BACKGROUND: Continuity of care is challenging when transferring patients across palliative care settings. These transfers are common due to the complexity of palliative care, which has increased significantly since the advent of palliative care services. It is unclear how palliative care services and professionals currently collaborate and communicate to ensure the continuity of care across settings, and how patient and family members are involved.
AIM: To explore healthcare professionals' experiences regarding the communicative aspects of inter-professional collaboration and the involvement of patient and family members.
DESIGN: Qualitative design, including focus group discussions.
SETTING/PARTICIPANTS: The study focused on one palliative care network in Belgium and involved all palliative care settings: hospital, hospital's palliative care unit, home care, nursing home. Nine group discussions were conducted, with diverse professionals (n = 53) from different care settings.
RESULTS: Timely and effective inter-professional information exchange was considered fundamental. A perceived barrier for interprofessional collaboration was the lack of a shared electronic health record. Efficiency regarding multidisciplinary team meetings and inter-professional communication were subject to improvement.A striking study finding was the perceived insufficient open communication of specialists towards patients and the lack of shared decision making. This not only hampered advance care planning discussions and early integration of palliative home care, but also the functioning of other professionals.
CONCLUSION: From the perspective of the integrated care framework, several areas of improvement on different levels of care and collaboration are identified. Support from policymakers and researchers is required to achieve integrated palliative care in regional networks.
Si, dans un premier temps, il peut paraître évident que ce sont les patients qui nous mettent en difficulté à travers le chemin douloureux de la maladie, il s’avère que les quelques cas qui ont engendré chez moi un ressenti de solitude, et par extension de désarroi, étaient tous liés à des incompréhensions avec les autres professionnels de santé en soins palliatifs. Accepter l’exercice d’écrire m’a permis de réfléchir rétroactivement sur les mécanismes en jeu, dans le but de progresser bien sûr, mais aussi d’éviter de nouvelles situations inconfortables.
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Purpose: End-of-life (EOL) decision-making is stressful. We conducted a quality improvement initiative to EOL decision-making and reduce stress for clinicians and patients’ relatives.
Methods: A before–after study running from 2010–2014 at four interdisciplinary intensive care units (ICU) in a German university hospital was performed. Between periods, a multifaceted intervention was implemented to improve timeliness, clinician involvement, and organisational support. Consecutive patients with severe sepsis and therapy limitations were included. Relatives were interviewed by telephone after 90 days to assess their psychological symptoms. Clinician burnout was assessed by staff surveys in each period.
Results: Participation in the pre- and postintervention period was 84/145 and 90/159 among relatives, and 174/284 and 122/297 among ICU clinicians. Staff judged intervention elements as mostly helpful, but implementation of intervention elements was heterogeneous. From pre- to postintervention, relatives’ risk of posttraumatic stress, depression and anxiety did not change (all p = 0.464). Clinicians’ risk of burnout increased (29% vs. 41%, p = 0.05). Relatives were highly satisfied in both periods (median of 9 vs. 9.2 on a 1–10 scale each). Attendings involved residents and nurses more often (both p = 0.018). Nurses more often had sufficient information to talk with relatives (41% vs. 62%, p = 0.002). Time to first EOL decision as well as barriers and facilitators of EOL decision-making did not change.
Conclusions: The intervention may have increased involvement in EOL decision-making, but was accompanied by an increased risk of clinician burnout maybe due to lack of improving communication skills and organisational support. More research is needed to understand which interventions can decrease clinician burnout.
Although patient satisfaction scores have been used in the inpatient setting for more than a decade, they are new to the hospice and home care setting. Hospice organizations began tracking Consumer Assessment of Healthcare Providers & Systems (CAHPS) scores in 2017, and beginning in 2019, the scores became accessible by the public. The purpose of this quality improvement project was to determine whether improved communication techniques had a positive effect on CAHPS scores at an outpatient nonprofit hospice organization. The intervention was divided into 2 parts, improving communication among staff and improving education provided to patients and their caregivers. This pilot project was implemented over a 4-month period, and the CAHPS scores were compared with those from the 4 months before preceding implementation.
