, and values regarding palliative care for residents of long-term care facilities. Methods The following databases will be searched for eligible papers: CINAHL, EMBASE, PubMed, PsychINFO, and Scopus. Studies that meet the inclusion criteria by addressing all of the phenomena of interest will be reviewed using the Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence. Two reviewers will independently assess the studies for methodological quality. The data will be extracted using the standardized JBI SUMARI extraction tool. Specific details about authors and publication date, study design, aims, context, population, cultural and linguistic background, location, main findings, limitations, and conclusions will be extracted and a level of credibility assigned. Categories will be developed from the findings. The findings will be presented diagrammatically and accompanied by a narrative to explain categories and synthesised findings. Discussion The review of the literature will synthesis key findings pertaining to the attitudes, beliefs, and values of the workforce providing palliative care to older people in long-term care, beyond what is known about palliative care knowledge in this workforce.
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Pub Date : 2021-11-02DOI: 10.1080/09699260.2021.1992088
Julia Panascia
Dear Editor, I read with great interest the article ‘Medical students do not feel confident in managing palliative care as future doctors’ by Melgaard and Neergaard [1] in Progress in Palliative Care. I wanted to offer my perspective on the article as a medical student with an interest in palliative care as well as a student who has faced many interruptions to my undergraduate medical education due to the COVID-19 pandemic. I am not surprised that the results of the study by Melgaard and Neergaard [1] found that medical students do not feel confident in managing palliative care. The literature recognises that medical students are often shielded from seeing really sick patients and undergraduate medical training is centred around fixing people [2]. I have often observed amongst my peers the harmful ideology that a dying patient is a failure. We fail our patients when we cannot see beyond ‘fixing their ailment’ and as a result, neglect to bring comfort and dignity to their lives. I am concerned that the lack of confidence and negative attitudes towards palliative care in medical students may stem from lack of exposure to patients in palliative care. It is interesting that a study by Hammel et al. [3] found that the British palliative care curriculum lead to medical students with ‘more confidence and more supportive attitudes towards PC (palliative care)’ compared to students from the United States. Medical education has had to face huge disruptions, challenges and changes due to the COVID-19 pandemic. I read an article by Boland et al. [4] that highlighted, as junior doctors we will inexorably have to face caring for a dying patient throughout our career. However, by the time I graduate, I will have only encountered palliative care via online teaching. It concerns me that I will not have had first-hand experience with the complex interplay of symptom management, psychological, social and spiritual support seen in palliative care. How I am supposed to forge empathic connections with patients with incurable illnesses, if I have never witnessed the profound difficulties of their experience? I agree with the author’s narrative that it very important to evaluate student confidence and knowledge, in particular when implementing new, elaborate curriculum changes in palliative care. This article is even more pertinent to the undergraduate medical curriculum now. I believe it raises questions as to whether my own medical school and potentially other British medical schools have done enough to evaluate confidence and attitudes towards palliative care. I think it is crucial that more studies are conducted to ascertain the impacts of the COVID-19 pandemic on undergraduate palliative care teaching. Yours sincerely,
{"title":"Comment on: ‘Medical students do not feel confident in managing palliative care as future doctors’","authors":"Julia Panascia","doi":"10.1080/09699260.2021.1992088","DOIUrl":"https://doi.org/10.1080/09699260.2021.1992088","url":null,"abstract":"Dear Editor, I read with great interest the article ‘Medical students do not feel confident in managing palliative care as future doctors’ by Melgaard and Neergaard [1] in Progress in Palliative Care. I wanted to offer my perspective on the article as a medical student with an interest in palliative care as well as a student who has faced many interruptions to my undergraduate medical education due to the COVID-19 pandemic. I am not surprised that the results of the study by Melgaard and Neergaard [1] found that medical students do not feel confident in managing palliative care. The literature recognises that medical students are often shielded from seeing really sick patients and undergraduate medical training is centred around fixing people [2]. I have often observed amongst my peers the harmful ideology that a dying patient is a failure. We fail our patients when we cannot see beyond ‘fixing their ailment’ and as a