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Palliative AND (Nursing Home OR Community)

Liesbeth Vanderveken, Birgitte Schoenmakers, Jan De Lepeleire
OBJECTIVE: The goal of palliative care is to improve quality of life when recovery is no longer possible. The study's objective was to widen our vision of potential (unspoken) needs at the end of life with patients, close relatives, nurses, and general practitioners to aim at more versatile but personal care. The question asked was how important patients, close relatives, and healthcare providers considered the 11 core themes in defining a good death, as described in the 2016 article "Defining a good death" by Meier et al...
December 18, 2018: American Journal of Geriatric Psychiatry
Barret Rush, Clark Fruhstofer, Keith R Walley, Leo Anthony Celi, Mayur Brahmania
BACKGROUND: Patients with end-stage liver disease (ESLD) have a reduced life expectancy and a significant symptom burden. Our aim is to determine if inpatient palliative care (PC) referral for patients with ESLD is associated with decreased hospital readmission rates. METHODS: The 2013 US Nationwide Readmission Database (NRD) was used for the current analysis. The NRD allows for longitudinal analysis of all patient hospital admissions across 22 states. Patients ≥18 years of age with a diagnosis of ESLD with at least two decompensating events were included in the analysis...
February 13, 2019: BMJ Supportive & Palliative Care
Hilary Stiel, Srivalli V Nagarajan, Benjamin C Forster, Josephine M Clayton
BACKGROUND: As modern medicine extends the life expectancy of patients with life-limiting illnesses and health system resource pressures intensify, palliative care physicians increasingly need to transfer stable patients from specialist palliative care units to nursing homes. The experience of palliative care physicians in decision-making and communicating with patients and families about the need for this transition is underexplored in the literature. AIM: This study aimed to explore the experiences of and communication techniques used by palliative care physicians as they consider and discuss nursing home placements for their patients...
March 2019: Palliative Medicine
Hsien Seow, Lialoma Salam-White, Daryl Bainbridge
BACKGROUND: Access to community-based specialist palliative care teams has been shown to improve patients' quality of life; however, the impact on health system expenditures is unclear. This study aimed to determine whether exposure to these teams reduces health system costs compared with usual care. METHODS: We conducted a retrospective matched cohort study in Ontario, Canada, using linked administrative data. Decedents treated by 1 of 11 community-based specialist palliative care teams in 2009/10 and 2010/11 (the exposed group) were propensity score matched (comorbidity, extent of home care, etc...
January 2019: CMAJ Open
Stephen Barclay, Emily Moran, Sue Boase, Margaret Johnson, Roberta Lovick, Jonathan Graffy, Patrick L White, Brenda Deboys, Katy Harrison, Brooke Swash
INTRODUCTION: Primary care has a central role in palliative and end of life care: 45.6% of deaths in England and Wales occur under the care of primary care teams at home or in care homes. The Community Care Pathways at the End of Life (CAPE) study investigated primary care provided for patients in the final 6 months of life. This paper highlights the opportunities and challenges associated with primary palliative care research in the UK, describing the methodological, ethical, logistical and gatekeeping challenges encountered in the CAPE study and how these were addressed...
February 12, 2019: BMJ Supportive & Palliative Care
Bella Vivat, Lucy Bemand-Qureshi, Jane Harrington, Sarah Davis, Patrick Stone
BACKGROUND: Little research has explored the detail of practice when using sedative medications at the end of life. One work package of the I-CAN-CARE research programme investigates this in UK palliative care. AIMS: To investigate current practices when using sedative medication at the end of life in London, UK, by (1) qualitatively exploring the understandings of palliative care clinicians, (2) examining documented sedative use in patient records and (3) comparing findings from both investigations...
February 12, 2019: Palliative Medicine
Nisha Sutherland, Elaine Wiersma, Paula Vangel
ABSTRACTAlthough providing direct care to residents with dementia, long-term care (LTC) home staff of registered nurses', registered practical nurses', and personal support workers' involvement in end-of-life decision-making is rarely acknowledged. The purpose of this study was to examine barriers and facilitators to LTC home staff involvement in end-of-life decision-making for people with advanced dementia. We report on the barriers to staff involvement in decision-making. Using an interpretive descriptive design, four major barriers to staff involvement in decision-making were identified: (a) the predominance of a biomedical model of care; (b) a varied understanding of a palliative approach; (c) challenging relationships with families; and (d) a discomfort with discussing death...
