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Towards evidence-based palliative care in nursing homes in Sweden: a qualitative study informed by the organizational readiness to change theory.

https://arctichealth.org/en/permalink/ahliterature296991
Source
Implement Sci. 2018 01 04; 13(1):1
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-04-2018
Author
Per Nilsen
Birgitta Wallerstedt
Lina Behm
Gerd Ahlström
Author Affiliation
Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83, Linköping, Sweden. per.nilsen@liu.se.
Source
Implement Sci. 2018 01 04; 13(1):1
Date
01-04-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Diffusion of Innovation
Evidence-Based Medicine
Female
Homes for the Aged - organization & administration
Humans
Nursing Homes - organization & administration
Palliative Care - organization & administration
Qualitative Research
Sweden
Abstract
Sweden has a policy of supporting older people to live a normal life at home for as long as possible. Therefore, it is often the oldest, most frail people who move into nursing homes. Nursing home staff are expected to meet the existential needs of the residents, yet conversations about death and dying tend to cause emotional strain. This study explores organizational readiness to implement palliative care based on evidence-based guidelines in nursing homes in Sweden. The aim was to identify barriers and facilitators to implementing evidence-based palliative care in nursing homes.
Interviews were carried out with 20 managers from 20 nursing homes in two municipalities who had participated along with staff members in seminars aimed at conveying knowledge and skills of relevance for providing evidence-based palliative care. Two managers responsible for all elderly care in each municipality were also interviewed. The questions were informed by the theory of Organizational Readiness for Change (ORC). ORC was also used as a framework to analyze the data by means of categorizing barriers and facilitators for implementing evidence-based palliative care.
Analysis of the data yielded ten factors (i.e., sub-categories) acting as facilitators and/or barriers. Four factors constituted barriers: the staff's beliefs in their capabilities to face dying residents, their attitudes to changes at work as well as the resources and time required. Five factors functioned as either facilitators or barriers because there was considerable variation with regard to the staff's competence and confidence, motivation, and attitudes to work in general, as well as the managers' plans and decisional latitude concerning efforts to develop evidence-based palliative care. Leadership was a facilitator to implementing evidence-based palliative care.
There is a limited organizational readiness to develop evidence-based palliative care as a result of variation in the nursing home staff's change efficacy and change commitment as well as restrictions in many contextual conditions. There are considerable individual- and organizational-level challenges to achieving evidence-based palliative care in this setting. The educational intervention represents one of many steps towards developing a culture conducive to evidence-based nursing home palliative care.
PubMed ID
29301543 View in PubMed
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Differences in discontinuation of statin treatment in women and men with advanced cancer disease.

https://arctichealth.org/en/permalink/ahliterature298923
Source
Biol Sex Differ. 2018 10 20; 9(1):47
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
10-20-2018
Author
Helena Bergström
Elsa Brånvall
Maria Helde-Frankling
Linda Björkhem-Bergman
Author Affiliation
Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo floor 7, SE-141 83, Huddinge, Sweden.
Source
Biol Sex Differ. 2018 10 20; 9(1):47
Date
10-20-2018
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage
Male
Middle Aged
Neoplasms - drug therapy - mortality
Palliative Care
Sweden - epidemiology
Withholding Treatment - statistics & numerical data
Abstract
Statins are often discontinued in patients with advanced cancer since the net effect of treatment is considered negative. However, guidelines concerning discontinuation of statin treatment are lacking. The aim of this study was to investigate any differences in time of discontinuation of statin treatment between men and women with advanced cancer disease.
Medical records from 195 deceased palliative cancer patients from a previous study cohort were reviewed. Patients treated with statins 2 years before death were identified as "statin users." The time of discontinuation of statin therapy was identified and correlated to time of death. Only patients that had incurable cancer disease at time of statin discontinuation were included in the analysis.
Fifty-four patients were identified as statin users, 29 women and 25 men. The average time span between discontinuation of statin treatment and time of death was significantly longer in women than in men, 10 months compared to 4 months (p?
PubMed ID
30342545 View in PubMed
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Teamwork in primary palliative care: general practitioners' and specialised oncology nurses' complementary competencies.

https://arctichealth.org/en/permalink/ahliterature294796
Source
BMC Health Serv Res. 2018 03 07; 18(1):159
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
03-07-2018
Author
May-Lill Johansen
Bente Ervik
Author Affiliation
Department of Community Medicine, UiT The Arctic University of Norway, N-9037, Tromsø, Norway. May-Lill.Johansen@uit.no.
Source
BMC Health Serv Res. 2018 03 07; 18(1):159
Date
03-07-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Clinical Competence
Female
Focus Groups
General Practitioners - psychology - statistics & numerical data
Humans
Male
Middle Aged
Norway
Oncology Nursing
Palliative Care - organization & administration
Physician-Nurse Relations
Primary Health Care - organization & administration
Qualitative Research
Abstract
Generalists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. There is little research on their contribution. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care.
A qualitative focus group and interview study in rural Northern Norway, involving 52 health professionals. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically.
The ideal cooperation between GPs and ONs was as a "meeting of experts" with complementary competencies. GPs drew on their generalist backgrounds, including their often long-term relationship with and knowledge of the patient. The ONs contributed longitudinal clinical observations and used their specialised knowledge to make treatment suggestions. While ONs were often experienced and many had developed a form of pattern recognition, they needed GPs' competencies for complex clinical judgements. However, ONs sometimes lacked timely advice from GPs, and could feel left alone with sick patients. To avoid this, some ONs bypassed GPs and contacted palliative specialists directly. While traditional professional hierarchies were not a barrier, we found that organization, funding and remuneration were significant barriers to cooperation. GPs often did not have time to meet with ONs to discuss shared patients. We also found that ONs and GPs had different strategies for learning. While ONs belonged to a networking nursing collective aiming for continuous quality improvement, GPs learned mostly from their individual experience of caring for patients.
The complementary competences and autonomous roles of a specialised nurse and a general practitioner represented a good match for primary palliative care. When planning high-quality teamwork in primary care, organizational barriers to cooperation and different cultures for learning need consideration.
Notes
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PubMed ID
29514681 View in PubMed
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Relatives' level of satisfaction with advanced cancer care in Greenland - a mixed methods study.

