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The role of ambulance services in reducing the gaps in access to end-of-life care: from conversations to policy 救护车服务在减少获得临终关怀方面的差距方面的作用:从对话到政策
IF 1.7 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2021-03-04 DOI: 10.1080/09699260.2020.1871174
B. Pekarsky, Amy E. Seymour-Walsh, Catherine Wright, Mathew Hooper, Colleen Carter
Reducing the gap between the need for and access to effective and best practice care at the end-of-life is a goal of the Australian palliative care sector. Largely absent from the suite of plans, strategies and frameworks that map Australia’s path to quality end-of-life care for all patients isPalliatiev CAre Australia the role of ambulance services. Instead, patients’ need for these services tends to be characterized as an undesirable consequence of an under-resourced palliative care sector and no longer necessary when the sector is fully resourced. We hypothesize that one reason for this characterization is that the ambulance and palliative care sectors have fundamentally different perspectives of end-of-life care. We conclude that further if the palliative care sector were to partner with ambulance services, the gap between the need for and access to end-of-life care would be reduced more rapidly and cost effectively.
澳大利亚姑息治疗部门的一个目标是缩小临终时获得有效和最佳实践护理的需求和机会之间的差距。Palliatiev CA在澳大利亚为所有患者提供优质临终关怀的一系列计划、战略和框架中基本上没有体现救护车服务的作用。相反,患者对这些服务的需求往往被描述为姑息治疗部门资源不足的不良后果,当该部门资源充足时,这种需求就不再必要了。我们假设,这种定性的一个原因是救护车和姑息治疗部门对临终关怀有着根本不同的看法。我们得出的结论是,如果姑息治疗部门与救护车服务合作,临终关怀的需求和获得之间的差距将更快、更具成本效益地缩小。
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引用次数: 5
A national collaborative to spread and scale paramedics providing palliative care in Canada: Breaking down silos is essential to success 在加拿大推广和扩大护理人员提供姑息治疗的全国性合作:打破孤岛是成功的关键
IF 1.7 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2021-03-04 DOI: 10.1080/09699260.2020.1871173
A. Carter, M. Arab, C. Cameron, M. Harrison, Charlotte Pooler, Ian McEwan, M. Austin, J. Helmer, Gurkan Ozel, Jessica Heathcote, N. Reardon, Elizabeth Anderson, M. Carey, R. S. Moxam, S. Crick
A national collaborative has been launched in Canada to spread and scale up the Paramedics Providing Palliative Care model. This builds on the knowledge that paramedics in the 9-1-1 (emergency/unscheduled) and scheduled models of care are both historically and currently asked by the public to provide urgent symptom relief within the context of a palliative approach, and that approximately 40% of dying people visit the emergency department in the last two weeks of life despite 70% wishing to die at home. A model of care including a palliative care clinical practice guideline or protocol, specific training, and a mechanism for sharing of goals of care, has been proven to improve the palliative and end of life experience for patients with palliative care needs and their families. It increases the comfort and confidence of paramedics and has benefits to the broader health system. Meaningful and very broad stakeholder engagement and inter-sectoral collaboration is absolutely essential to the success of this innovative approach to care.
加拿大发起了一项全国性合作,以推广和扩大“医护人员提供姑息治疗”模式。这建立在这样一个知识的基础上,即9-1-1(紧急/计划外)和计划外护理模式的护理人员在历史上和目前都被公众要求在姑息治疗的背景下提供紧急症状缓解,大约40%的垂死者在生命的最后两周去急诊科就诊,尽管70%的人希望在家中死去。一种护理模式,包括姑息治疗临床实践指南或方案、特定培训和护理目标共享机制,已被证明可以改善有姑息治疗需求的患者及其家人的姑息治疗和临终体验。它增加了医护人员的舒适度和信心,对更广泛的卫生系统也有好处。有意义和非常广泛的利益相关者参与和部门间合作对于这种创新的护理方法的成功至关重要。
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引用次数: 8
Staff stakeholder views on the role of UK paramedics in advance care planning for patients in their last year of life 员工利益相关者对英国护理人员在病人生命的最后一年提前护理计划中的作用的看法
IF 1.7 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2021-03-04 DOI: 10.1080/09699260.2021.1872140
L. Goodwin, Alyesha Proctor, K. Kirby, S. Black, L. Pocock, S. Richardson, J. Stonehouse, H. Taylor, S. Voss, J. Benger
Background Early advance care planningh as clear benefits for patients approaching the end of their life, yet many of those attended by UK paramedics do not have this planning in place. Aims To explore staff stakeholder views on the role of UK paramedics in advance care planning, including the use of the Gold Standards Framework Proactive Identification Guidance for screening and referral of patients. Methods In-depth semi-structured telephone interviews with paramedics, general practitioners, Emergency Department and community doctors and nurses in the South West of England. Results Seventeen staff stakeholders participated. Four main themes were identified: a lack of advance care planning; variation across health conditions; a lack of joined-up care; poor-quality end of life conversations. Paramedic use of the Gold Standards Framework Proactive Identification Guidance to screen and refer patients for advance care planning was seen as feasible and acceptable, with perceived benefitssuch as identifying patients not accessing primary care, and the potential to reduce avoidable hospital admissions. Conclusions UK paramedics are well-placed toscreen and refer patients for advance care planning. Further research is needed to explore how this type of intervention might be developed to fit into a community-centred approach aimed at improving advance care planning.
