Interdisciplinary cooperation of GPs in palliative care at home: a nationwide survey in The Netherlands

OBJECTIVE: To investigate the occurrence and predictors of interdisciplinary cooperation of GPs with other caregivers in palliative care at home. DESIGN: In a prospective study among 96 general practices, the GPs involved identified all dying patients during the study period of 12 months. The GPs received an additional post-mortem questionnaire for each patient who died during the study period, and registered the healthcare providers with whom they cooperated. Multivariable logistic regression analysis was used to identify the predictors of GP cooperation with other caregivers. SETTING: Second Dutch National Survey in General Practice. SUBJECTS: A total of 743 patients who received palliative care according to their GP. MAIN OUTCOME MEASURES: Interdisciplinary cooperation between GP and other healthcare providers. RESULTS: During the study period, 2194 patients died. GPs returned 1771 (73%) of the questionnaires. According to the GPs, 743 (46%) of their patients received palliative care. In 98% of these palliative care patients, the GP cooperated with at least one other caregiver, with a mean number of four. Cooperation with informal caregivers (83%) was most prevalent, followed by cooperation with other GPs (71%) and district nurses (63%). The best predictors of cooperation between GPs and other caregivers were the patient's age, the underlying disease, and the importance of psychosocial care. CONCLUSION: In palliative care patients, GP interdisciplinary cooperation with other caregivers is highly prevalent, especially with informal caregivers and other primary care collaborators. Cooperation is most prevalent in younger patients, patients with cancer as underlying disease, and if psychosocial care is important.     

Predictors of home death of home palliative cancer care patients: a cross-sectional nationwide survey

Objectives

To identify factors influencing the place of death among home palliative cancer care patients, focusing on the role of nurses in terms of pre- and post-discharge from hospital to home care settings.

Design, settings and participants

A cross-sectional nationwide questionnaire survey was conducted at 1000 randomly selected homecare agencies in Japan. The questionnaires were completed by primary community nurses of home palliative patients just after their discharge. A total of 568 responses were analyzed (effective response rate, 69%).

Results

Multivariate logistic regression analysis revealed the following independent factors of place of death among those patients: desire for home death at referral by both patient and family caregiver; caregiver relationship to patient as daughter or daughter-in-law; totally bedridden functional status of patient; patient not suffering from depression and/or anxiety at referral; patients and caregivers duly informed about the dying process/death in detail, as well as instructed by community nurses about pain management and how to treat/prevent bedsores in home care settings.

Conclusions

This study demonstrated the importance of both the hospital and community nurses’ role in increasing the patients’ chance of dying at home. Hospital nurses should support early transfer to home palliative care according to their assessment of the desire of patient/family caregiver for home death, the patients’ clinical status, and caregivers’ ability to provide patient care at home. Community nurses should inform patients/family caregiver in detail about the dying process/death just after discharge, relieve patient pain, treat/prevent bedsores, and instruct family caregivers on their symptom control.     

A comprehensive picture of palliative care at home from the people involved

The purpose of this study was to identify the comprehensive picture of palliative care in the home, as experienced by the people involved. The study is a secondary analysis of three phenomenological studies including six cancer patients, six next of kin and six district nurses. Data were collected in qualitative interviews using an interview guide. The interviews were tape-recorded and transcribed verbatim. In this secondary analysis, data were analysed by hermeneutic analysis guided by Gadamer. The guiding questions during the reading were: Is there an advantage receiving palliative care at home? Is there a disadvantage receiving palliative care at home? The findings indicate that the advantages of palliative care at home is; striving for normal life, including the care in the home composed of physical care and emotional/mental care. Striving for normal life also includes emotional feelings, safety and resources and policies which regulates this activity. Disadvantages of palliative care at home are commitment, composed of adaptation and extra work, and demands, composed of frustration and uncertainty. If the people involved are to be able to manage the situation and optimize living while dying, there must be support and resources facilitating the situation.     

Treatment adherence and patients’ acceptance of home infusions with adenosine 5′-triphosphate (ATP) in palliative home care

Goals of work  In preterminal cancer patients, provision of palliative care in the patients’ own environment is preferred. The aim of the present study was to evaluate patients’ and caregivers’ treatment adherence and patients’ acceptance of home infusions with adenosine 5′-triphosphate (ATP). Patients and methods  Preterminal cancer patients (life expectancy <6 months) with mixed tumor types were eligible for the study. Patients received a maximum of eight weekly intravenous 8–10 h ATP infusions. Evaluation of treatment adherence was based on registration of protocol deviations and patients’ acceptance by structured interviews with patients. Main results  Fifty-one patients received a total of 266 intravenous ATP infusions. The infusion protocol was well executed: mean duration ≈8.30 h, stepwise achievement of the maximum infusion rate within 30 min in 65% of the infusions, and almost no delay in weekly administration. All except one patient were not burdened by the administration of the infusions at home and none of them had felt afraid. The majority of patients found the advantages of the ATP infusions outweighing the disadvantages. However, an important bottleneck in the administration of ATP infusions at home was difficulty in establishing venous access. Conclusion  ATP infusions at home are well accepted by patients. Difficulties in establishing venous access might be reduced by composing specialized home infusion teams working both at the day care center and at home or by adopting an alternative route of venous access.     