February 11, 2019: Canadian Journal on Aging, la Revue Canadienne du Vieillissement
Kathryn Huber, Kanan Patel, Sarah Garrigues, Bruce Leff, Christine Ritchie
OBJECTIVES: The objective of this study was to describe the use of interdisciplinary teams (IDTs) in home-based medical care practices. DESIGN: We performed a secondary data analysis using results from the 2013 National Home-Based Primary Care and Palliative Care Network survey of home-based medical care (HBMC) practices. SETTING AND PARTICIPANTS: Two hundred forty-six unique HBMC practices were included in this study. METHODS: Descriptive statistics and frequency distributions were generated on the sample characteristics, practice IDT configurations, and routine use of IDT meetings...
February 6, 2019: Journal of the American Medical Directors Association
Rekha Rachel Philip, Emilie Venables, Abdulla Manima, Jaya Prasad Tripathy, Sairu Philip
BACKGROUND: Home-based palliative care is an essential resource for many communities. We conducted a qualitative study to explore perceptions of a home-based palliative care programme in Kerala, India, from the perspective of patients, their care-givers and the doctors, nurses and volunteers running the intervention. METHODS: A descriptive qualitative study was carried out. One focus group discussion (FGD) was conducted with patients (n = 8) and two with male and female volunteers (n = 12); and interviews were conducted with doctors (n = 3), nurses (n = 3) and care-givers (n = 14)...
February 4, 2019: BMC Palliative Care
Charmaine L Blanchard, Oluwatosin Ayeni, Daniel S O'Neil, Holly G Prigerson, Judith S Jacobson, Alfred I Neugut, Maureen Joffe, Keletso Mmoledi, Mpho Ratshikana-Moloko, Paul E Sackstein, Paul Ruff
CONTEXT: Identifying factors that affect terminally ill patients' preferences for and actual place of death may assist patients to die where they wish. OBJECTIVE: To investigate factors associated with preferred and actual place of death for cancer patients in Johannesburg, South Africa. METHODS: In a prospective cohort study at a tertiary hospital in Johannesburg South Africa, adult patients with advanced cancer and their caregivers were enrolled from 2016 to 2018...
January 29, 2019: Journal of Pain and Symptom Management
Shirley Willis, Sally Anstey
This article encourages nurses to explore leadership in district nursing practice and community teams. The challenges faced by district nurses are discussed in relation to the current health policy agenda in Wales and the increasingly complex care demands being placed on district nursing services because of the aging population and the rise in numbers of individuals living longer with multiple long-term health conditions. The concept of compassionate leadership is presented and discussed using a case study approach...
February 2, 2019: British Journal of Community Nursing
Rowena Ivers, Brad Jackson, Trish Levett, Kyla Wallace, Scott Winch
OBJECTIVE: To evaluate the acceptability of a cancer care team based at an Australian Aboriginal medical service in supporting patients' cancer journeys and to assess improvements in access to cancer care. DESIGN: The cancer care team consisted of an Australian Aboriginal health worker, counsellor and enrolled nurse employed for 2 days a week, supported by a general practitioner. The cancer care team supported patients from prediagnosis while investigations were being undertaken, at diagnosis and through treatment, such as surgery, chemotherapy and radiotherapy, and follow-up, including to palliative care and grief support where these were required...
January 29, 2019: Australian Journal of Rural Health
Cecilia W M Kwan, Carmen W H Chan, Kai Chow Choi
BACKGROUND: A life review is a promising intervention to enhance spiritual well-being in older people. Conventional life review interventions are lengthy and often led by psychologists. OBJECTIVES: This is the first randomised controlled trial study to examine the effectiveness and applicability of a nurse-led short term life-review intervention in people with life limiting diseases, the purpose being to enhance their spiritual well-being and lower their anxiety and depression...
January 3, 2019: International Journal of Nursing Studies
Antje Freytag, Markus Krause, Anna Bauer, Bianka Ditscheid, Maximiliane Jansky, Sabine Krauss, Thomas Lehmann, Ursula Marschall, Friedemann Nauck, Werner Schneider, Kathleen Stichling, Horst Christian Vollmar, Ulrich Wedding, Winfried Meißner
BACKGROUND: Since 2007, the German statutory health insurance covers Specialized Outpatient Palliative Care (SAPV). SAPV offers team-based home care for patients with advanced and progressive disease, complex symptoms and life expectancy limited to days, weeks or months. The introduction of SAPV is ruled by a directive (SAPV directive). Within this regulation, SAPV delivery models can and do differ regarding team structures, financing models, cooperation with other care professionals and processes of care...
