Issues for General Practitioners Caring for Dying Patients in the Home

1999 ◽  
Vol 5 (2) ◽  
pp. 9 ◽  
Author(s):  
Annette Street ◽  
Jeanine Blackford ◽  
Anne Turley ◽  
Judy Kelso
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Terminally Ill ◽  
Team Approach ◽  
Fee For Service ◽  
Quality Health Care ◽  
Care Services ◽  
Dying Patients ◽  
Palliative Care Services ◽  
Counselling Program

General practitioners have a central role in the provision of quality health care to the terminally ill patient and family in their own homes. Staff from the Department of Human Services were concerned that GPs were experiencing stress through their increasing role in the provision of palliative care and that there was a need for a fee-for-service stress counselling program for them. A small qualitative study was conducted to verify this perceived need. Semi-structured telephone interviews were conducted with 50 GPs selected from a sample of metropolitan attendees at postgraduate educational activities or doctors known to palliative care services. GPs faced a number of issues in their care for terminally ill people in the community but a fee-for-service counselling program was deemed unnecessary. Evidence from the study confirmed that effective communication strategies between GPs, palliative care services and acute hospitals, an interdisciplinary team approach, and improved understanding between health professionals would enhance the quality of care for dying people and their caregivers.

Managing Severe Chronic Breathlessness in Chronic Obstructive Pulmonary Disease Is Challenging for General Practitioners

2020 ◽  
pp. 104990912095906
Author(s):  
John Politis ◽  
Peter Eastman ◽  
Brian Le ◽  
John Furler ◽  
Louis Irving ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Pulmonary Disease ◽  
General Practitioners ◽  
Chronic Obstructive ◽  
Specialist Palliative Care ◽  
Obstructive Pulmonary Disease ◽  
Care Services ◽  
Palliative Care Services ◽  
Severe Copd

Context: Patients with advanced chronic obstructive pulmonary disease (COPD) can develop increasing breathlessness, which can persist despite optimal medical management—refractory breathlessness. Management can be challenging for all clinicians and requires a broad approach that includes optimization of disease directed therapies, non-pharmacological strategies to manage breathlessness and for some patients opioids. Objectives: To explore the approaches to breathlessness management and palliative care undertaken by Australian General Practitioners (GP) for patients with severe COPD and refractory breathlessness. Methods: A case-vignette based survey was conducted with Australian GPs to determine their approaches to breathlessness management and palliative care in COPD. Results: Of the 137 GPs, 66% recommended commencing an additional medication to manage refractory breathlessness. Thirty-eight GPs (28%) recommended opioids and 26 (19%) recommended guideline discordant treatments. Two-thirds of GPs had concerns regarding the use of opioids in COPD. Half (55%) of GPs were comfortable providing general palliative care to patients with COPD and 62 (45%) had referred patients with COPD to specialist palliative care services. Most respondents wanted further training to manage severe COPD and severe chronic breathlessness. Conclusion: Most GPs recognized and were willing to add specific treatments for severe chronic breathlessness. However, experience prescribing opioids for severe chronic breathlessness was low, with many practitioners holding significant concerns regarding adverse effects. Many GPs are uncomfortable offering a palliative approach to their COPD patients, yet these patients are not routinely referred to specialist palliative care services despite their immense needs. GPs therefore desire education and support to overcome these barriers.

scholarly journals Pain talk in palliative care: A qualitative analysis

2019 ◽  
Author(s):  
Yijin Wu
Keyword(s):  
Palliative Care ◽  
Conversation Analysis ◽  
Care Provider ◽  
Terminally Ill ◽  
Care Providers ◽  
Care Services ◽  
Healthcare Settings ◽  
Palliative Care Setting ◽  
Palliative Care Services ◽  
Problematic Experiences

Abstract Aim Using the method of Conversation Analysis (CA), this study aims to demonstrate how the palliative care provider uses different types of interactional practices to address patient’s pain concerns. Background The delivery of palliative care services could be facilitated through effective communication. The method of conversation analysis is effective in improving communication skills. Conversation analysis, used in other healthcare settings, also is a useful way to explore the interactional details between palliative care providers and terminally ill patients. Method The data showed in this study are obtained from 2 videotapes of provider-patient interaction in palliative care settings. The videos and the initial transcript of them are collected from the Alexander St website http://ctiv.alexanderstreet.com, an educational resource presenting a large collection of psycho-therapeutic videos. The data is analyzed using the method of conversation analysis. Results In this study, an illustrative analysis is demonstrated to show the potential of conversation analysis for research on pain talk in palliative care. It has been shown that conversation analysis could contribute to unfolding the interactional details regarding “pain talk” in palliative care settings. Specifically, CA could provide a detailed a description and interpretation of the conversational practices used to construct palliative care provider participation in delivering pain talk. In addition, CA could also demonstrate the interactional resources by which patients disclose their experiences of physical and spiritual pain to the palliative care provider and the way how the palliative care provider responds to patient’s problematic experiences. Conclusion This study identifies five types of interactional resources which are used to deal with patient’s pain concerns in palliative care setting. A conversation analytical study of pain talk in palliative care could provide a turn-by-turn description of how the palliative care provider communicates with the terminally ill patient in terms of pain concerns. The findings in this study could inform how the palliative care provider initiates, delivers and develops a pain talk with the terminally ill patient effectively.

scholarly journals Risk Factors for Anticipatory Grief in Family Members of Terminally Ill Veterans Receiving Palliative Care Services

2015 ◽  
Vol 11 (3-4) ◽  
pp. 244-266 ◽  
Author(s):  
Laurie A. Burke ◽  
Karen A. Clark ◽  
Khatidja S. Ali ◽  
Benjamin W. Gibson ◽  
Melissa A. Smigelsky ◽  
...  
Keyword(s):  
Risk Factors ◽  
Palliative Care ◽  
Family Members ◽  
Terminally Ill ◽  
Anticipatory Grief ◽  
Care Services ◽  
Palliative Care Services

Development and validation of the clinician palliative perception scale (CPPS).