我国肿瘤患者居家护理研究文献的计量分析

目的 对我国居家肿瘤患者的护理状况进行文献回顾和分析,了解其研究现状和存在的问题,为我国居家护理实践和护理科研提供参考。方法 分别以“居家”、“肿瘤”、“护理”为关键词或主题词”对中国知网、万方、维普、中国生物医学文献数据库公开发表的我国肿瘤患者居家护理的相关文献进行检索分析,检索时限为建库至2020年4月。对题名、发表年份、期刊、著者数、第一作者(地域、机构、机构属性)、通讯作者、基金情况、文献类型、研究内容,关键词、资料收集方法等进行统计分析。结果 共获得201篇期刊文献,发文量随年份变化呈递增趋势,纳入期刊发表文献种类众多,共发表在108种期刊上,文献第一作者所属省份地区差异大,以江苏,上海等地居多。有基金支持的文献占比37%,研究类型以类试验性研究为主,研究内容集中于癌痛、PICC、用药和居家宁养等方面。结论 我国肿瘤患者居家护理相关的实验性研究质量相对较差,有待提高,且发文量地域差异大,居家护理实践需借助互联网的独特优势,突破地域限制。同时居家肿瘤患者重点护理问题突出,我国护理管理者应进一步规范相关护理技术规范,保证居家护理的规范性、安全性。     

The involvement of intensive care nurses in end-of-life decisions: a nationwide survey

Objective To investigate the prevalence and predictors of intensive care nurses active involvement in end-of-life (EOL) decisions.Design and setting A survey of intensive care nurses from 36 intensive care units (ICUs) in New Zealand.Measurements and results A total of 611 ICU nurses from 35 ICUs responded to this survey. The response rate was estimated to be between 43% and 81%. Seventy-eight percent of respondents reported active involvement in EOL decisions, especially the senior nurses (level IV vs. I nurses, OR 7.9; nurse educators vs. level I nurses, OR 4.3). Asian (OR 0.2) and Pacific Islander nurses (OR 0.2) were less often involved than European nurses. Sixty-eight percent of respondents preferred more involvement in EOL decisions, and this preference was associated with the perception that EOL decisions are often made too late (OR 2.2). Sixty-five percent believed their active involvement in EOL decisions would improve nursing job satisfaction.Conclusions Most ICU nurses in New Zealand reported that they are often involved in EOL decisions, especially senior and European nurses.     

基于多学科协作的缓和医疗在心力衰竭患者中应用的Meta分析

目的:评价基于多学科协作的缓和医疗在心力衰竭患者中的应用效果。方法:计算机检索PubMed、Embase、CINAHL、The Cochrane Library、中国生物医学文献数据库、中国知网、万方数据库、维普等中英文数据库中有关心力衰竭患者实施缓和医疗的随机对照试验,检索时限为建库至2020年12月31日。由2名研...     

Interventions to support people with dementia and their caregivers during the transition from home care to nursing home care: A systematic review

BackgroundDuring the transition of people with dementia from home to nursing home family caregivers often feel burdened.ObjectivesWe aimed to 1) identify interventions which support people with dementia and their caregivers in the transition from home care to nursing home care, 2) synthesize the evidence for efficacy of these interventions, and 3) examine whether the identified interventions have been systematically developed, evaluated and implemented according to the Medical Research Council guidance on complex interventions.DesignA systematic review of randomised controlled trials was conducted according to the recommendations specified in the Cochrane Handbook for Intervention Reviews. The review protocol was registered in PROSPERO (2015: CRD42015019839). Reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement.Data sourcesMEDLINE, CENTRAL, PsycINFO, CINAHL, OTseeker, and PEDro, were searched. Other sources included Google Scholar, and ALOIS.Review methodsTwo reviewers independently assessed the eligibility of the articles. Data extraction was performed by one reviewer and verified independently by another. The Cochrane Risk of Bias tool was used for critical appraisal. Development and evaluation of the identified interventions were assessed, taking the Medical Research Council guidance into account. Review findings were synthesized narratively.ResultsThe search yielded 1278 records. Five studies were included, all conducted in the United States (4 RCTs and 1 cRCT with a total of 695 participants). The psychosocial interventions were individual and family counseling via telephone or ad hoc all of which addressed only informal caregivers. The intervention components, content and mode of delivery differed widely with inconsistent results. Significant intervention effects were found for the reduction of caregivers’ depressive symptoms, burden, feeling of guilt, emotional distress, overload, and interactions with staff. Other outcomes, i.e. stress, placement adaptation, role overload, and role captivity, were not statistically significantly affected. The assessment for bias risk across studies varied from moderate to low. Only two studies tested the feasibility of the intervention before full scale evaluation, none evaluated the implementation process according to the Medical Research Council framework.ConclusionsWe identified only a few studies with heterogeneous outcomes; evidence regarding the effectiveness of psychosocial interventions is thus insufficient. Further research is needed focusing on the development and evaluation of complex psychosocial interventions and more well-designed RCTs with larger sample sizes based on a rigorous methodology. Reporting on feasibility and implementation processes of interventions should be guaranteed, since it is crucial to evaluate transferability across care settings.     

