Concepts and definitions for “supportive care,” “best supportive care,” “palliative care,” and “hospice care” in the published literature, dictionaries, and textbooks

Purpose

Commonly used terms such as “supportive care,” “best supportive care,” “palliative care,” and “hospice care” were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms.

Methods

We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched.

Results

Nine of 32 “SC/BSC,” 25 of 182 “PC,” and 12 of 42 “HC” articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. “SC” focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, “HC” focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both “PC” and “SC/BSC” were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for “SC/BSC,” “PC,” and “HC,” respectively. “SC/BSC” was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings.

Conclusion

We identified defining concepts for “SC/BSC,” “PC,” and “HC” and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions.     

Is anyone listening? Does anyone care? Menopausal and postmenopausal health risks, outcomes, and care

Healthy People 2000, the national strategy for improving the health of individuals in the United States, provides direction for the prevention of chronic illnesses, injuries, and infectious diseases by specifying desired outcomes for specific populations. The authors focus on outcomes for several illnesses and conditions known to significantly affect the health of women who are menopausal or postmenopausal. These include osteoporosis, hypertension, cardiovascular disease, stroke, diabetes mellitus type 2, congestive heart failure, and obesity. Suggestions for advanced nurse practitioner assessment and intervention are provided for the reader.     

Health care providers’ perception,knowledge, barriers and practice of kangaroo care for preterm baby in Indonesia

This study explored the health care providers' perception, knowledge, barriers and practice of Kangaroo Mother Care (KMC) for premature infants. Total of 111 participants working in NICU and Perinatology wards from four hospitals in Central Java, Indonesia were recruited to this study. The participants were invited to complete the four sections of the Kangaroo Mother Care Questionnaire. Generally they have been practicing KMC with good perception even with deficient knowledge about KMC. Yet the health care providers perceived high barriers to practice KMC and perceived uncomfortable practicing KMC in certain situation. KMC practice in Indonesia need to be highly promoted to be practiced and campaigned thus the health care providers’ negative perception could be reduced as well as educate them to be more confident practicing KMC with adequate knowledge.     

Accountable care organizations, the patient-centered medical home, and health care reform: what does it all mean?

Medical care in the United States is plagued by extremely high costs, poor quality, and fragmented delivery. In response, new concepts of integrated health care delivery have developed, including patient-centered medical homes and accountable care organizations (ACOs). This article reviews these concepts and includes a detailed discussion of the Centers for Medicare and Medicaid Services' ACO and Shared Savings Proposed Rule.     

Headache patients in primary care and a tertiary care unit in Zürich, Switzerland

The Headache and Pain Clinic (HPC) is a unit of the Zürich Neurology Department, established in 1966. In the present study demographic features, clinical characteristics and medical management of primary and tertiary care patients were compared in two groups of 181 patients each, seen by general practitioners (GPs) or the HPC, respectively, for primary headaches in 1998. There was a preponderance of women and the socially underprivileged in both samples. Chronic headache was overrepresented in the HPC (44.7%). Loss of work for >2 months was found exclusively in the HPC (9.9%). Of the GP patients, 40% were using triptans and 26.5% in the HPC. One-third of both groups had had complementary and alternative medical treatment. Differences in management strategies reflected differences in headache severity and chronicity. Results indicated that remaining shortcomings of diagnosis and treatment of headache in primary care could be minimized by involving GPs in similar non-commercial studies.     

ACOs, PCMHs, and health care reform: nursing's next frontier?

National health reform includes an emphasis on integrated service delivery models including Accountable Care Organizations and Patient-Centered Medical Homes. These value-based models of care delivery may offer opportunities for nursing to advance its patient care and profession. This paper presents four pillars of health care delivery reform-team-based care; cross-team communication, coordination and collaboration; infrastructure and technology; and aligned payment incentives -intended to improve quality of care while reducing cost increases. Opportunities and challenges for nursing are discussed in this context.     

Knowledge of,and participation in,advance care planning: A cross-sectional study of acute and critical care nurses’ perceptions

BackgroundNurses have a core role in facilitating discussions and enacting decisions about end-of-life issues for patients in hospitals. Nurses’ own knowledge and attitudes may influence whether they engage in meaningful end-of-life conversations with patients.AimsTo determine in a sample of nurses working in acute and critical care hospital wards:1) their knowledge of advance care planning, including the authority of substitute decision-makers and legal validity of advance directives;2) their own participation in advance care planning decision-making practices; and3) associations between nurses’ socio-demographic characteristics; clinical expertise; and knowledge and behaviour in relation to advance care planning practices.DesignQuestionnaire-based, cross-sectional study.Setting and participantsThe study was conducted with 181 registered and enrolled nurses employed in acute and critical care wards of three metropolitan hospitals in Australia.ResultsNurses were least knowledgeable about items relating to the authority of medical (56%) and financial (42%) substitute decision-makers. Few nurses had prepared advance directives (10%) or appointed medical (23%) or financial (27%) decision-makers, when compared to discussing end-of-life wishes (53%) or organ donation (75%). Overall, 15% of nurses had not engaged in any advance care planning practices. Nurses who had cared for 11–30 dying patients in the last six months were more likely to have an increased knowledge score. Older nurses were more likely to participate in a greater number of advance care planning practices and an increase in shifts worked per week led to a significant decrease in nurses’ participation.ConclusionNurses have a key role in providing advice and engaging dying patients and their families in advance care planning practices. Nurses’ own knowledge and rates of participation are low. Further education and support is needed to ensure that nurses have an accurate knowledge of advance care planning practices, including how, when and with whom wishes should be discussed and can be enacted.     

The specialist palliative care team in Forlì, Italy

 A specialist palliative care team (SPCT) for the care of terminal cancer patients was established at Forlì in 1986. Over the years, its staff and the patients cared for have been increasing in numbers up to the present levels of importance. For 12 years the service was supplied by a private institution, Istituto Oncologico Romagnolo (IOR). The National Health Service (NHS) has since stepped in and is now supplying home care directly, leaving the IOR with a cultural, supporting, role and with the promotion of volunteer recruitment. The care provided by the specialist group active in the patients' homes is integrated into the primary care provided by the family doctors. A plan is being realized to establish a palliative care unit (PCU) within the city hospital. The group has also been engaged in research for many years, giving special attention both to prognostic factors in very advanced cancer patients and to the organization and evaluation of the service costs. Moreover, two training courses in palliative care are organized biennially, one for all health workers in the region and one for volunteers co-operating with the medical teams. Published online: 3 August