Journal of Palliative Care最新文献

ObjectivesRecently, atrial fibrillation (AF) has contributed to an increase in cardiovascular deaths in the U.S. Palliative care (PC) and atrial ablation (AA) procedure can elevate quality of life of high-risk AF patients, who are associated with multiple comorbidities. We explore the combined PC and AA management among high-risk mortality groups with AF.MethodsThis pooled cross-sectional retrospective data used the National Inpatient Sample (2016-2021) and included national estimates of 2,965,334 hospital discharges in the high-risk mortality group with AF. Multivariable regression was performed to determine the factors associated with AA procedure and PC centered on CHA2DS2-VASc score, systolic heart failure, and in-hospital mortality. Race/ethnicity, health insurance, and hospital location were controlled in multivariable analyses.ResultsPalliative care utilization was on an uptrend from 9.02% in 2016 to 12.29% in 2021. Factors that were negatively associated with PC utilization were increasing CHA2-DS2-VASc score (OR = 0.878), systolic heart failure (OR = 0.976), AA procedure (OR = 0.287), racial minorities, and rural residents. Atrial ablation was positively associated with systolic heart failure (OR = 2.920) and was negatively associated with increasing CHA2-DS2-VASc score (OR = 0.951) and PC utilization (OR = 0.283). Racial minorities and rural residents were less likely to receive AA procedure.ConclusionsPalliative care utilization was associated with lower probability of AA procedures by approximately 75%, and vice versa. Atrial ablation procedures and PC utilization were discrete choice patterns indicating healthcare providers' tendency to favor the status quo and current practices rather than initiating change. Health disparities in PC utilization and AA procedures were identified in racial minorities and rural residents. Call to action is warranted to increase PC awareness and harmonious approach of PC and AA procedure for those with high-risk mortality AF patients in the U.S. hospitals.

ObjectivePalliative care is more commonly provided to patients with cancer than to those with non-oncological conditions. Little is known about the prevalence of inappropriate care and whether differences exist depending on the underlying disease. This study investigates the care during the last month of life in patients with cancer and non-oncological conditions, such as amyotrophic lateral sclerosis (ALS), chronic obstructive pulmonary disease (COPD), and dementia, considering the care setting (nursing home vs. community care).MethodsWe conducted a population-based, retrospective analysis of deceased in 2016-2019 with COPD (n = 4,036), dementia (n = 40,853), or ALS (n = 608). Logistic regression analyses compared the care quality with that of the deceased with cancer (n = 58,315). Interaction analyses examined setting effects. Outcome measures included validated quality indicators: hospital and intensive care unit (ICU) stays, emergency service utilization, and place of death.ResultsDeceased with COPD, dementia, and ALS more frequently utilized emergency services compared to those with cancer (40.4%, 28.4%, 29.0% vs. 24.4%, respectively, p < .05) and were less likely to die in a hospital (excluding palliative care units; 38.2%, 15.3%, 25.7% vs. 40.3%, respectively, p < .05). Differences were observed in ICU (13.6%, 3.4%, 6.1% vs. 4.3%, respectively, p < .05) and hospital admissions (42.7% for COPD vs. 31.5% for oncological patients, p < .001). The same pattern was observed across all conditions: deceased in community care had higher rates in all quality indicators than those in nursing homes.ConclusionsThe results suggest differences in care quality depending on the underlying disease. Nononcological patients in community care are less frequently and less adequately cared for than oncological patients.

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.