近10年国内外老年居家护理研究热点的对比分析

目的探讨国内和国外老年居家护理研究热点的差异,为我国老年居家护理研究提供参考。方法基于CNKI、Web of Science核心合集,检索2010年1月1日—2020年7月8日收录的国内外老年居家护理相关文献,采用SPSS、COOC等软件对检索结果进行可视化分析。结果近10年国内和国外老年居家护理共同研究热点为健康教育、家庭照顾者、生活质量、老年痴呆、社区护理、长期护理。国内和国外学者对老年痴呆、长期护理研究的侧重点不同。近10年国内外老年居家护理研究热点差异体现在护理模式、家庭功能、老年人身心健康管理等方面,国内学者多关注老年人躯体疾患管理,国外学者在居家老年人疾病管理上更注重老年人健康管理、尊严等高维度需求的满足。结论近10年国内外老年居家护理研究热点差异主要集中在护理层面,国内注重疾病护理,国外更注重高维度的心理需求与健康水平管理;提示我国学者可以开展老年人高维度需求方面的现状调研,以及满足策略的相关研究。     

Factors related to the acceptance of home care and nursing homes among older Egyptians: A cross-sectional study

Background

Socio-demographic changes may deprive older Egyptians from receiving care by family members and raise the question of how they react if they become dependent on help.

Objective

The objective of this study was to determine factors related to the acceptance of home care and nursing homes among older Egyptians.

Design

A two group comparative design based on self-reports.

Participants

The sample was composed of 344 older persons receiving home care or staying in a nursing home and 267 non-care recipients.

Setting

The study was conducted in Greater Cairo.

Methods

Factors related to the acceptance of home care and nursing homes were determined separately for each group by logistic regression.

Results

Lesser feelings of shame while receiving care from non-family members were related to an increased acceptance of both kinds of care. For non-care recipients disagreement to the traditional idea of family care had a similar effect. For care recipients the experience made with a particular kind of care was strongly related to its acceptance.

Discussion

Home care is a new phenomenon in Cairo and in contrast to nursing homes it was unknown to most study participants. For this reason any conclusion about which kind of service is preferred by older Egyptians would be a premature one.

Conclusion

Feelings of shame while receiving care from a non-family member are more important than functional limitations when older Egyptians are considering the options of home care and nursing homes.     

Roles, service knowledge and priorities in the provision of palliative care: a postal survey of London GPs

OBJECTIVES: To explore general practitioners' (GPs) current involvement in and attitudes towards the provision of palliative care in primary care. METHODS: Postal survey of 356 London-based GPs, assessing attitudes towards palliative care provision, district nursing and specialist palliative care services, and priorities for future service development. RESULTS: Currently, 65% of GPs were providing palliative care to patients on their list; 72% agreed or strongly agreed palliative care was a central part of their role; and 27% wanted to hand care over to specialists. Most GPs (66%) disagreed with the statement that 'palliative care is mainly district nursing (DN) work'. Many were unaware of out-of-hours DN and specialist palliative care services. Multi-variable analysis found four GP characteristics--larger practice size, more years experience as a GP, receipt of palliative care education, and current provision of palliative care--were associated with agreement that palliative care was central to a GP's role. CONCLUSION: A minority of NHS GPs in London would rather have no involvement in palliative care in primary care. Knowledge of current services for palliative care is generally poor among GPs. These findings highlight potential gaps in services, particularly in small practices. Specialists will need to consider these factors in working with GPs to develop primary palliative care and to enable greater access to specialist palliative care.     

