Overcoming Barriers to Growth in Home-Based Palliative Care

Bowman, Brynn; Twohig, Jeanne Sheils; Meier, Diane E.

doi:10.1089/jpm.2018.0478

Cited by 24 publications

(26 citation statements)

References 4 publications

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“…It is concluded that the lack of codes, which consists of the care protocol, nursing tariffs and insurance coverage subcategories, is one of the barriers to home‐based palliative care. This finding is in line with the findings reported by Bowman, Twohig, and Meier (2019), who described the ambiguity of the application of national standards to home care plans as one of the barriers to home‐based palliative care (Bowman et al., 2019). In a study in Germany, the barriers to home palliative care for children were the shortage of clear legal regulations and the lack of professional services (Jünger et al., 2010).…”

Section: Discussionsupporting

confidence: 90%

Barriers to home‐based palliative care in people with cancer: A qualitative study of the perspective of caregivers

et al. 2020

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Aim To investigate the barriers to home‐based palliative care for cancer patients from professional caregivers' experiences. Design A qualitative study. Method This is a descriptive‐qualitative study carried out in the community‐based care. Twenty‐three participants took part in this study. Data were collected through semi‐structured interviews. Results Data analysis led to the identification of three category of barriers including the lack of instructions (the lack of clinical practice guidelines, the ambiguity of tariffs and the lack of insurance coverage), family desperation (family views of prognosis, distrust and poverty) and lack of professionalism (limited knowledge, the use of amateur nurses and siloed care). Developing a care protocol and providing resources support contribute to the development of home‐based palliative care. Moreover, the education of families and training courses for nurses must be fostered.

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Section: Discussionsupporting

confidence: 90%

Barriers to home‐based palliative care in people with cancer: A qualitative study of the perspective of caregivers

et al. 2020

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“…Financial support is critical to maintaining a care program. Some home-based palliative care programs in the United States have also encountered similar challenges [38]. Despite the good intentions behind the call to establish home-based end-of-life care, the government should also devise supportive policies and provide financial support to facilitate the delivery of such care and meet the needs of the patients and their families [39, 40].…”

Section: Discussionmentioning

confidence: 99%

An examination of home-based end-of-life care for cancer patients: a qualitative study

Lai

Chen

et al. 2019

BMC Palliat Care

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BackgroundOnly a small number of patients have utilized the home-based end-of-life care service in Shanghai that has been offered since 2012. This study explores how home-based end-of-life care is delivered in community health service centers in Shanghai and examines the difficulties in the delivery of the care.MethodsThis was a qualitative study in which data were collected from interviews and analyzed using qualitative content analysis. Nineteen health care providers with experience in delivering home-based end-of-life care in 12 community health service centers were recruited. The interviews were conducted between August 2018 and February 2019.ResultsFour themes emerged from the interviews: (i) Patients under home-based end-of-life care: Patients receiving the care were cancer patients with less than 1 year of life expectancy. The criteria for patients were broad. (ii) Service structure: The service was delivered regularly by the physicians and nurses using the approaches of home visits and/or telephone follow-ups. (iii) Service process: The service consisted of multiple components, including monitoring the patient’s condition, managing the patient’s symptoms, giving daily care instructions, performing nursing procedures, and giving psychological support. However, most of the care focused on monitoring the patients and managing their physical discomfort. (iv) Difficulties in delivering care: Being unable to provide the service and feeling powerless when facing psycho-spiritual problems were the two major difficulties. Three factors contributed to the suspension of the service: The gap between the service and the needs of the patients, a lack of patients, and low work motivation. The demand that the truth be concealed from the families and their attitude of avoiding talking about death were the key factors of the failure of psycho-spiritual care.ConclusionsSeveral issues should be addressed before the service can be further developed, including fully understanding the needs and preferences of local patients and their families, securing more financial support and a better supply of drugs, delivering better training for staff, and ensuring greater rewards for individuals and institutions providing the service.

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“…A national survey of HBPC organizations found a substantial lack of standardization of practice guidelines, oversight, and a lack of payment structures [ 71 , 72 ]. Sustainable financing methods are lacking, and HBPC program design is not standardized to the same degree as hospice programs.…”

Section: Methodsmentioning

confidence: 99%

Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician

et al. 2022

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Eighty-one percent of persons living with cancer have an emergency department (ED) visit within the last 6 months of life. Many cancer patients in the ED are at an advanced stage with high symptom burden and complex needs, and over half is admitted to an inpatient setting. Innovative models of care have been developed to provide high quality, ambulatory, and home-based care to persons living with serious, life-limiting illness, such as advanced cancer. New care models can be divided into a number of categories based on either prognosis (e.g., greater than or less than 6 months), or level of care (e.g., lower versus higher intensity needs, such as intravenous pain/nausea medication or frequent monitoring), and goals of care (e.g., cancer-directed treatment versus symptom-focused care only). We performed a narrative review to (1) compare models of care for seriously ill cancer patients in the ED and (2) examine factors that may hasten or impede wider dissemination of these models.

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Overcoming Barriers to Growth in Home-Based Palliative Care

Cited by 24 publications

References 4 publications

Barriers to home‐based palliative care in people with cancer: A qualitative study of the perspective of caregivers

Barriers to home‐based palliative care in people with cancer: A qualitative study of the perspective of caregivers

An examination of home-based end-of-life care for cancer patients: a qualitative study

Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician

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