PURPOSE: Considering the great need for palliative care in hospitals, it is essential for hospital staff to have palliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care. However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need for further knowledge about the process of palliative consultations. The purpose of this study therefore was to examine how palliative consultations in hospitals are practised, as perceived by consultants and health care professionals on receiving wards.
DESIGN/METHODOLOGY/APPROACH: Focus groups with palliative care consultation services, health care personnel from receiving wards and managers of consultation services. Interpretive description and constant comparative method guided the analysis.
FINDINGS: Variations were seen in several aspects of practice, including approach to practice and represented professions. The palliative consultants were perceived to contribute by creating space for palliative care, adding palliative knowledge and approach, enhancing cooperation and creating opportunity to ameliorate transition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultation services utilised proactive practices that took the initiative in relation to the receiving wards.
ORIGINALITY/VALUE: A lack of policy and divergent views on how to conceptualise palliative care appeared to be associated with variations in consultation practices, tentative approaches and a bottom-up driven development. This study adds knowledge, implying theoretical transferability as to how palliative care consultations can be practised, which is useful when designing and starting new consultation services.
BACKGROUND: End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses' attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe.
METHODS: A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1320 registered nurses within 7 hospitals in Lithuania.
RESULTS: Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient's spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient's relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement.
CONCLUSIONS: Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.
INTRODUCTION: Caring for terminally ill children influences nurses' and allied health provider's quality of life, ability to provide personalized, dignified and empathetic care and even their concepts of personhood. In the absence of data this review utilizes the Ring Theory of Personhood (RToP) to evaluate how a physician's concept of personhood is affected caring for terminally ill children in order to better support them holistically.
METHODS: Using PRISMA Guidelines, 14 researchers carried out independent searches of PubMed, CINAHL, PsycINFO, Cochrane Library and gray literature databases for articles published between 2000 to 2019. Concurrent and independent employment of content and thematic analysis (Split Approach) was used to enhance the trustworthiness of the analysis.
RESULTS: 13,424 titles and abstracts were retrieved, 188 full texts were evaluated, and 39 articles were included and analyzed. Identical categories and themes identified using the Split Approach suggest that caring for dying children in PPC impacts the physician's professional identity, clinical decision making, personal well-being and relationships. The data also suggests that the magnitude of these effects depends on the presence of protective and risk factors.
CONCLUSION: Aside from providing a novel insight into the upon the physician, this review proffers a unique approach to accounting for the presence, magnitude and influence of incoming catalysts, resultant conflicts, and protective and risk factors upon the physician's personhood. Further studies into the changes in personhood are required. Design of a personalized assessment tool based on the RToP will help direct timely, appropriate and personalized support to these physicians.
Au coeur de nombreuses réformes et d'un contexte socio-économique difficile, les établissements de santé sont amenés à repnser leurs organisations et les conditions de travail sont donc modifiées. En lien avec ce contexte en perpétuel changement et le travail propre de soignant, les émotions prennent une place prépondérante. En effet, la complexification des organisations impose aux différents acteurs de s'adapter et de réinventer de nouvelles manières de travailler ensemble. Les pratiques managériales doivent également être innovantes, afin d'accompagner les soignants qui risquent de perdre leur sens de leurs pratiques professionnelles. L'auteure s'est donc intéressée aux conditions permettant les échanges, le soutien et l'expression des professionnels de santé lors des situations à forte charge émotionnelle. L'enquête par entretiens semi-directifs auprès de cadres de santé et d'infirmières permettra d'interroger le lien entre la démarche participative et intelligence émotionnelle.
