Support practices by an interdisciplinary team in a palliative-care unit for relatives of patients in agonal phase

Abstract

Background In the absence of extant recommendations, the aim of this study was to formalise support practices used by an interdisciplinary team in a palliative-care unit (PCU) for the relatives of patients in the agonal phase preceding death. The secondary objective was to understand the expectations of relatives during this phase in terms of the support provided by professionals and volunteers. Methods Thirty-two people took part in this study; all were interviewed through focus groups (FGs). Each FG comprised one category of individuals working in the PCU: nurses, care- assistants, doctors, psychologists, other professionals, palliative-care volunteers, and relatives. Groups were surveyed using an interview guide, and the interviews were recorded and transcribed to enable identification and characterization of all practices. Care practices were classified into four categories: current consensual practices (i.e. performed by all team members), occasional consensual practices, non-consensual practices (performed by one or a few participants), and practices to be developed. Results In total, 215 practices were mentioned by professionals and palliative-care volunteers: 150 current consensual practices, 48 occasional consensual practices, 1 non-consensual practice, 16 practices yet to be developed, and 29 practices for relatives. Many practices were mentioned by different categories of participants; thus, after cross-checking, the number of practices decreased from 215 to 52. A list of practices deemed desirable by all was drawn up and then validated by the entire interprofessional team. These practices were organised around four themes: providing care and ensuring comfort; communicating, informing, and explaining; interacting; and mobilising interdisciplinary skills. Conclusions These results underline the importance of the quality of care provided to patients, the attention given to the relatives themselves, and they highlight the importance of the helping relationship. Following this study, which established a list of varied practices aimed at supporting the relatives of patients in agonal phase, it will be important to set up a broader study seeking to establish a consensus on these practices with an interprofessional group of experts from other PCUs using broad surveys and an adapted methodology. Such studies will make it possible to develop training modules for teams working with relatives.

Primary Palliative Care in Urology: Quality Improvement Summit 2021-2022

“…First, patients with advanced disease and their families currently have unmet quality of life‒related needs, and urologists in collaboration with palliative care clinicians are well positioned to help meet those needs. 15,20,22,23 Of the 4 domains of care defined during the Summit, patient disease-specific needs are generally addressed by the treatment teams, but more holistic patient issues, such as symptoms and family needs, are currently inconsistently addressed for patients in urologic oncology, stones, FPMRS, and general urology. Summit participants reached consensus that given the deep and intricately woven relationship urologists have with their patients, urologists should lead the effort to meet patient and family needs in all domains of care.…”

“…Palliative care provision by providers other than palliative care clinicians is broadly designated “primary palliative care.” However, primary palliative care models have yet to be broadly developed, and tools needed for systematic knowledge transfer of palliative care principles and practices through education and training of interdisciplinary advanced disease care teams require further investment and research to clarify their effectiveness and guide further implementation. 8,19-21 Research is particularly needed to understand the integration of palliative approaches and services in surgery. As a clinical specialty, urology is well positioned to lead efforts in improving palliative care use among patients with advanced urologic health conditions.…”

Quality of Care Effect on Cancer Patient's Well-Being and Its Impact on the Private Hospital Reputation

“…For instance, family discussions can lessen frequently observed discrepancies between the patient and his relatives regarding the clinical status, disease course, and the patient's critical diagnosis [12]. One of the most popular metrics used to evaluate family-centered care is the measurement of care processes [13].…”

Assistant nurses' experiences of thirst and ethical dilemmas in dying patients in specialized palliative care—A qualitative study

“…In Sweden, the most common occupation in the healthcare field is that of an assistant nurse, with an estimated 200,000 individuals working in this role across the country (Strömqvist, 2021). Assistant nurses' work in PC is about taking care of the terminally ill patient's basic needs, such as personal hygiene, the prevention of decubitus, nutrition, elimination, skin care, oral care, optimizing the environment for the patient and providing comfort care (Mélin et al, 2020; Östergötland, 2019). They also monitor various symptoms (Value of the Nursing Assistant in Palliative Care, 2019).…”