Referral patterns and proximity to palliative care inpatient services by level of socio-economic disadvantage. A national study using spatial analysis

Currow, David C.; Allingham, Samuel F; Bird, Sonia; Yates, Patsy; Lewis, Joanne; Dawber, James; Eagar, Kathy

doi:10.1186/1472-6963-12-424

Cited by 43 publications

(40 citation statements)

References 39 publications

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“…However, services participating in PCOC are representative of Australian palliative care services generally. 22 Furthermore, service managers were asked to distribute the survey to well-informed staff members. Qualitative research aims to include people from a variety of backgrounds who are willing and able to discuss the phenomenon in depth, focusing on their experiences of the issues under discussion.…”

Section: Discussionmentioning

confidence: 99%

Palliative care health professionals’ experiences of caring for patients with advance care directives

Johnson

Singer

Masso³

et al. 2015

Aust. Health Review

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Objective. To explore the health professionals' (HPs) perceptions and experiences of advance care directives (ACDs) and advance care planning in Australian palliative care services.Methods. A nationwide survey of 105 palliative care services was conducted, with two HPs from each service invited to participate. A qualitative analysis of open responses about advance care planning was undertaken.Results. Sixty questionnaires were returned with open responses. Most responders were nurses (75%), aged 40 years (80%) and with a mean of 12 years palliative care experience. Data were grouped into four key themes: (1) the ACD; (2) the process of developing ACDs; (3) the process of using ACDs; and (4) the consequences of having ACDs. Participants were positive about advance care planning, commenting that ongoing communication about end-of-life care ensures mutual understanding between patients, family and HPs. Provision of care was considered easier and more efficient with an ACD in place. ACDs were perceived to reduce distrust and conflict between family, friends and HPs, and promote communication. Suboptimal documentation, clarity and explicitness limited the usefulness of ACDs when they were available.Conclusions. Advance care planning benefits HPs, patients and their family. To maximise these benefits, ACDs need to be clear, comprehensive, medically relevant and transportable documents.What is known about the topic? Ideally, advance care planning encompasses the identification and documentation of a person's preferences for future medical treatments and care in preparation for an occasion when the person cannot express their values and wishes. The uptake and practice of advance care planning is inconsistent, and the extent to which it is used by health professionals and patients is variable. Many people are cared for at the end of life in specialist palliative care services, but the intersection between palliative care and advance care planning remains under-researched. What does this paper adds? ACDs facilitate communication and advance care planning; help establish trust between health professionals, patients and their families; and make multiple aspects of care easier for HPs. Processes surrounding ACDs, particularly inadequate documentation, limit adherence and application. What are the implications for practitioners? Clear communication is necessary for effective ACD development and application. The presence of an ACD makes communication and advance care planning easier, and improves trust between HPs, patients and their family. To be useful, ACDs must be clear, comprehensive, medically relevant, transportable documents.

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Section: Discussionmentioning

confidence: 99%

Palliative care health professionals’ experiences of caring for patients with advance care directives

Johnson

Singer

Masso³

et al. 2015

Aust. Health Review

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“…3). Because ENABLE is based on the CIC, which is also the basis of some of the most successful HF disease self management programs demonstrating improved disease-focused HF self-management and survival outcomes, 30,[33][34][35][36][37][38][39][40][41][42] we were confident that it would be adaptable to this very different illness trajectory.…”

Section: Introductionmentioning

confidence: 99%

“…5,15,22,23 However, few PC models have undergone systematic development and testing to address the individualized needs of patients with advanced HF and their family caregivers, especially for those in community-based rural locations where geographic distances and access to care can present significant challenges. 30 Following our first demonstration project in cancer, we recognized the challenges of access in our rural environment. We converted the intervention to be delivered primarily by phone and focused our nurse coaching on helping patients to identify prospectively local community resources.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, patients receive an in-person PC team assessment based on National Consensus Project PC guidelines. 22 ENABLE [21][22][23] is the first successful PC intervention in the rural advanced cancer population to apply Wagner's Chronic Illness Care (CIC) model, [24][25][26][27][28][29][30] which shifted the cancer care paradigm by introducing concurrent PC earlier in the disease trajectory (see Fig. 3).…”

