Journal of Palliative Care最新文献

ObjectivesPediatric end-of-life (EOL) care at home is often provided by community palliative care (CPC) nurses who are not specialist pediatric service providers. This study explores the challenges, benefits, and future directions of home-based EOL care as perceived by CPC nurses in New South Wales (NSW), Australia.MethodsEleven CPC nurses participated in a semi-structured interview to elicit information about their attitudes and experiences regarding their work in providing community-based EOL care to children. Reflexive thematic analysis was used to explore themes regarding the benefits, challenges and their thoughts on future directions regarding home-based EOL care.ResultsChallenges identified by CPC nurses included resource access, complexity of pediatric, models of care, and family psychological factors. Benefits included patient and family autonomy, home comforts and the nurses' sense of satisfaction. CPC nurses suggested the need for increased education, support and collaboration.ConclusionAreas of possible clinical and organizational improvements are discussed, including more pediatric training and experience for CPC nurses.

Objectives: Pediatric end-of-life (EOL) care at home is often provided by community palliative care (CPC) nurses who do not specialize in pediatrics. This study aimed to better understand the challenges CPC nurses face when providing EOL care to children at home. Methods: A total of 52 CPC nurses across New South Wales (NSW), Australia, participated in an online survey about their training, attitudes, and experiences regarding the provision of home-based pediatric EOL care. Participants were asked to reflect back over a "negative" experience of caring for a child at EOL, where things did not go as well as hoped, and a "positive" EOL care experience, where nurses perceived that care of the child and family went well, and respond to questions about these experiences. Results: Confidence of CPC nurses when providing EOL care to pediatric patients was significantly lower than when caring for adults (p's < .05). Most respondents expressed the desire for more training in pediatric EOL care. Cases identified as negative by CPC nurses did not significantly differ from positive cases in terms of the timing of the referral to CPC, clinical symptoms at EOL, or how well informed the nurses felt. Siblings were present at EOL in 74% of the negative experiences and 86% of the positive experiences, reportedly receiving significantly poorer support in the negative experiences (p = .002). Conclusion: This research contributes to an improved understanding of the challenges associated with home-based pediatric EOL care and highlights potential areas for improvement in CPC service delivery and training.

ObjectiveThis study was conducted to evaluate the relationship between the frequency of spiritual care and job satisfaction of palliative care nurses.MethodsThis study was a cross-sectional type. The study population consisted of nurses working in palliative care units of three hospitals in eastern Turkey. The study was conducted with 110 nurses who agreed to participate in the study. The researchers' "Information Form", "Nurse Spiritual Care Therapeutics Scale" and "Nurse Job Satisfaction Scale" were used to collect data. Data was collected by face-to-face interview method between August and September 2022.ResultsIt was determined that the nurses scored 45.2 ± 15.8 points from the Nurse Spiritual Care Therapeutics Scale and 4.1 ± 0.7 points from the nurse job satisfaction scale. There was a positive and moderately significant relationship between the frequency of spiritual care giving and job satisfaction of nurses. The frequency of giving spiritual care positively affected job satisfaction (β = .409) and predicted it by 19% (Adjusted R² = .195). It was determined that satisfaction with the unit (palliative care) mediated the relationship between the frequency of spiritual care and job satisfaction.Conclusion"Palliative care nurses' frequency of providing spiritual care was moderate and their job satisfaction was high, with frequency of providing spiritual care having a positive effect on job satisfaction. This suggests that increasing opportunities for nurses to provide spiritual care may further enhance their job satisfaction, leading to improved overall well-being.

ObjectivesHow health and social care professionals need to work together to deliver advance care planning (ACP) in nursing homes is not fully understood, with a reliance on professionals external to the nursing home to support ACP in the United Kingdom. The objectives of this study were to (a) examine the factors that influence multi-professional involvement in the ACP process within nursing homes and (b) explore how multi-professional working impacts the ACP process in nursing homes.MethodsUsing ethnography, data was collected through observation, interviews and document review from 36 participants including residents (n = 6), relatives (n = 4), nursing home staff (n = 19) and visiting professionals (n = 7). Data analysis combined thematic analysis, mapping of ACP trajectories for participant residents, and documentary analysis of nursing home policies.ResultsThere was conceptual confusion around ACP. How ACP was understood and what was prioritised for inclusion varied between residents and professionals, and between different professionals. That ACP was frequently integrated with routine care planning was not recognised in how professionals accounted for their ACP practice. Professionals prioritised biomedical concerns, despite this not reflecting resident priorities and policy suggesting a broader definition. This created difficulties in enacting ACP, with a holistic understanding of resident wishes not always captured.ConclusionsA shared understanding of ACP was not consistently evident from those tasked with its enactment. This, combined with professional construction of ACP in biomedical terms, limits multi-professional working and can prevent a person-centred process being achieved for nursing home residents.

This correspondence emphasizes the use of the Delphi technique to set regional priorities in palliative and end-of-life care research. It offers a structured framework to develop research that aligns with the most pressing needs of patients and providers. This approach can be adapted to improve palliative care in resource-limited settings such as the Philippines.