背景早期提前护理计划对即将结束生命的患者有明显的好处,但许多由英国护理人员护理的患者并没有这样的计划。目的探讨员工利益相关者对英国护理人员在预先护理规划中的作用的看法,包括使用黄金标准框架主动识别指南对患者进行筛查和转诊。方法对英格兰西南部的护理人员、全科医生、急诊科和社区医生和护士进行半结构化电话访谈。结果17名工作人员利益攸关方参加了会议。确定了四个主要主题:缺乏预先护理规划;健康状况的差异;缺乏联合护理;质量差的临终谈话。医护人员使用黄金标准框架主动识别指南来筛查和转诊患者以进行预先护理计划被认为是可行和可接受的,其好处包括识别无法获得初级护理的患者,并有可能减少可避免的住院人数。结论英国护理人员能够很好地筛查和推荐患者进行预先护理计划。需要进一步的研究来探索如何发展这种类型的干预措施,以适应以社区为中心的方法,旨在改进预先护理规划。
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引用次数: 5
Bibliography 参考书目
IF 1.7 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2021-03-04 DOI: 10.1080/09699260.2021.1890364
J. Gabbard, N. Pajewski, Kathryn, E. Callahan
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引用次数: 0
Timing of palliative care referral in patients with advanced Non-Small Cell Lung Cancer: a retrospective cohort study 晚期非小细胞肺癌患者姑息治疗转诊的时机:一项回顾性队列研究
IF 1.7 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2021-03-03 DOI: 10.1080/09699260.2021.1890914
F. Binder, C. M. Ungaro, M. B. Bonella, Carlos Cafferata, D. Giunta, B. Ferreyro
Introduction: Early palliative care referral is recommended for patients with Stage IV Non-Small Cell Lung Cancer (NSCLC) irrespective of the decision to administer cancer-directed therapies. Diagnosis-to-referral and referral-to-death intervals, proposed as measures of quality of care, are rarely reported in low-and-middle income settings. Objective: to estimate the 6-month cumulative incidence of palliative care referrals and the length of referral-to-death intervals among patients with Stage IV NSCLC at a teaching hospital in Argentina. Methods: Patients with Stage IV NSCLC diagnosed between 2012 and 2017 were followed up until December 2019. We retrieved the first contact with palliative care services and date of death from centralized Electronic Health Records. Cumulative incidence of palliative care referrals was estimated by fitting a Fine & Gray competing risks model. Results: Ninety-two patients were included. Median age was 71.5 years (IQR 63–79 years), 55% were women. Median survival time was 375 days (95% CI: 204–508 days). Considering death as a competing risk, the 6-month cumulative incidence of palliative care referrals was 37% (95% CI: 27% to 47%). Among referred patients, the median referral-to-death interval was 31 days. Discussion: Further research should focus on identifying and overcoming barriers to timely palliative care referrals in this population.