Section: Introductionmentioning

confidence: 99%

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Translating and Testing the ENABLE: CHF-PC Concurrent Palliative Care Model for Older Adults with Heart Failure and Their Family Caregivers

Dionne‐Odom

KonoAlan

FrostJennifer

et al. 2014

Journal of Palliative Medicine

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Background: Heart failure (HF) and palliative care (PC) organizations recommend early PC to improve the quality of life of patients living with HF. Objective: We conducted a two-phase formative evaluation study to translate a cancer-focused concurrent PC intervention into one that would be appropriate for rural-dwelling adults with New York Heart Association Class III-IV HF and their primary caregivers. Methods: Phase I: We tailored the intervention for an HF population via literature review, expert consultation, and clinician (N = 15) small group interviews. Phase II: We enrolled 11 patient/caregiver dyads to assess intervention feasibility and satisfaction. We assessed participants' experiences and satisfaction after session/ week three and session/week six via digitally recorded interviews. Clinician and participant interviews were transcribed and content analyzed. Outcome measures were evaluated for completion rates and effect sizes. Results: Phase I: Clinicians described barriers to initiating PC in HF, triggers for initiating PC, and suggestions for intervention improvement. Phase II: Participants were able to complete the majority of study sessions, measures, and interviews. Satisfaction interviews revealed the content to be relevant and comprehensive in addressing HF patient and caregiver primary concerns; however, participants unanimously suggested making the intervention available earlier in the illness trajectory. Efficacy measures demonstrated small to medium effect sizes. Conclusions:We tailored and demonstrated feasibility of providing an early, concurrent palliative care intervention to patients with advanced HF and their caregivers. Based on this experience we are now conducting an efficacy trial in a racially diverse sample.

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“…23 The demographic data confirm that the survey is representative of those organisations and those staff who provide palliative care for patients. For example, based on full-time equivalents, the ratio of nursing staff to medical staff working in palliative care across Australia is approximately 9.5 : 1.…”

Section: Discussionmentioning

confidence: 52%

Advance care planning in palliative care: a national survey of health professionals and service managers

Sellars¹,

Silvester²,

Masso³

et al. 2015

Aust. Health Review

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Objective. To identify the attitudes, knowledge and practices regarding advance care planning (ACP) in palliative care.Methods. A nationwide online survey was distributed to Australian palliative care services associated with the Palliative Care Outcomes Collaboration (n = 105). Seventy-three health professionals (HPs) and 59 service managers completed the survey.Results. Regarding ACP, 51% of service managers reported relevant policies and procedures were in place in their service and 44% included ACP in job descriptions. Most HPs were confident in undertaking ACP, including initiating discussions with patients and complying with documents; however, only 44% reported receiving ACP specific training. Although 58% of HPs reported having conversations about ACP with more than 11 patients in the past 6 months, only 44% of managers report that it is offered to most patients. Thirty per cent of HPs were aware of others not adhering to patient wishes in the past 6 months and only 43% of HPs (and 37% of managers) believed ACP is done well within their service.Conclusions. This first national survey examining ACP in palliative care services demonstrates there is a need to improve systems to support ACP and to understand circumstances in which ACP wishes are not followed.What is known about the topic? ACP is increasingly recognised as an important part of care of people in hospital and community settings. However, currently there is no empirical evidence about the national uptake and quality of ACP in palliative care settings specifically. What does this paper add? This nationwide survey shows improvements on past small-scale research showing that ACP is supported by palliative care health professionals; however, the organisational ACP processes and systems did not support best practice in this regard. What are the implications for practitioners? Palliative care organisations should incorporate ACP systems (including greater access to ACP policies and guidelines) that support health professionals to complete ACP with clients who want to. Greater access to support, such as ACP training and resources, would assist with development of ACP documentation and adherence.

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Referral patterns and proximity to palliative care inpatient services by level of socio-economic disadvantage. A national study using spatial analysis

Cited by 43 publications

References 39 publications

Palliative care health professionals’ experiences of caring for patients with advance care directives

Palliative care health professionals’ experiences of caring for patients with advance care directives

Translating and Testing the ENABLE: CHF-PC Concurrent Palliative Care Model for Older Adults with Heart Failure and Their Family Caregivers

Advance care planning in palliative care: a national survey of health professionals and service managers

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