Description of the sources of stress for palliative-care nurses: Implications for decision makers

2013 ◽  
Author(s):  
Lise Fillion ◽  
◽  
Louise Saint-Laurent ◽  
Martine Fortier
Keyword(s):  
Palliative Care ◽  
Decision Makers

scholarly journals Palliative Care Evidence Review Service (PaCERS): a knowledge transfer partnership

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Mala Mann ◽  
Amanda Woodward ◽  
Annmarie Nelson ◽  
Anthony Byrne
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Knowledge Transfer ◽  
Review Process ◽  
Support Service ◽  
Decision Makers ◽  
Systematic Review Methods ◽  
Skill Sets ◽  
Service Redesign ◽  
Evidence Review

AbstractThe importance of linking evidence into practice and policy is recognised as a key pillar of a prudent approach to healthcare; it is of importance to healthcare professionals and decision-makers across the world in every speciality. However, rapid access to evidence to support service redesign, or to change practice at pace, is challenging. This is particularly so in smaller specialties such as Palliative Care, where pressured multidisciplinary clinicians lack time and skill sets to locate and appraise the literature relevant to a particular area. Therefore, we have initiated the Palliative Care Evidence Review Service (PaCERS), a knowledge transfer partnership through which we have developed a clear methodology to conduct evidence reviews to support professionals and other decision-makers working in palliative care.PaCERS methodology utilises modified systematic review methods as there is no agreed definition or an accepted methodology for conducting rapid reviews. This paper describes the stages involved based on our iterative recent experiences and engagement with stakeholders, who are the potential beneficiaries of the research. Uniquely, we emphasise the process and opportunities of engagement with the clinical workforce and policy-makers throughout the review, from developing and refining the review question at the start through to the importance of demonstrating impact. We are faced with the challenge of the trade-off between the timely transfer of evidence against the risk of impacting on rigour. To address this issue, we try to ensure transparency throughout the review process. Our methodology aligns with key principles of knowledge synthesis in defining a process that is transparent, robust and improving the efficiency and timeliness of the review.Our reviews are clinically or policy driven and, although we use modified systematic review methods, one of the key differences between published review processes and our review process is in our relationship with the requester. This streamlining approach to synthesising evidence in a timely manner helps to inform decisions faced by clinicians and decision-makers in healthcare settings, supporting, at pace, knowledge transfer and mobilisation.

Are hospital clinicians aware of legislation surrounding provision of palliative care?

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 118-118
Author(s):  
Aaron Kee Yee Wong
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Decision Makers ◽  
Medical Decision ◽  
Poor Knowledge ◽  
Tertiary Teaching ◽  
Futile Treatment ◽  
Substitute Decision Makers ◽  
Legal Frameworks ◽  
The Right

118 Background: Many deaths require medical treatment to be withheld or withdrawn. Patients or their substitute decision makers may disagree with these decisions, and sometimes refuse the right to appropriate palliative care. An awareness of legal frameworks surrounding end of life decisions is vital to navigate through these conflicts. Without this, patients suffer unnecessarily. Methods: 542 hospital doctors and nurses were recruited from a large metropolitan public tertiary teaching hospital network involving 5 campuses and 2 medical schools. A questionnaire examined their regarding legislation surrounding end of life care, both in adults with and without capacity. Results: Approximately a quarter of respondents did not believe that the “Not for Resuscitation Form” is legally a medical decision. Most doctors (68%), but not nurses, believed competent patients cannot demand futile treatment. Most clinicians (79% doctors and 85% nurses) erroneously believe that competent patients can refuse appropriate palliative care. There was significant confusion regarding the roles of substitute decision makers. Most clinicians could not find the advance directive. Groups with most correct answers were doctors, had 5-10 years experience, and were in palliative care and critical care specialties. Conclusions: This study confirms poor knowledge regarding legislation surrounding provision of palliative care. An unusually high proportion believed patients could refuse appropriate palliative care. Most clinicians could not locate advance directives. Most nurses believed patients could legally demand futile treatment. Both junior and senior staff had comparably poor knowledge in this area.

scholarly journals Cancer Council NSW - Policy and Advocacy: “I Care For Palliative Care” Campaign to Increase Government Investment in Specialist Palliative Care Services

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 172s-172s
Author(s):  
A. Engel
Keyword(s):  
Palliative Care ◽  
Media Coverage ◽  
Aboriginal People ◽  
Community Support ◽  
Qualitative Evaluation ◽  
Decision Makers ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Cancer Council ◽  
Palliative Care Services