The current status of palliative care teams in Japanese University Hospitals: a nationwide questionnaire survey

Goal Although the importance of the palliative care team (PCT) to university hospitals is widely accepted, the issues of palliative care at the national level have not been clarified. We conducted a nationwide survey of the current status of PCTs in all (123) Japanese university hospitals. Materials and methods In 2003, 2004 and 2005, the authors conducted a self-reporting cross-sectional survey. Questionnaires were mailed to nursing directors and selected PCT members of all Japanese university hospitals. Results Of 123 hospitals in 2005, 99 (80%) returned the questionnaire; 33% used PCTs, and 11% used certified PCTs. Our findings include: annual number of patients treated by PCTs (83/70 ± 64, mean/median ± SD), daily number of patients treated by PCTs (12/11 ± 14), and days of PCT care per patient (30/30 ± 22). Certified PCTs treated more patients per year (p = 0.004) and more patients per day (p < 0.001) compared to noncertified PCTs. Over the 3-year period, the number of hospitals utilizing PCTs only slightly increased (2003: 27%, 2004: 29%, 2005: 33%), as did those using certified PCTs (2003: 3%, 2004: 9%, 2005:11%). In 2005, the reasons for noncertification of PCTs included “lack of physicians who specialize in palliative care (82%)” and “lack of nurses who specialize in palliative care (56%).” Conclusions The entire system of palliative care in Japanese university hospitals is currently insufficient. The lack of physicians and nurses who specialize in palliative care is a significant barrier, and therefore, the initiation of a formal training system for these health care professionals is a high priority issue. The Society of Paliative Care for University Hospital.     

高等医学院校安宁疗护教育的发展现状

安宁疗护教育是提高医学生临终照护能力,巩固和促进安宁疗护学科发展的基石。该文对国内外安宁疗护教育中的课程设置、教学形式与方法、实践基地建设、师资力量及考核方式进行回顾,针对我国安宁疗护教育中存在的不足,通过借鉴国外经验为完善我国医学院校安宁疗护教育提出可行性建议。     

The experience of family caregivers caring for a terminal patient at home: A research review

IntroductionOne of the key aspects of the care of terminal patients is care delivered in their own home. Increasingly, the process of dying is moving from hospitals to homes. Although this process is directly related to the support of the social health environment, the involvement of family caregivers is essential. Given the impact that caring for a terminally ill family member has on people’s lives, it is necessary to comprehend their personal experience in a holistic way.ObjectiveTo reveal the experience of family caregivers who are caring for a terminal patient in their home.DesignA qualitative systematic review of articles published from 2000 to 2015 was conducted between March and September of 2015. The following databases were consulted: CINAHL, PubMed, PsycINFO, Cochrane Library, SciELO and Dialnet. After applying the selection criteria, 12 relevant studies were identified. Subsequently, two of the reviewers jointly performed a qualitative content analysis of them.ResultsThe analysis permitted the caregivers’ experiences to be grouped into five themes: 1) Learning the diagnosis: uncertainty about the future and the prospects of death; 2) Feeling the physical and emotional burden of care; 3) Experiencing a limited life; 4) Redefining the relationship with the person being cared for; and 5) Valuing the importance of the support of the environment.ConclusionsThis review shows that caring for a family member with advanced illness in the home has a great impact on the personal realm of the caregiver and in the relationship he or she maintains with the ill family member. Being involved in the process of dying translates into a prodigious physical and psychological effort, together with a substantial limitation on the normal development of their own life. Additionally, the caregiver must face and establish a new relationship with the family member, in accordance with the new ethos, without the help of a formal structure providing the necessary support. These results may help to focus attention on family caregiver needs and to develop the knowledge necessary to meet the current demands of end-of-life health care in the home.     

肺移植受者居家护理需求质性研究的Meta整合

目的 系统评价和整合肺移植受者居家护理需求的质性研究,为制订以肺移植受者需求为导向的健康教育并开展延续性护理服务提供依据。 方法 检索PubMed、Embase、Web of Science、Cochrane Library、CINAHL、ProQuest、中国知网、万方数据库、维普数据库、中国生物医学文献数据库关于肺移植受者居家护理需求的质性研究,检索时限为建库至2020年8月。使用“澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准（2016）”评价文献质量,采用Meta整合方法对结果进行整合。 结果 共纳入11篇研究,提炼出60个研究结果,归纳出11个新类别,最终综合为信息需求、生理需求、心理精神需求和社会需求4个整合结果。 结论 肺移植受者居家护理需求具有多样化、特殊性的特点。移植团队应高度重视肺移植受者的居家护理需求,根据需求情况为其提供居家教育、监测、肺康复指导和社会支持,进而提高肺移植受者的自我管理能力和生活质量。