Objectif: Au Québec, comme ailleurs dans le monde, bien que le soutien aux familles concernées par les soins palliatifs soit jugé prioritaire, peu de recherches ont été publiées sur le maintien de la relation familiale dans un contexte d’hospitalisation, pourtant essentielle au bien-être des patients et de leurs proches. La présente étude vise donc à décrire les perceptions de proches, plus précisément d’enfants d’âge adulte, sur les changements vécus dans la relation avec un parent hospitalisé en soins palliatifs.
Méthode: Six enfants adultes de patients hospitalisés en soins palliatifs ont participé à une entrevue semi-structurée. L’analyse des transcriptions d’entrevues s’inspire de l’analyse phénoménologique interprétative.
Résultats: Les résultats révèlent des changements de communications verbales et non verbales, notamment l’apparition de gestes d’affection et de connexions symboliques. L’adoption de rôles relationnels spécifiques au contexte, des enjeux relatifs aux perceptions d’implication, et l’intensité et l’éloignement de l’expérience affective sont aussi constatés. En outre, certaines croyances sur la mort et les moyens d’obtenir une conclusion à la relation pourraient avoir une influence sur l’expérience relationnelle des proches. Le personnel hospitalier semble aussi pouvoir agir indirectement sur la relation familiale selon les participants.
Conclusion: Cette étude postule l’existence de trajectoires distinctes d’évolution de la relation familiale en contexte d’hospitalisation en soins palliatifs. Elle permet par ailleurs de constater le rôle de la création de sens dans l’expérience des enfants adultes. Elle informe finalement les intervenants sur les aspects à considérer pour soutenir ces enfants adultes.
OBJECTIVE: Collusion is a largely unconscious, dynamic bond, which may occur between patients and clinicians, between patients and family members, or between different health professionals. It is widely prevalent in the palliative care setting and provokes intense emotions, unreflective behavior, and negative impact on care. However, research on collusion is limited due to a lack of conceptual clarity and robust instruments to investigate this complex phenomenon. We have therefore developed the Collusion Classification Grid (CCG), which we aimed to evaluate with regard to its potential utility to analyze instances of collusion, be it for the purpose of supervision in the clinical setting or research.
METHOD: Situations of difficult interactions with patients with advanced disease (N = 10), presented by clinicians in supervision with a liaison psychiatrist were retrospectively analyzed by means of the CCG. Result 1) All items constituting the grid were mobilized at least once; 2) one new item had to be added; and 3) the CCG identified different types of collusion.
SIGNIFICANCE OF RESULTS : This case series of collusions assessed with the CCG is a first step before the investigation of larger samples with the CCG. Such studies could search and identify setting-dependent and recurrent types of collusions, and patterns emerging between the items of the CCG. A better grasp of collusion could ultimately lead to a better understanding of the impact of collusion on the patient encounter and clinical decision-making.
Grief and bereavement are universal human experiences that do not discriminate based on sex, gender, or sexual orientation. Existing literature provides valuable insight into the bereavement experiences of persons who identify as heterosexuals, but much less can be found on persons who identify as lesbian, gay, bisexual, or transgender/queer* (LGBT*). Given that the historical experiences of loss and personal characteristics such as interpersonal, familial, and social patterns of coping with grief are likely to influence the bereavement process, this study focused on the impact of partner bereavement on the interpersonal relationships and subsequent partnerships of the LGBT* bereaved. To this end, the purpose of this study was to use a mixed-methods approach to better understand how LGBT* persons described their experiences with partner bereavement and to identify what effect these experiences had on interpersonal relationships and subsequent partnerships.
BACKGROUND: Little is known of how to organize non-malign palliative care, and existing knowledge show that patients with COPD live with unmet palliative needs and low quality of life. With the intent to improve palliative care for patients with COPD, we changed the structure of our outpatient clinic from routine visits by a pulmonary specialist to a structure where each patient was assigned a nurse, offered annual advance care planning dialogues, and ad hoc pulmonary specialist visits. The aim of this study was to explore COPD patients' experiences with a new and altered palliative organization.
METHODS: The design was interpretive description as described by Thorne. We conducted ten semi-structured interviews with patients with severe COPD from January 2017 to December 2017.