简介:建议对癌症(NSCLC)IV期患者进行早期姑息治疗转诊,无论是否决定实施癌症导向治疗。诊断转诊和转诊至死亡间隔,作为衡量护理质量的指标,在中低收入环境中很少报道。目的:评估阿根廷一家教学医院IV期非小细胞肺癌患者6个月姑息治疗转诊的累计发生率和转诊至死亡间隔的时间。方法:对2012年至2017年间诊断为IV期NSCLC的患者进行随访,直至2019年12月。我们从集中的电子健康记录中检索到了与姑息治疗服务的第一次接触和死亡日期。姑息治疗转诊的累计发生率是通过拟合Fine&Gray竞争风险模型来估计的。结果:包括92例患者。中位年龄为71.5岁(IQR 63–79岁),55%为女性。中位生存时间为375天(95%可信区间:204–508天)。考虑到死亡是一种相互竞争的风险,姑息治疗转诊的6个月累计发生率为37%(95%置信区间:27%至47%)。在转诊患者中,转诊至死亡的中位间隔为31天。讨论:进一步的研究应侧重于识别和克服这一人群中及时转诊姑息治疗的障碍。
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引用次数: 0
Citizens appreciate talking about death and learning end-of-life care – a mixed-methods study on views and experiences of 5469 Last Aid Course participants 公民喜欢谈论死亡和学习临终关怀——一项对5469名临终援助课程参与者的观点和经历进行的混合方法研究
IF 1.7 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2021-02-25 DOI: 10.1080/09699260.2021.1887590
G. Bollig, Frans Brandt Kristensen, D. L. Wolff
Background Most people would prefer to die at home. Engaging citizens in end-of-life care may contribute to making home death possible for more people. Aims To test the feasibility and acceptability of Last Aid Courses in different countries and to explore the views and experiences of participants with the course. Methods International multi-centre study with a questionnaire based mixed methods design. 408 Last Aid Courses were held in three different countries. Of 6014 course participants, 5469 participated in the study accounting for a response rate of 91%. Results The median age of participants was 56 years. 88% were female. 76% of participants rated the course “very good”. 99% would recommend it to others. Findings from the qualitative data revealed that participants found the atmosphere comfortable; instructors competent; appreciated the course format, duration, topics and discussions about life and death. Conclusions Last Aid Courses are both feasible and accepted by citizens from different countries. They have a huge potential to inform citizens and to encourage them to engage in care at home. Future research should investigate the long-term effects of the course on the ability and willingness of participants to provide end-of-life care and the impact on the number of home-deaths.
大多数人宁愿死在家里。让公民参与临终关怀可能有助于使更多的人有可能在家中死亡。目的测试临终援助课程在不同国家的可行性和可接受性,并探讨参与者对课程的看法和经验。方法采用问卷调查法设计国际多中心研究。408 .最后援助课程在三个不同的国家举办。在6014名课程参与者中,有5469人参与了研究,应答率为91%。结果参与者的中位年龄为56岁。88%是女性。76%的参与者认为课程“非常好”。99%的人会推荐给别人。定性数据的结果显示,参与者发现氛围舒适;教练主管;赞赏课程的形式、持续时间、主题和关于生与死的讨论。结论临终救助课程是可行的,并为各国公民所接受。他们有巨大的潜力告知公民并鼓励他们参与家庭护理。未来的研究应调查课程对参与者提供临终关怀的能力和意愿的长期影响,以及对在家死亡人数的影响。
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引用次数: 11
Discordant Beliefs and Practices of Physicians Referring Cancer Patients to Palliative Care 医生为癌症患者提供姑息治疗的不和谐信念与实践
IF 1.7 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2021-02-21 DOI: 10.1080/09699260.2021.1887588
M. Al-Shahri, Heba Ateya, Dafer M. Al-Shehri
Objectives We aimed to examine the concordance between beliefs and practices of physicians regarding the timing of referring cancer patients to a PC team. Methods We reviewed records of cancer deaths in a palliative care unit (PCU) over three years. Physicians who initiated the referral to PC completed a questionnaire. The referral time was categorized into early (> 90 days), intermediate (31–90 days) or late (≤ 30 days). Results For 208 cancer deaths (63% females), the median age was 55 years. The median referral time was 33 days. Only 9.6% of patients were referred early, while the majority were either referred late (47.1%) or fell in the intermediate category (43.3%). All of the referring physicians believed that a PC service is essential in an oncology center and 73.7% stated that cancer patients should be referred to PC at diagnosis or when cancer becomes incurable. No patient- or physician-related factors were significantly associated with the referral time. Conclusions Despite the unanimous belief among this group of physicians that cancer patients should be referred to PC at or before diagnosing its incurability, initiation of early referrals to PC was remarkably rare. Such a striking discordance between beliefs and practices merits further investigation.