Background and context: I Care for Palliative Care Campaign was developed and delivered by the Cancer Council NSW between November 2015 and July 2017. This advocacy campaign was developed in recognition of the fact that the state had fewer palliative physicians and palliative care nurses than were needed to meet the palliative care demands of the NSW community. This meant that some people with life-limiting cancer were being denied quality of life and were unable to die in the place of their choosing. Moreover, Aboriginal people remained disadvantaged by limited access to specialist palliative care that fits with their community values, beliefs, rituals, heritage and place. Aim: The primary aim of the campaign was to secure additional funding from the NSW Government for an additional 10 FTE palliative physician positions; an extra 129 FTE palliative care nurse positions; and provision of culturally-appropriate specialist palliative care services to Aboriginal people. Strategy/Tactics: Various tactics were used, including collection and sharing of engaging community stories via media and online channels, mobilizing community support via training and events, and targeted engagement of key decision-makers and members of parliament (MPs), which took into consideration marginal electorates, personal experiences with cancer, and geography, noting the issue disproportionally impacts regional and rural communities. An online and offline “pledge” activity was also used, providing both the public and MPs with an opportunity to support the campaign. Program/Policy process: Meetings, the pledge activity, collection and presentation of stories and community-events were all incorporated into a program of activities over the campaign period to engage decision-makers and ultimately influence the policy-making process. Outcomes: An independent qualitative evaluation confirmed that the campaign was undoubtedly a success. It noted that the campaign created an environment in which the NSW government made a historic decision to provide an additional $100 million in funding for palliative care services over four years. Without the campaign, palliative care could well have lost out to other healthcare and government spending priorities. What was learned: The campaign confirmed the power of personal stories as an effective campaign tactic to influence decision-makers. Empowering volunteers to generate local media coverage also resulted in significantly greater coverage for the campaign. The “pledge” activity for MPs was also an effective tactic that brought together the issue, the politician and our brand. Aspects to be improved include simplifying our policy ask, evaluating the resources we invest in key decision makers versus less influential MPs, and assessing how we better integrate political context and political experts into our campaign planning and governance.

scholarly journals Filling Gaps on Stability Data: Development, Validation and Application of a Multianalyte UHPLC-DAD Method to Determine the Stability of Commonly Administered Drugs in Different Carrier Solutions Used in Palliative Care

Analytica ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 33-43
Author(s):  
Christian Steuer ◽  
Ursina Müller ◽  
Fiona Haller ◽  
Peter Wiedemeier
Keyword(s):  
Palliative Care ◽  
Internal Standard ◽  
Reversed Phase ◽  
Decision Makers ◽  
Carrier Solution ◽  
Subcutaneous Infusion ◽  
Continuous Subcutaneous Infusion ◽  
Stability Data ◽  
The Stability ◽  
Parenteral Drug

In palliative care, continuous subcutaneous infusion (CSCI) is common practice for drug administration when oral application of drugs is not feasible or not reliable anymore. However, use of CSCI is limited to chemical stability of drugs and their combination in carrier solution. To determine the stability of different mixtures of commonly used drugs in palliative care, a multi-analyte UHPLC-DAD method controlled by an internal standard was successfully developed. The method was validated in terms of specificity, accuracy, precision, and linearity across the calibration range. Seven analytes could be separated within 10 min by C18-reversed phase chromatography. The method was successfully applied to close gaps in stability data and complete missing data for decision makers in health care units. Our results indicated the stability of binary mixtures and one ternary mixture in 0.9% saline and 5% glucose as carrier solutions. The obtained data will support pharmacists in palliative care for the preparation of parenteral drug solutions in the future.

scholarly journals “The system is well intentioned, but complicated and fallible” interviews with caregivers and decision makers about palliative care in Canada

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Nicole Luymes ◽  
Nicole Williams ◽  
Liz Garrison ◽  
Donna Goodridge ◽  
Maria Silveira ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care System ◽  
Health Care Professionals ◽  
Yukon Territory ◽  
Decision Makers ◽  
Key Factors ◽  
Factors Affecting ◽  
Centered Care ◽  
Care System

Abstract Background Canadian palliative care (PC) philosophy seeks to support individuals in a person-centered and sensitive manner. Unfortunately, philosophy does not necessarily translate into practice and this divide may leave patients without appropriate care at the end of life, causing distress for some families. The primary goal of the study was to identify key factors affecting perceptions of quality PC from the perspective of informal caregivers and decision makers (e.g., program managers) and to understand how their experiences within the health care system may have influenced their perceptions. Methods Nine caregivers and 11 decision makers from Yukon Territory, British Columbia, Alberta, Ontario, & Nova Scotia shared their experiences in PC via interview or focus group. Audio recordings were transcribed verbatim and qualitatively analyzed for themes. Results Three themes emerged, including the Caregiver as Anchor, Bewildering System, and Patient, Caregiver, and Family-Centered Care. While these results resembled other studies on caregivers and individuals receiving PC, the present study also uncovered systemic concerns. There was agreement between the two participant groups across most subthemes, however only caregivers reported feelings of being trapped by the health care system and a general lack of respect from health care professionals. Additionally, caregivers stressed the importance of preserving some sort of normalcy in daily life despite the individual’s illness. Conclusions Caregivers are critical. The health care system expects them to help a great deal, but they often do not feel supported or respected and the system is lacking the capacity and resources to meet their needs while they are grieving loss and struggling to meet demands.

Effective Palliative Care in the Trauma Setting

2020 ◽  
Vol 86 (11) ◽  
pp. 1441-1444
Author(s):  
Kristen L. Schultz ◽  
Karen J. Brasel ◽  
David H. Zonies ◽  
Mackenzie R. Cook
Keyword(s):  
Palliative Care ◽  
Exploratory Laparotomy ◽  
Decision Makers ◽  
Surgical Team ◽  
Improvement Program ◽  
Worst Case ◽  
American College Of Surgeons ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

A 55-year-old man undergoes emergent exploratory laparotomy and splenectomy following a motorcycle collision. Following surgery, he is found to have a traumatic brain injury requiring decompressive craniectomy and intracranial pressure monitoring. The patient then continues to have complications throughout his hospital course. Using the American College of Surgeons Trauma Quality Improvement Program guidelines, the surgical team has early and ongoing primary palliative care discussions to foster communication and determine goals of care for the patient. As the patient deteriorates, the surgical team continues meeting with the patient’s surrogate decision makers to discuss the best case and worst case scenarios regarding the patient’s prognosis and expected quality of life.

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