RESULTS: Patients described how the professional relationship and the availability of their nurse was considered as the most important and positive change. It made the patients feel safe, in control, and subsequently influenced their ability to self-manage their life and prevent being hospitalized. The patients did not emphasize the advanced care planning dialogues as something special or troublesome.
CONCLUSION: We showed that it is relevant and meaningful to establish a structure that supports professional relationships between patient, nurse and physician based on patients needs. The new way of structuring the outpatient care was highly appreciated by COPD patients and made them feel safe which brought confidence in self-management abilities.
Qu'est-ce que l'interdisciplinarité ? Ce mode d'action vise un objectif commun, au bénéfice de la personne soignée et de ses proches, en faisant collaborer les différents professionnels du soin. Elle nécessite que ceux-ci, compétents dans leur champ disciplinaire, apprennent à se connaître, à s'écouter et à se faire confiance. La ritualisation des réunions, s'appuyant sur une méthodologie et une organisation formalisées, permettent de l'initier.
Ce livre s'adresse à tous les professionnels de santé, en formation ou en exercice, qui s'interrogent sur la dynamique du soin et sur leur rôle au sein d'une équipe soignante. Il a été pensé comme un guide qui permettra aux équipes de mettre en place des actions interdisciplinaires dans leur quotidien.
There is increasing awareness of the need for effective communication in health care, particularly with people who face a frightening diagnosis and an uncertain future for themselves or someone close to them.
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Adolescent and young adults diagnosed with cancer represent a vulnerable population needing careful collaborative care from interprofessional teams. Healthcare providers must understand and appreciate the respective scopes of practice of palliative care team members to maximize the quality of care provided to these patients. A team of graduate students engaged in a collaborative learning activity to explore professional roles and responsibilities of palliative care team members when caring for adolescent and young adult oncology patients. Following a literature review and community expert interviews, students identified shared responsibilities of all team members and unique contributions of various professions. Engaging in this process highlighted and clarified the full scope of practice for each specialized team member. Educators should consider utilizing a similar collaborative learning activity to enhance students' understanding of the roles and responsibilities of each member of the interprofessional healthcare team.
Objective: Our intention was to describe and compare the perspectives of national hospice thought leaders, hospice nurses, and former family caregivers on factors that promote or threaten family caregiver perceptions of support.
METHOD: Nationally recognized hospice thought leaders (n = 11), hospice nurses (n = 13), and former family caregivers (n = 14) participated. Interviews and focus groups were audiotaped and transcribed. Data were coded inductively, and codes were hierarchically grouped by topic. Emergent categories were summarized descriptively and compared across groups.
RESULTS: Four categories linked responses from the three participant groups (95%, 366/384 codes): (1) essentials of skilled communication (30.6%), (2) importance of building authentic relationships (28%), (3) value of expert teaching (22.4%), and (4) critical role of teamwork (18.3%). The thought leaders emphasized communication (44.6%), caregivers stressed expert teaching (51%), and nurses highlighted teamwork (35.8%). Nurses discussed teamwork significantly more than caregivers (z = 2.2786), thought leaders discussed communication more than caregivers (z = 2.8551), and caregivers discussed expert teaching more than thought leaders (z = 2.1693) and nurses (z = 2.4718; all values of p < 0.05).
SIGNIFICANCE OF RESULTS: Our findings suggest differences in priorities for caregiver support across family caregivers, hospice nurses, and thought leaders. Hospice teams may benefit from further education and training to help cross the schism of family-centered hospice care as a clinical ideal to one where hospice team members can fully support and empower family caregivers as a hospice team member.
Les soignants sont confrontés à la maladie et à la mort, parfois régulièrement. Face à ces situations difficiles, les émotions qu’ils éprouvent affectent leur vie dans toutes ses composantes : corporelle, intellectuelle, spirituelle et sociale. Il est important de prendre en compte ces émotions et d’identifier les ressources qui peuvent être proposées aux soignants. La solidarité entre soignants et la cohésion d’équipe sont également essentielles.
