Home-Based Palliative Care Team Perspectives on Challenges in Patient Referral and Enrollment

Enguídanos, Susan; Lomeli, Sindy; Kogan, Alexis Coulourides; Rahman, Anna; Lewis, Nicole

doi:10.1016/j.jpainsymman.2022.01.011

Cited by 9 publications

(7 citation statements)

References 23 publications

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“…Additional effort to create and improve community awareness through repeated sensitization in the community is also warranted. 33–35 Our study has also identified similar factors that are required for the establishment of CBPC in a rural community-based setting in low-middle-income countries. 36,37…”

Section: Discussionmentioning

confidence: 56%

“…29 Lack of awareness and capacity building at the community level, reluctance, and misconceptions due to several sociocultural factors remain the main barriers as found in our study. 33,34 These challenges can be overcome by enhancing the quality of palliative care delivery through training and empowering palliative care patients. Additional effort to create and improve community awareness through repeated sensitization in the community is also warranted.…”

Section: Discussionmentioning

confidence: 99%

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Need of community-based palliative care in rural India and factors that influence its sustainability: a comprehensive exploration using qualitative methodology in rural Puducherry, India

Prajitha,

Subbaraman,

Siddharth Raman

et al. 2023

Palliat�Care

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Background: The existing palliative care services in India are concentrated in urban areas, attached to tertiary care hospitals. This poses issues relating to access and equity for people in rural locations and with low socioeconomic status. A Community-Based Palliative Care (CBPC) service named Sanjeevan has been initiated in Puducherry, a union territory of India to provide physical, social, psychological, and emotional support to incurably ill people, including older adults living in rural areas. Objectives: To understand the social mechanisms that underpin the implementation of CBPC in rural parts of India and the challenges to its sustainability. Design: Qualitative research using focus group discussions (FGDs) and key informant interviews (KIIs). Methods: Community-based participatory research (CBPR) approach was used in this study, and descriptive analysis was done. Through CBPR it was possible to document and interpret local knowledge on the community concerns and assets along with the experiences of the community members. Purposive sampling was used to identify vocal participants involved in patient care and areas of the Sanjeevan program such as financial management, administration, and community mobilization. Seven KIIs and four FGDs were conducted, with 7–8 participants in each. Results: The analysis indicated the need for a CBPC and the factors enabling its establishment. The findings revealed capacity building, resources for palliative care services, and the existing social structure of the community being the main challenges that need to be overcome for better penetration of CBPC services into society. Demand generation through sensitization and administration of services based on the need and regular follow-up remains the key strategies for the sustainability of the program. Conclusion: The CBPC program like ‘Sanjeevan’ adopted in the rural area of Puducherry can be cited as an example and can be replicated in other rural settings with similar sociocultural characteristics to support people living with end-stage diseases.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Need of community-based palliative care in rural India and factors that influence its sustainability: a comprehensive exploration using qualitative methodology in rural Puducherry, India

Prajitha,

Subbaraman,

Siddharth Raman

et al. 2023

Palliat�Care

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“…The results of our study suggest that this goal can be more difficult to achieve in subjects with severe multimorbidity and cancer. Therefore, specific pathways should be developed for home care of older patients with cancer or severe frailty, considering the principles of palliative care [28,29].…”

Section: Discussionmentioning

confidence: 99%

The Multidisciplinary Mobile Unit (MMU) Program Bringing Hospital Specialist Geriatric Competencies at Home: A Feasible Alternative to Admission in Older Patients with Urgent Complaints

Nouvenne,

Ticinesi,

Siniscalchi

et al. 2024

JCM

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Background/Objectives: Older patients are subject to a high number of Emergency Department (ED) visits and hospitalizations. Innovative strategies to manage geriatric urgencies in the community are thus needed. Methods: In this prospective observational study, we examined the case mix of a hospital-based domiciliary urgent care service tailored to older patients, called Multidisciplinary Mobile Unit (MMU), from January to September 2023. The service, activated by general practitioners or territorial specialists during workdays, provided domiciliary geriatric assessment, point-of-care diagnostics, including multi-site ultrasound and lab tests, and therapeutical measures, including intravenous treatment and insertion of invasive devices, with the goal of reaching on-site stabilization and avoiding ED referral. We collected data regarding multimorbidity, polypharmacy, and frailty according to the Clinical Frailty Scale (CFS), reasons for MMU activation, and diagnostic and therapeutical services provided. The assessed outcomes were immediate hospitalization after a visit, 30-day admission, and 30-day mortality. Results: Participants (n = 205, 102 M) were mostly aged (median age 83 years old), with multimorbidity and frailty (CFS median 6). The most frequent reasons for MMU activation were dyspnea (49%), cough (34%), and musculoskeletal pain (17%), while the commonest diagnostic test provided was thoracic ultrasound (81%). Only five patients (2.4%) were hospitalized immediately after MMU visit. The 30-day rate of hospitalization was 10.2%, with age, cancer, and abdominal pain as independent predictors on a stepwise binary logistic regression model. 30-day mortality was 4.9%. Conclusions: The MMU model is a feasible strategy to manage geriatric urgencies, especially involving the cardiorespiratory system, is associated with good outcomes and may prevent ED visits.

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“…29 The unique benefit of home-based palliative care services is that compared with traditional hospice services, there is no prerequisite for a limited survival prognosis (6 mo for hospice services) to be eligible. 37 These services can be rendered in the comforts of the patients' home while the patient is undergoing aggressive treatments for alleviation of pain and suffering. On the other hand, home-based palliative care has had its own issues with utilization.…”

Section: Opportunities To Improve Quality Of Lifementioning

confidence: 99%

End-of-Life and Palliative Care Issues for Patients Living with Pulmonary Arterial Hypertension: Barriers and Opportunities

Ali

Sahay

2023

Semin Respir Crit Care Med

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Pulmonary arterial hypertension (PAH) is a progressive, incurable disease that results in significant symptom burden, health care utilization, and eventually premature death. Despite the advancements made in treatment and management strategies, survival has remained poor. End-of-life care is a challenging issue in management of PAH, especially when patients are in younger age group. End-of-life care revolves around symptom palliation and reducing psychosocial disease burden for a dying patient and entails advanced care planning that are often challenging. Thus, support from palliative care specialist becomes extremely important in these patients. Early introduction to palliative care in patients with high symptom burden and psychosocial suffering is suggested. Despite of the benefits of an early intervention, palliative care remains underutilized in patients with PAH, and this significantly raises issues around end-of-life care in PAH. In this review, we will discuss the opportunities offered and the existing barriers in addressing high symptom burden and end-of-life care issues. We will focus on the current evidence, identify areas for future research, and provide a call-to-action for better guidance to PAH specialists in making timely, appropriate interventions that can help mitigate end-of-life care issues.

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Home-Based Palliative Care Team Perspectives on Challenges in Patient Referral and Enrollment

Cited by 9 publications

References 23 publications

Need of community-based palliative care in rural India and factors that influence its sustainability: a comprehensive exploration using qualitative methodology in rural Puducherry, India

Need of community-based palliative care in rural India and factors that influence its sustainability: a comprehensive exploration using qualitative methodology in rural Puducherry, India

The Multidisciplinary Mobile Unit (MMU) Program Bringing Hospital Specialist Geriatric Competencies at Home: A Feasible Alternative to Admission in Older Patients with Urgent Complaints

End-of-Life and Palliative Care Issues for Patients Living with Pulmonary Arterial Hypertension: Barriers and Opportunities

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