result, neglect to bring comfort and dignity to their lives. I am concerned that the lack of confidence and negative attitudes towards palliative care in medical students may stem from lack of exposure to patients in palliative care. It is interesting that a study by Hammel et al. [3] found that the British palliative care curriculum lead to medical students with ‘more confidence and more supportive attitudes towards PC (palliative care)’ compared to students from the United States. Medical education has had to face huge disruptions, challenges and changes due to the COVID-19 pandemic. I read an article by Boland et al. [4] that highlighted, as junior doctors we will inexorably have to face caring for a dying patient throughout our career. However, by the time I graduate, I will have only encountered palliative care via online teaching. It concerns me that I will not have had first-hand experience with the complex interplay of symptom management, psychological, social and spiritual support seen in palliative care. How I am supposed to forge empathic connections with patients with incurable illnesses, if I have never witnessed the profound difficulties of their experience? I agree with the author’s narrative that it very important to evaluate student confidence and knowledge, in particular when implementing new, elaborate curriculum changes in palliative care. This article is even more pertinent to the undergraduate medical curriculum now. I believe it raises questions as to whether my own medical school and potentially other British medical schools have done enough to evaluate confidence and attitudes towards palliative care. I think it is crucial that more studies are conducted to ascertain the impacts of the COVID-19 pandemic on undergraduate palliative care teaching. Yours sincerely,","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"29 1","pages":"319 - 319"},"PeriodicalIF":1.7,"publicationDate":"2021-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41750437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-10DOI: 10.1080/09699260.2021.1975397
Amanda Fischer, Annabelle May, Matthew Lancaster, Kim Alexander, P. Good
Abstract In Australia, despite the growing need for palliative care, there is a shortage of palliative care professionals. The literature suggests that nurse practitioners (NPs) are well positioned to innovate the current model of palliative medicine. This prospective study evaluates the implementation of a new NP role within an established multidisciplinary palliative care service. In this study, patients under the care of the NP had fewer admissions to an acute hospital compared to the rest of the service (17.0% vs. 27.2%), as well as no acute admissions for terminal care and a greater number of patients who achieved their preferred place of death (87.2% vs. 72.2%). A survey of the multidisciplinary team revealed that the majority of responders (93.3%) felt that the NP role had a positive impact on patient care and was holistic, safe, and met patients’ needs. Neutral or negative survey responses highlighted the need for further education or refinement of the role in areas such as prescribing and ability to refer patients directly to medical specialists. Overall, study results were positive and support the introduction of the NP role into a specialist palliative care service but more research is required to assess the effectiveness of the role.
{"title":"Evaluation of a nurse practitioner role within a specialist palliative care service in Australia","authors":"Amanda Fischer, Annabelle May, Matthew Lancaster, Kim Alexander, P. Good","doi":"10.1080/09699260.2021.1975397","DOIUrl":"https://doi.org/10.1080/09699260.2021.1975397","url":null,"abstract":"Abstract In Australia, despite the growing need for palliative care, there is a shortage of palliative care professionals. The literature suggests that nurse practitioners (NPs) are well positioned to innovate the current model of palliative medicine. This prospective study evaluates the implementation of a new NP role within an established multidisciplinary palliative care service. In this study, patients under the care of the NP had fewer admissions to an acute hospital compared to the rest of the service (17.0% vs. 27.2%), as well as no acute admissions for terminal care and a greater number of patients who achieved their preferred place of death (87.2% vs. 72.2%). A survey of the multidisciplinary team revealed that the majority of responders (93.3%) felt that the NP role had a positive impact on patient care and was holistic, safe, and met patients’ needs. Neutral or negative survey responses highlighted the need for further education or refinement of the role in areas such as prescribing and ability to refer patients directly to medical specialists. Overall, study results were positive and support the introduction of the NP role into a specialist palliative care service but more research is required to assess the effectiveness of the role.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"295 - 304"},"PeriodicalIF":1.7,"publicationDate":"2021-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42000010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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