目的我们旨在检查医生在将癌症患者转诊到PC团队的时间方面的信念和实践之间的一致性。方法回顾三年来癌症在姑息治疗室(PCU)的死亡记录。开始转诊到PC的医生完成了一份问卷调查。转诊时间分为早期(>90天)、中期(31-90天)或晚期(≤30天)。结果208例癌症死亡(63%为女性)的中位年龄为55岁。中位转诊时间为33天。只有9.6%的患者被早期转诊,而大多数患者要么被延迟转诊(47.1%),要么属于中间类(43.3%)。所有转诊医生都认为PC服务在肿瘤中心至关重要,73.7%的医生认为癌症患者应在诊断时或癌症无法治愈时转诊到PC。没有患者或医生相关因素与转诊时间显著相关。结论尽管这组医生一致认为癌症患者应在诊断为可治愈时或之前转诊PC,但早期转诊PC的情况非常罕见。信仰和实践之间如此明显的不一致值得进一步调查。
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引用次数: 0
Strengthening advance care planning in rural residential aged care through multidisciplinary educational case conferences: A hybrid implementation-effectiveness study 通过多学科教育案例会议加强农村居家养老超前护理规划:一项实施-效果混合研究
IF 1.7 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2021-02-14 DOI: 10.1080/09699260.2021.1872136
S. Rainsford, Sally Hall Dykgraaf, Rosny Kasim, Christine B Phillips, N. Glasgow
Strengthening advance care planning in residential aged care is now a priority. This hybrid implementation-effectiveness study aimed to implement and evaluate the effectiveness of multidisciplinary educational case conferences (MuDECC) in end-of-life planning in two Australian rural residential aged care facilities. MuDECCs are hour long meetings with the resident (where appropriate), their family/guardian and a multidisciplinary team of healthcare providers (including community pharmacists) to discuss and plan for the resident’s future end-of-life care needs. Between November 2018 and July 2019 ten MuDECCs were convened. The implementation was evaluated using a utilisation-focused approach. Intervention outcomes were documented advance care plans, availability of anticipatory end-of-life medications, and participant satisfaction. Of 23 persons who died during the study period, 65% had a documented end-of-life care plan; 57% had anticipatory medications charted. MuDECCs were reported to be acceptable, effective, and a valuable learning experience. By providing a framework for informed decision making and joint problem sharing, MuDECCs were effective in facilitating advance care planning and prescribing of anticipatory medications. However, MuDECCs were time consuming to organise with disproportionate responsibilities or time commitments borne by several key individuals. The necessary personal and professional capital to implement MuDECCs may be limited or unavailable in some rural locations.
加强居家养老的预先护理规划是目前的优先工作。本混合实施-有效性研究旨在实施和评估多学科教育案例会议(MuDECC)在澳大利亚两家农村老年护理机构的临终规划中的有效性。MuDECCs是与居民(如适用)、他们的家人/监护人和多学科医疗保健提供者团队(包括社区药剂师)进行长达一小时的会议,讨论和规划居民未来的临终关怀需求。2018年11月至2019年7月期间,召开了10次多边经济合作会议。使用以利用为中心的方法对实现进行评估。干预结果记录了预先护理计划、预期临终药物的可用性和参与者满意度。在研究期间死亡的23人中,65%的人有书面的临终关怀计划;57%的人服用了预期药物。据报道,mudecc是可接受的、有效的,并且是宝贵的学习经验。通过提供一个知情决策和共同问题分享的框架,MuDECCs有效地促进了预先护理计划和预见性药物的处方。然而,组织mudecc非常耗时,由几个关键人员承担不成比例的责任或时间承诺。在一些农村地区,实施混合经济发展的必要个人和专业资本可能有限或无法获得。
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引用次数: 4
Could kinesiology taping of the inspiratory muscles help manage chronic breathlessness? An opinion paper 运动机能学上的吸气肌胶带能帮助控制慢性呼吸困难吗?一篇评论文章
IF 1.7 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2021-01-24 DOI: 10.1080/09699260.2021.1872137
Gourav Banerjee, A. Rose, M. Briggs, P. Plant, Mark I. Johnson
Chronic or refractory breathlessness adversely affects quality of life. Current treatment strategies for managing breathlessness are often inadequate in providing complete relief. Kinesiology taping is generally used in musculoskeletal practice for preventive and rehabilitative purposes. Recently, our attention was drawn to the plausible mechanism(s) and indication for use of kinesiology taping for managing chronic breathlessness. We present a brief review of the scientific rationale and efficacy of kinesiology taping for respiratory function-related outcomes. Through this publication, we hope to catalyse discussions amongst palliative care professionals and researchers on the potential use of kinesiology taping in the management of chronic breathlessness.