An interprofessional education (IPE) simulation-based geriatric palliative care training was developed to educate health professions students in team communication. In health care, interprofessional communication is critical to team collaboration and patient and family caregiver outcomes. Studies suggest that acquiring skills to work on health care teams and communicate with team members should occur during the early stage of professional education. The Interprofessional Education Collaborative (IPEC®) competency-based framework was used to inform the training. An evaluation examined attitudes toward health care teams, self-efficacy in communication skills, interprofessional collaboration, and participant satisfaction with the training experience. One-hundred and eleven participants completed pre- and post-training surveys. Overall, a majority of participants (97.3%) were satisfied with the training and reported more positive attitudes toward health care teams and greater self-efficacy in team communication skills. IPE participants had higher collaboration scores compared to observer learners. Further research is needed to explore long-term effects of IPE in clinical practice.
To address job satisfaction, and therefore employment retention, of hospice social workers, this study examined how relationships with other members of the interdisciplinary hospice team and perceptions of hospice leadership may be associated with job satisfaction of hospice social workers. The sample of 203 hospice social workers was recruited by e-mailing invitations to hospice social workers identified by hospice directors in three states, use of online social media sites accessed by hospice social workers, and snowball sampling. Study measures included professional experience, hospice characteristics, interdisciplinary collaboration, perception of servant leadership, and intrinsic and extrinsic job satisfaction. Variables significant in the model for intrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, and feeling valued by the hospice physician. Variables significant in the model for extrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, feeling valued by the hospice physician, and number of social workers at the hospice. Interdisciplinary collaboration was more important for intrinsic job satisfaction and leadership style was more important for extrinsic job satisfaction. Profit status of the hospice, experience of the social worker, caseload size, and other variables were not significant in either model. These results support previous findings that leadership style of the hospice director and relationships with hospice colleagues are important for hospice social workers' job satisfaction. Such low-cost modifications to the hospice work environment, albeit not simple, may improve job satisfaction of hospice social workers.
OBJECTIVES: (1) Compare family decision-makers' perceptions of quality of communication with nursing home (NH) staff (nurses and social workers) and clinicians (physicians and other advanced practitioners) for persons with advanced dementia; (2) determine the extent to which characteristics of NH residents and family decision-makers are associated with those perceptions.
DESIGN: Secondary analysis of baseline data from a cluster randomized trial of the Goals of Care intervention.
SETTING: Twenty-two NHs in North Carolina.
PARTICIPANTS: Family decision-makers of NH residents with advanced dementia (n = 302).
MEASUREMENTS: During the baseline interviews, family decision-makers rated the quality of general communication and communication specific to end-of-life care using the Quality of Communication Questionnaire (QoC). QoC item scores ranged from 0 to 10, with higher scores indicating better quality of communication. Linear models were used to compare QoC by NH provider type, and to test for associations of QoC with resident and family characteristics.
RESULTS: Family decision-makers rated the QoC with NH staff higher than NH clinicians, including average overall QoC scores (5.5 [1.7] vs 3.7 [3.0], P < .001), general communication subscale scores (8.4 [1.7] vs 5.6 [4.3], P < .001), and end-of-life communication subscale scores (3.0 [2.3] vs 2.0 [2.5], P < .001). Low scores reflected failure to communicate about many aspects of care, particularly end-of-life care. QoC scores were higher with later-stage dementia, but were not associated with the age, gender, race, relationship to the resident, or educational attainment of family decision-makers.
CONCLUSION: Although family decision-makers for persons with advanced dementia rated quality communication with NH staff higher than that with clinicians, they reported poor quality end-of-life communication for both staff and clinicians. Clinicians simply did not perform many communication behaviors that contribute to high-quality end-of-life communication. These omissions suggest opportunities to clarify and improve interdisciplinary roles in end-of-life communication for residents with advanced dementia.