Articles: palliative-care.
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J Pain Symptom Manage · Jul 2021
Emerging palliative care innovations in the ED: a qualitative analysis of programmatic elements during the COVID-19 pandemic.
Health systems have aspired to integrate palliative care (PC) into the emergency department (ED) to improve care quality for over a decade, yet there are very few examples of implemented models in the literature. The coronavirus disease 2019 (COVID-19) pandemic led to an increase in the volume of seriously ill patients in EDs and a consequent rapid increase in PC integration in many EDs. ⋯ Several new innovations in PC-ED care delivery emerged during COVID. Many innovations leveraged different types of clinicians to deliver care, an increased physical presence of PC in the ED, and used technology to enhance care delivery. These innovations may serve as a framework for institutions as they plan for evolving needs in the ED during and after COVID. Additional research is needed to evaluate the impact of these programs and understand their applicability beyond the pandemic.
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Background: Much end-of-life care is provided in hospital, yet little is known about the delivery of palliative care during end-of-life hospitalizations. Objectives: To characterize the level of palliative care involvement across hospitalizations in the last year of life. Methods: A population-based retrospective cohort study of adults in Ontario, Canada, who died between April 1, 2012, and March 31, 2017, and had at least one acute care hospitalization in their last year of life. ⋯ Most hospitalizations with palliative care involvement (85.6%) occurred in the two months before death. Compared to patients who received no inpatient palliative care, patients who received a high level of palliative care involvement tended to be younger, died of cancer, resided in urban or lower income neighborhoods, and had fewer chronic conditions. Discussion: While many hospitalizations occurred in the last year of life, the majority did not involve palliative care, and very few had a high level of palliative care involvement.
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Palliative medicine · Jul 2021
Health and social care professionals' experiences of providing end of life care during the COVID-19 pandemic: A qualitative study.
Health and social care professionals' ability to address the needs of patients and their relatives at end of life is likely to have been impacted by the COVID-19 pandemic. ⋯ There is a need for flexible visiting arrangements at end of life during a pandemic. A systems-level approach is necessary to promote the wellbeing of health and social care professionals providing end of life care during and after a pandemic.
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J Pain Symptom Manage · Jul 2021
Narrative Approach to Goals of Care Discussions: Adapting the 3-Act Model Training to an Online Format.
The three-Act Model, a narrative approach to goals of care (GOC) discussions centered on patients' individual stories, has proven to be effective as measured by objective skill improvement among medical trainees. This study describes the adaptation of the in-person curriculum to a streamlined, online format, in the setting of the Covid19 pandemic. We hypothesized that high levels of skill proficiency and learner satisfaction observed in previous in-person cohorts would be sustained amongst trainees in the online setting. ⋯ After completing the adapted online three-Act Model training, nearly all learners were scored to be proficient in GOC communication skills and reported high satisfaction with the online curriculum. Achieving high quality more efficiently represents genuine educational value. Further, these online teaching results show that the three-Act Model training can be delivered to geographically distanced learners.
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J Pain Symptom Manage · Jul 2021
Health care professionals' experiences with pre-loss care in pediatrics; goals, strategies, obstacles and facilitators.
Although parents experience grief when confronted with their child's deterioration and imminent death, most bereavement care is focused on supporting parents after child loss. Insight into intentions and strategies of the health care professionals (HCPs) in preloss care during the end of life is still lacking. ⋯ HCPs strive to improve parental coping after the child's death, yet apply strategies that positively influence parental preparedness and well-being during the end of life as well. Individual HCPs are left with many uncertainties. A more robust approach based on theory, evidence, and training is needed to improve preloss care in pediatrics.