January 26, 2019: BMC Palliative Care
Jina M Taub, Heather Coats, Curtis Coats, Ardith Doorenbos, Rajeswari Siva, Vathsala Sadan, Greeda Alexander, Shandrila Immanuel, Vinitha Ravindran, Selva Titus Chacko, Riana Nolet
BACKGROUND: A public health approach to palliative care supports community-dwelling adults with advanced illness. A better understanding of successful community-based palliative care programmes and partnerships is needed to expand community-based services for ageing populations. AIMS: This study describes two organisations in two different countries that provide health and social services to community-dwelling adults with advanced illness. METHODS: Unstructured key-informant interviews and observational data were collected at the Christian Medical College's College of Nursing Community Health Programme (Vellore, India) and at Phinney Neighborhood Association Village (Seattle, Washington, USA)...
January 2, 2019: International Journal of Palliative Nursing
Arno Maetens, Kim Beernaert, Robrecht De Schreye, Kristof Faes, Lieven Annemans, Koen Pardon, Luc Deliens, Joachim Cohen
OBJECTIVES: To evaluate the impact of palliative home care support on the quality of care and costs in the last 14 days of life. DESIGN: Matched cohort study using linked administrative databases. SETTING: All people who died in Belgium in 2012 (n=107 847). PARTICIPANTS: 8837 people who received palliative home care support in the last 720 to 15 days of life matched 1:1 by propensity score to 8837 people who received usual care...
January 21, 2019: BMJ Open
Sixten Elmstedt, Hanna Mogensen, Dan-Erik Hallmans, Björn Tavelin, Staffan Lundström, Magnus Lindskog
BACKGROUND: One-quarter of all cancer deaths in Sweden occur in hospitals. If the place of death affects the quality of end-of-life (EOL) is largely unknown. METHODS: This population-based, retrospective study included all adults cancer deaths reported to the Swedish Register of Palliative Care in 2011-2013 (N = 41,729). Hospital deaths were compared to deaths occurring in general or specialised palliative care, or in nursing homes with respect to care quality indicators in the last week of life...
January 11, 2019: Acta Oncologica
Valentin Kouyoumdjian, Elise Perceau-Chambard, Corinne Sisoix, Marilène Filbet, Colombe Tricou
AIM: The aim of the present study was to find out physicians' perceptions about the transfer of dying nursing home residents to emergency departments. METHOD: This qualitative study used semi-structured interviews, and data were analyzed using qualitative methods. Participants were medical directors of nursing homes who were informed by e-mail and included when they agreed to take part in our study. RESULTS: We interviewed 12 medical directors until data saturation...
January 8, 2019: Geriatrics & Gerontology International
Kirsten Evenblij, Maud Ten Koppel, Tinne Smets, Guy A M Widdershoven, Bregje D Onwuteaka-Philipsen, H Roeline W Pasman
BACKGROUND: End-of-life conversations are rarely initiated by care staff in long-term care facilities. A possible explanation is care staff's lack of self-efficacy in such conversations. Research into the determinants of self-efficacy for nurses and care assistants in end-of-life communication is scarce and self-efficacy might differ between care staff of mental health facilities, nursing homes, and care homes. This study aimed to explore differences between care staff in mental health facilities, nursing homes, and care homes with regard to knowledge about palliative care, time pressure, and self-efficacy in end-of-life communication, as well as aiming to identify determinants of high self-efficacy in end-of-life communication...
January 8, 2019: BMC Palliative Care
Linda Read Paul, Charleen Salmon, Aynharan Sinnarajah, Ron Spice
PURPOSE: Providing specialized palliative care support to elderly patients in rural areas can be challenging. The purpose of this study was to gain a preliminary understanding of the experience of using mobile web-based videoconferencing (WBVC) for conducting in-home palliative care consults with elderly rural patients with life-limiting illness. METHODS: This was a descriptive, exploratory, proof-of-concept study with a convenience sample of 10 WBVC visits. A palliative care clinical nurse specialist (PC-CNS), in the home with the patient/family and home care nurse (HC-N), used a laptop computer with webcam and speakerphone to connect to a distant palliative care physician consultant (PC-MD) over a secure Internet connection...
January 7, 2019: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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