Factors associated with unscheduled care use by cancer decedents: a systematic review with narrative synthesis

Mills, Sarah; Geneen, Louise J; Buchanan, Deans; Guthrie, Bruce; Smith, Blair H.

doi:10.1136/bmjspcare-2020-002410

Cited by 8 publications

(7 citation statements)

References 44 publications

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“…Several authors have shown the usefulness of a nurse specialist in PC in the ES, or that the collaboration between the emergency department and PC was positive, as we mentioned above would improve health care. Likewise, the widespread complaint was for lack of time, overload, lack of training or inadequate training with respect to the scope of PC [31,32]. In fact, some authors say that respiratory and gastrointestinal oncological processes can be well managed without using emergency units [33].…”

Section: Discussionmentioning

confidence: 99%

Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review

et al. 2020

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Background and objectives: Palliative care (PC) prevents and alleviates patients´ suffering to improve their quality of life in their last days. In recent years, there has been an increase in visits to the emergency services (ES) by patients who may need this type of care. The aims were to describe the training and capacitation of nurses from ES in PC. Accordingly, a systematic review was performed. Materials and Methods: Medline, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were used. The search equation was “Palliative care and nursing care and emergency room”. A total of 12 studies were selected. Results: The studies agree on the need for training professionals in PC to provide a higher quality care, better identification of patient needs and to avoid unnecessary invasive processes. Similarly, the implementation of a collaborative model between ES and PC, the existence of a PC specialized team in the ES or proper palliative care at home correspond to a decrease in emergency visits, a lower number of hospitalizations or days admitted, and a decrease in hospital deaths. Conclusions: The development of PC in the different areas of patient care is necessary. Better palliative care leads to a lower frequency of ES by terminal patients, which has a positive impact on their quality of life. Access to PC from the emergency unit should be one of the priority health objectives due to increment in the aged population susceptible to this type of care.

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Section: Discussionmentioning

confidence: 99%

Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review

et al. 2020

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“…Unscheduled care research has focussed previously on emergency department attendance and people with cancer. [27][28][29] This study included all NHS unscheduled healthcare services and people who died from any underlying cause. Cohort studies using large administrative datasets are being used increasingly to measure healthcare systems outcomes and screen populations with serious illness for palliative care and care planning.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Integrating lived experiences of out-of-hours health services for people with palliative and end-of-life care needs with national datasets for people dying in Scotland in 2016: A mixed methods, multi-stage design

et al. 2022

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Background: Unscheduled care is used increasingly during the last year of life by people known to have significant palliative care needs. Aim: To document the frequency and patterns of use of unscheduled healthcare by people in their last year of life and understand the experiences and perspectives of patients, families and professionals about accessing unscheduled care out-of-hours. Design: A mixed methods, multi-stage study integrating a retrospective cohort analysis of unscheduled healthcare service use in the last year of life for all people dying in Scotland in 2016 with qualitative data from three regions involving service users, bereaved carers and general practitioners. Setting: Three contrasting Scottish Health Board regions and national datasets for the whole of Scotland. Results: People who died in Scotland in 2016 ( n = 56,407) had 472,360 unscheduled contacts with one of five services: telephone advice, primary care, ambulance service, emergency department and emergency hospital admission. These formed 206,841 individual continuous unscheduled care pathways: 65% starting out-of-hours. When accessing healthcare out-of-hours, patients and carers prioritised safety and a timely response. Their choice of which service to contact was informed by perceptions and previous experiences of potential delays and whether the outcome might be hospital admission. Professionals found it difficult to practice palliative care in a crisis unless the patient had previously been identified. Conclusion: Strengthening unscheduled care in the community, together with patient and public information about how to access these services could prevent hospital admissions of low benefit and enhance community support for people living with advanced illness.

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Section: Introductionmentioning

confidence: 99%

“…People dying from cancer frequently attend the General Practice Out-of-Hours (GPOOH) service in their last year of life [13][14][15][16] . However, all large-scale research into unscheduled care in the UK has relied on routine healthcare datasets 13,15 , which only contain coded data. Data coding is the process by which medical, social, prescribing, and other routinely-collected clinical information are recorded in a set of pre-determined categories.…”

Section: Introductionmentioning

confidence: 99%

Free-text analysis of general practice out-of-hours (GPOOH) use by people with advanced cancer: an analysis of coded and uncoded free-text data

et al. 2022

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Background: People with advanced cancer frequently use the GP Out-of-Horus (GPOOH) service. Significant amounts of routine GPOOH data are uncoded, and therefore omitted from existing healthcare datasets. Aim: To conduct a free-text analysis of a GPOOH dataset, to identify reasons for attendance and care delivered through GPOOH to people with advanced cancer. Design and setting: Analysis of GPOOH healthcare dataset containing all coded and free-text information for 5,749 attendances, from a cohort of 2,443 people who died from cancer in Tayside, Scotland in 2012-2015. Method: Random sampling methods selected 575 consultations for free-text analysis, each analysed by two independent reviewers, to determine assigned presenting complaints, key and additional palliative care symptoms recorded in free-text, evidence of anticipatory care planning and free-text recording of dispensed medications. Interrater reliability concordance established through Kappa testing. Results: Over half of all coded reasons for attendance (n=293, 51.0%) were ‘other’ or missing. Free-text analysis demonstrated that nearly half (n=284, 49.4%) of GPOOH attendances by people with advanced cancer were for pain or palliative care. More than half of GPOOH attendances (n=325, 56.5%) recorded at least one key or additional palliative care symptom in free-text, with the commonest being breathlessness, nausea, vomiting and cough. Anticipatory care planning was poorly recorded in both coded and uncoded records. Uncoded medications were dispensed in over a quarter of GPOOH consultations. Conclusion: GPOOH delivers a substantial amount of pain management and palliative care, much of which is uncoded and therefore unrecognised and under-reported in existing large healthcare data analyses.

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Factors associated with unscheduled care use by cancer decedents: a systematic review with narrative synthesis

Cited by 8 publications

References 44 publications

Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review

Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review

Integrating lived experiences of out-of-hours health services for people with palliative and end-of-life care needs with national datasets for people dying in Scotland in 2016: A mixed methods, multi-stage design

Free-text analysis of general practice out-of-hours (GPOOH) use by people with advanced cancer: an analysis of coded and uncoded free-text data

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