慢性或难治性呼吸困难会对生活质量产生不利影响。目前治疗呼吸困难的策略往往不足以提供完全缓解。运动学胶带通常用于肌肉骨骼练习,用于预防和康复目的。最近,我们的注意力被吸引到了使用运动机能学胶带治疗慢性呼吸困难的合理机制和适应症上。我们简要回顾了运动机能学录音对呼吸功能相关结果的科学原理和疗效。通过这本出版物,我们希望促进姑息治疗专业人员和研究人员之间关于运动机能学录音在慢性呼吸困难治疗中的潜在用途的讨论。
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引用次数: 0
The experiences of well-being of family caregivers in palliative care: A qualitative study using thematic analysis 姑息治疗中家庭照顾者的幸福体验:一项使用主题分析的定性研究
IF 1.7 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2021-01-24 DOI: 10.1080/09699260.2021.1872135
T. Beng, Yeoh Kee Ying, Cheah Ai Xin, Lim Ee Jane, D. Lin, Lim Poh Khuen, D. Capelle, Sheriza Izwa Zainuddin, Loh Ee Chin, Lam Chee Loong
Background Family caregivers play an important role in supporting patients at the end of life. Although providing care for palliative care patients can be inherently stressful, it is possible for family caregivers to experience both positive experiences and stress simultaneously. Understanding these positive experiences can be helpful to aid counterbalancing the negative aspect of caregiving. Objective and Methods Therefore, we conducted a qualitative study using face-to-face interviews with semi-structured questions to explore the experiences of well-being of palliative care family caregivers from a positive perspective. The entire sample consisted of 18 family members caring for cancer patients and 2 family members caring for patients with motor neuron disease. The interviews were transcribed verbatim and thematically analyzed with qualitative research software NVIVO. Results The themes generated from the analysis are: (1) Acceptance, (2) Gratitude, (3) Hope, (4) Happiness and (5) Support. Conclusions The 5 themes provide 6 constructs for independent intervention. Understanding these themes that promote caregiver well-being can be a guide for us to take care of our family caregivers.
家庭照护者在支持临终病人方面发挥着重要作用。虽然为姑息治疗患者提供护理本身就有压力,但家庭护理者有可能同时经历积极的经历和压力。理解这些积极的经历有助于平衡照顾的消极方面。因此,我们采用面对面访谈的半结构化问题进行质性研究,从积极的角度探讨姑息治疗家庭照护者的幸福感体验。整个样本由18名照顾癌症患者的家庭成员和2名照顾运动神经元疾病患者的家庭成员组成。访谈被逐字记录下来,并用定性研究软件NVIVO进行主题分析。结果分析得出的主题是:(1)接受,(2)感恩,(3)希望,(4)幸福,(5)支持。结论5个主题提供了6种独立干预构念。了解这些促进照顾者幸福的主题可以指导我们照顾我们的家庭照顾者。
{"title":"The experiences of well-being of family caregivers in palliative care: A qualitative study using thematic analysis","authors":"T. Beng, Yeoh Kee Ying, Cheah Ai Xin, Lim Ee Jane, D. Lin, Lim Poh Khuen, D. Capelle, Sheriza Izwa Zainuddin, Loh Ee Chin, Lam Chee Loong","doi":"10.1080/09699260.2021.1872135","DOIUrl":"https://doi.org/10.1080/09699260.2021.1872135","url":null,"abstract":"Background Family caregivers play an important role in supporting patients at the end of life. Although providing care for palliative care patients can be inherently stressful, it is possible for family caregivers to experience both positive experiences and stress simultaneously. Understanding these positive experiences can be helpful to aid counterbalancing the negative aspect of caregiving. Objective and Methods Therefore, we conducted a qualitative study using face-to-face interviews with semi-structured questions to explore the experiences of well-being of palliative care family caregivers from a positive perspective. The entire sample consisted of 18 family members caring for cancer patients and 2 family members caring for patients with motor neuron disease. The interviews were transcribed verbatim and thematically analyzed with qualitative research software NVIVO. Results The themes generated from the analysis are: (1) Acceptance, (2) Gratitude, (3) Hope, (4) Happiness and (5) Support. Conclusions The 5 themes provide 6 constructs for independent intervention. Understanding these themes that promote caregiver well-being can be a guide for us to take care of our family caregivers.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"29 1","pages":"209 - 216"},"PeriodicalIF":1.7,"publicationDate":"2021-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1872135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44098784","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}
引用次数: 0
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PROGRESS IN PALLIATIVE CARE
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