Compassionate collaborative care: an integrative review of quality indicators in end-of-life care

Abstract

BackgroundCompassion and collaborative practice are individually associated with high quality healthcare. When combined in a compassionate collaborative care (CCC) practice framework, they are reported to improve health, strengthen care provision, and control health costs. Little is known about how to integrate and measure CCC, yet it is fundamentally applied in palliative and end-of-life care settings. This study aimed to identify quality indicators of CCC by systematically reviewing and synthesizing the current state of the palliative and end-of-life care literature.MethodsAn integrative review of the palliative and end-of-life care literature was conducted using Whittemore and Knafl’s method. Donabedian’s healthcare quality framework was applied in the data analysis phase to organize and display the data. The analysis involved an iterative process that applied a constant comparative method.ResultsThe final literature sample included 25 articles. Patient and family-centered care emerged as a primary structure for CCC, with overarching values including empathy, sharing, respect, and partnership. The analysis revealed communication, shared decision-making, and goal setting as overarching processes for achieving CCC at end-of-life. Patient and family satisfaction, enhanced teamwork, decreased staff burnout, and organizational satisfaction are exemplars of outcomes that suggest high quality CCC. Specific quality indicators at the individual, team and organizational levels are reported with supporting exemplar data.ConclusionsCCC is inextricably linked to the inherent values, needs and expectations of patients, families and healthcare providers. Compassion and collaboration must be enacted and harmonized to fully operationalize and sustain patient and family-centered care in palliative and end-of-life practice settings. Towards that direction, the quality indicators that emerged from this integrative review provide a two-fold application in palliative and end-of-life care. First, to evaluate the existing structures, processes, and outcomes at the patient-family, provider, team, and organizational levels. Second, to guide the planning and implementation of team and organizational changes that improve the quality delivery of CCC.

Recurrent oral squamous cell carcinoma‐incorporating advance care planning in education and practice

“…First, the alignment of values and goals in this patient's care improved the process for team‐based decision making that involved the clinical providers, as well as the patient and her husband . These conversations happened early in her diagnosis and often throughout her management, and her providers’ honesty about prognosis facilitated a realistic picture of her disease circumstances, which allowed her to reflect on her priorities of care . For example, the avoidance of surgical facial disfigurement was important for her psychosocial function, and she adamantly refused the prospect of additional recommendations for adjuvant radiation therapy given the perceived risk of additional complications.…”

“…The role of the dentist as thoughtful, reasonable clinician, as well as patient advocate and comrade should be emphasized. This role may seem to be unique to dental oncology in a hospital setting; however, the dentist in a well‐established practice has the unique opportunity for continuity of care and advocacy based on a long‐standing interpersonal patient relationship . In particular, dentists in the community have an opportunity and obligation to participate in early diagnosis, as well as the management of oral complications of head and neck cancer therapy, and to provide the associated care continuity to patients familiar to their practice .…”

“…9 These conversations happened early in her diagnosis and often throughout her management, and her providers' honesty about prognosis facilitated a realistic picture of her disease circumstances, which allowed her to reflect on her priorities of care. 10,11 For example, the avoidance of surgical facial disfigurement was important for her psychosocial function, and she adamantly refused the prospect of additional recommendations for adjuvant radiation therapy given the perceived risk of additional complications. Second, the legal documentation of her decisions provided guidance and structure in difficult situations when emotions were heightened.…”

“…This role may seem to be unique to dental oncology in a hospital setting; however, the dentist in a well-established practice has the unique opportunity for continuity of care and advocacy based on a long-standing interpersonal patient relationship. 10 In particular, dentists in the community have an opportunity and obligation to participate in early diagnosis, as well as the management of oral complications of head and neck cancer therapy, and to provide the associated care continuity to patients familiar to their practice. [16][17][18][19] This enhancement would decrease the cost and travel burden to patients, as well as reduce the burden of care for cancer centers and provide local support to the impacted patient and their collaborative team.…”

Towards an understanding of compassion from an Islamic perspective

“…Based on knowing many aspects of the quality of care, many patients and health service recipients made unsolicited comments on the usefulness and warmth of nursing staff before, during and after providing specialised care (Coetzee & Klopper, 2010). The result of the increased technological component of health-related information, patients and those accompanying them became more sensitive not only to the quality of care, but also to the human touch behind the caring hands (Pfaf & Markaki, 2017). Calls for greater focus on compassion have been driven by reports of serious failings in compassionate care in several hospitals (Burridge, Winch, Kay, & Henderson, 2015;Youngson, 2008).…”