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 179-179
Author(s):  
Aaron Kee Yee Wong
Keyword(s):  
Palliative Care ◽  
Hospital Staff ◽  
Service Improvement ◽  
Care Provision ◽  
Self Confidence ◽  
Care Services ◽  
Dying Patients ◽  
Tertiary Teaching ◽  
Palliative Care Services ◽  
Development And Validation

179 Background: Worldwide healthcare systems identify a need to provide better evidence based service models for palliative care. There is little data and no standard tool that informs clinicians’ perceptions on palliative care to identify areas for service improvement and education. We aimed to develop and validate a tool to determine perceptions of hospital staff on palliative care provision, self confidence in providing palliative care, and predictors and barriers to requesting assistance. Methods: 604 hospital clinicians were recruited in person and online from a large metropolitan public tertiary teaching hospital network involving 5 campuses and 2 medical schools. They completed the CPPS (Clinician Palliative Perception Scale). Principal components analysis, exploratory factor analysis, and logistic regression were performed to examine the factor structure and relationship to clinical practice. Results: Four factors were extracted: confidence in providing palliative care, requesting assistance, global perceptions on palliative care provision, and barriers to referring. Increased confidence was significantly associated with increased likelihood of referring or requesting assistance and also associated with a good global perception on palliative care provision. Confidence was also significantly associated with years of experience and with spending > 50% time looking after dying patients. Good perception of palliative care provision was highest among oncologists. Conclusions: This is the largest quantitative study ever done looking at perceptions of palliative care provision among health professionals. The CPPS is a valid and reliable tool useful for both practice and research. Its 4 identified constructs are consistent with literature on perceptions and utilisation of palliative care services. Barriers to referring involved misconceptions that palliative care would prematurely shorten patient lifespans. Others did not refer due to confidence in their own skill. This tool can be used to correlate these constructs against other solid outcome measures to assist in service improvement and identifying research needs. It can also be used to determine clinicians’ educational requirements.

scholarly journals Service change and innovation in community end-of-life care during the COVID-19 pandemic: Qualitative analysis of a nationwide primary care survey

2021 ◽  
pp. 026921632110493
Author(s):  
Sarah Mitchell ◽  
Madeleine Harrison ◽  
Phillip Oliver ◽  
Clare Gardiner ◽  
Helen Chapman ◽  
...  
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
United Kingdom ◽  
End Of Life ◽  
General Practitioners ◽  
End Of Life Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services

Background: Primary healthcare teams (general practice and community nursing services) within the United Kingdom provided the majority of community end-of-life care during COVID-19, alongside specialist palliative care services. As international healthcare systems move to a period of restoration following the first phases of the pandemic, the impact of rapidly-implemented service changes and innovations across primary and specialist palliative care services must be understood. Aim: To provide detailed insights and understanding into service changes and innovation that occurred in UK primary care to deliver end-of-life care during the first phase of the COVID-19 pandemic. Design: Cross-sectional online survey. Responses were analysed using descriptive statistics and thematic analysis. Setting/participants: United Kingdom survey of general practitioners and community nurses, circulated via regional and national professional networks. Results: A total of 559 valid responses were received from 387 community nurses, 156 general practitioners and 16 ‘other’. Over a third of respondents ( n = 224; 40.8%) experienced changes in the organisation of their team in order to provide end-of-life care in response to the COVID-19 pandemic. Three qualitative themes were identified: COVID-19 as a catalyst for change in primary palliative care; new opportunities for more responsive and technological ways of working; and pandemic factors that improved and strengthened interprofessional collaboration. Conclusion: Opportunity has arisen to incorporate cross-boundary service changes and innovations, implemented rapidly at the time of crisis, into future service delivery. Future research should focus on which service changes and innovations provide the most benefits, who for and how, within the context of increased patient need and complexity.

Perspectives on palliative care in Lebanon: Knowledge, attitudes, and practices of medical and nursing specialties

2009 ◽  
Vol 7 (3) ◽  
pp. 339-347 ◽  
Author(s):  
Huda Abu-Saad Huijer ◽  
Hani Dimassi ◽  
Sarah Abboud
Keyword(s):  
Palliative Care ◽  
Formal Education ◽  
Terminally Ill ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Terminally Ill Patients ◽  
Care Services ◽  
Palliative Care Services ◽  
Knowledge And Attitude ◽  
Knowledge Attitudes And Practices

AbstractObjective:Our objective was to determine the knowledge, attitudes, and practices of physicians and nurses on Palliative Care (PC) in Lebanon, across specialties.Method:We performed a cross-sectional descriptive survey using a self-administered questionnaire; the total number of completed and returned questionnaires was 868, giving a 23% response rate, including 74.31% nurses (645) and 25.69% physicians (223).Results:Significant differences were found between medical and surgical nurses and physicians concerning their perceptions of patients' and families' outbursts, concerns, and questions. Knowledge scores were statistically associated with practice scores and degree. Practice scores were positively associated with continuing education in PC, exposure to terminally ill patients, and knowledge and attitude scores. Acute critical care and oncology were found to have lower practice scores than other specialties.Significance of results:Formal education in palliative care and development of palliative care services are very much needed in Lebanon to provide holistic care to terminally ill patients.

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