Objective(s): The majority of deaths in Singapore (62.1%) occur in the hospital, but most nurses do not have palliative care (PC) education. An online e-learning course, "Essential Palliative Care Approach for Nurses" (EPAN), was developed to close the learning gap. The study aimed to evaluate the impact of EPAN on general nurses' knowledge, confidence, and attitude in delivering end-of-life care. Methods: Convergent parallel mixed methods design. Results: 1708 nurses (67%), mostly from inpatient and ambulatory settings, completed EPAN. Statistically significant increases in mean scores across knowledge, confidence, and attitude (p < 0.05) remained consistent immediately post-course and 3 months post-course. Respondents shared their intentions to change practice in the immediate post-course survey (n = 1155) and how they have practiced end-of-life care in the 3-month post-course survey (n = 777). Major categories from the content analysis included: (i) actualise confidence to deliver effective communication, (ii) making time and showing empathy in end-of-life care, (iii) advocating for end-of-life care, (iv) proactive collaboration with other healthcare professionals, (v) navigated and accepted end-of-life boundaries, and (vi) able to self-manage emotions. Conclusions: EPAN, developed within an Asian context, has demonstrated a significant impact on nurses' knowledge, confidence, and attitude in delivering end-of-life care. This has broader implications for general palliative care education in countries of similar cultural concerns.

ObjectiveAdvance care planning (ACP) is increasingly recognized as a public health priority globally, with cultural aspects influencing people's knowledge, attitudes, and behaviours toward ACP. Despite being one of the largest diaspora groups, the Chinese community remains under-researched in this area. This study aims to examine the knowledge, attitudes, and health behaviours related to ACP among Chinese diaspora within a region in the United Kingdom.MethodA cross-sectional online survey based on the Theory of Planned Behaviour was conducted with 284 Chinese adults recruited from four social and voluntary organisations in the United Kingdom.ResultsThe study found low awareness (15%) and knowledge (mean score: 2.26 ± 1.78) of ACP, with less than 5% of the participants engaging with ACP. This contrasted with participants' attitudes (17.24 ± 2.57) and behavioural intention (14.93 ± 3.26) toward ACP, which were generally positive. Behavioural intention was the strongest predictor of engaging with ACP (OR 3.29, 95% CI: 1.35-8.02, p = 0.01). Participants with previous end-of-life care experience had a better understanding of ACP; older age and higher knowledge of ACP were associated with more positive attitudes. Cultural beliefs associated with the level of family involvement, legal aspects, and the availability of information in one's first language was significant influences on engagement with ACP.ConclusionsDespite low awareness and engagement with ACP among the Chinese diaspora, positive attitudes and behavioural intention suggest potential for increased engagement. This could be achieved through culturally tailored interventions that address cultural influences and complexity surrounding legal requirements. Further research is needed to develop and test such interventions.

Objective: Patient-centered care is widely recognized as a crucial component of high-quality end-of-life care. As this approach remains limited in China, this study sought to develop quality measures specifically tailored to end-of-life care within the country. Methods: Initial indicators were established through a comprehensive review of existing measures. Using the modified Delphi Method, a two-round survey with experts (n = 14) was applied to evaluate the importance of each item. Results: The authoritative coefficient of two rounds of expert consultation was 0.86 and 0.87, and the Kendall coefficient of concordance for the two rounds was 0.232 and 0.270 (P < 0.001), respectively, demonstrating an acceptable consensus among the experts. As a result, 31 key quality indicators were identified and deemed important. Conclusions: This study developed a scale for patient-centered end-of-life care quality measurement in China, consisting of six dimensions and 31 indicators. This scale lays a solid foundation for quality improvement initiatives and future development of patient-centered end-of-life care.

ObjectiveCAPACITI (Community Access to PAlliative Care via Interprofessional Teams Improvement) is a virtual training program that teaches primary care providers how to incorporate an early palliative approach to care in practice. Building this capacity can help primary care providers better meet the needs of their seriously ill patients; however, there has been limited in-depth study as to the added benefits of active facilitation in on-line education. We completed a qualitative inquiry with CAPACITI participants to explore perceived differences in self-directed and facilitated e-learning to understand how these modalities contribute to change in practice.MethodsWe completed a qualitative analysis of semi-structured focus groups with primary care teams that participated in CAPACITI. This study was part of a cluster randomized controlled trial where teams were randomized to self-directed or facilitated modalities for each of the three CAPACITI modules. We followed a qualitative descriptive design, using a constant comparative approach to determine emergent themes to understand participant experience and preference in learning modality.ResultsWe conducted 63 focus groups throughout the trial, representing 42 unique teams, about a quarter of which had experienced both learning modalities at the time of the focus group. Qualitative analysis revealed three main themes: changes in thinking (ie identifying patients early in the illness trajectory), change in behavior (ie increased collaboration), and preference in learning modality and perceived benefits. Interestingly, we found no overwhelming preference in learning modality.ConclusionsSelf-directed and facilitated learning modalities were both perceived as effective in promoting changes in thinking and behavior among primary care providers across diverse care settings. Future studies should further explore the use of tailored facilitation such as simulated patient encounters and innovative coaching strategies to optimally promote behavior change in virtual palliative care education.