https://arctichealth.org/en/permalink/ahliterature291168
Source
Int J Circumpolar Health. 2017; 76(1):1335148
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
2017
Author
Mikaela Augustussen
Lise Hounsgaard
Michael Lynge Pedersen
Per Sjøgren
Helle Timm
Author Affiliation
a Ilisimatusarfik , University of Greenland , Nuuk , Greenland.
Source
Int J Circumpolar Health. 2017; 76(1):1335148
Date
2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Arctic Regions
Cross-Sectional Studies
Decision Making
Family - psychology
Female
Greenland
Humans
Interviews as Topic
Inuits
Male
Middle Aged
Neoplasms - therapy
Palliative Care - psychology
Patient Participation
Personal Satisfaction
Prospective Studies
Time-to-Treatment
Abstract
Palliative cancer care in Greenland is provided by health professionals at local level, the national Queen Ingrid's Hospital and at Rigshospitalet in Denmark. To improve and develop care for relatives of patients with advanced cancer, we conducted a mixed method study examining relatives' level of satisfaction with care and treatment and their current main concerns. The aim was to investigate relatives' level of satisfaction with advanced cancer care and bring to light their current main concerns. The FAMCARE-20 questionnaire was translated to Greenlandic and pilot tested. The questionnaire was supplemented by open-ended questions about relative's current main concerns and analyzed with a phenomenological hermeneutical approach. Greenlandic patients with advanced cancer who were previously participating in a prospective study were asked if their closest adult relative would participate in the study. Telephone interviews were conducted and relatives responded to the questionnaire. A total of thirty-two relatives were contacted by telephone and 30 (94%) completed the FAMCARE-20 questionnaire and answered open-ended questions. The highest rate of satisfaction was with the availability of a hospital bed (66%) and relatives were the most dissatisfied with the lack of inclusion in decision making related to treatment and care (71%) and the length of time required to diagnose cancer (70%). Responses to the open-ended questions revealed that relatives faced challenges in gaining access to information from health professionals. They experienced a lack of security, worries about the future and a lack of support at home. The study showed a substantial level of dissatisfaction among relatives of patients with advanced cancer. We strongly recommend a focus on psychosocial care, more access to information and to include relatives in decision making and in the future planning of palliative care services. An assessment of relatives' needs is essential to develop an adequate palliative care in a range of settings.
Notes
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Cites: Fam Pract. 2003 Jun;20(3):304-10 PMID 12738700
PubMed ID
28613119 View in PubMed
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Patients' and caregivers' needs, experiences, preferences and research priorities in spiritual care: A focus group study across nine countries.

https://arctichealth.org/en/permalink/ahliterature299387
Source
Palliat Med. 2018 01; 32(1):216-230
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
01-2018
Author
Lucy Ellen Selman
Lisa Jane Brighton
Shane Sinclair
Ikali Karvinen
Richard Egan
Peter Speck
Richard A Powell
Ewa Deskur-Smielecka
Myra Glajchen
Shelly Adler
Christina Puchalski
Joy Hunter
Nancy Gikaara
Jonathon Hope
Author Affiliation
1 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Source
Palliat Med. 2018 01; 32(1):216-230
Date
01-2018
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adaptation, Psychological
Adult
Aged
Aged, 80 and over
Belgium
Canada
Caregivers - psychology
Female
Finland
Focus Groups
Humans
Kenya
Male
Middle Aged
Neoplasms - nursing
Palliative Care - psychology
Poland
Quality of Life - psychology
Republic of Korea
South Africa
Spirituality
Stress, Psychological - psychology
Terminally Ill - psychology
United Kingdom
United States
Abstract
Spiritual distress is prevalent in advanced disease, but often neglected, resulting in unnecessary suffering. Evidence to inform spiritual care practices in palliative care is limited.
To explore spiritual care needs, experiences, preferences and research priorities in an international sample of patients with life-limiting disease and family caregivers.
Focus group study.
Separate patient and caregiver focus groups were conducted at 11 sites in South Africa, Kenya, South Korea, the United States, Canada, the United Kingdom, Belgium, Finland and Poland. Discussions were transcribed, translated into English and analysed thematically.
A total of 74 patients participated: median age 62 years; 53 had cancer; 48 were women. In total, 71 caregivers participated: median age 61 years; 56 were women. Two-thirds of participants were Christian. Five themes are described: patients' and caregivers' spiritual concerns, understanding of spirituality and its role in illness, views and experiences of spiritual care, preferences regarding spiritual care, and research priorities. Participants reported wide-ranging spiritual concerns spanning existential, psychological, religious and social domains. Spirituality supported coping, but could also result in framing illness as punishment. Participants emphasised the need for staff competence in spiritual care. Spiritual care was reportedly lacking, primarily due to staff members' de-prioritisation and lack of time. Patients' research priorities included understanding the qualities of human connectedness and fostering these skills in staff. Caregivers' priorities included staff training, assessment, studying impact, and caregiver's spiritual care needs.
To meet patient and caregiver preferences, healthcare providers should be able to address their spiritual concerns. Findings should inform patient- and caregiver-centred spiritual care provision, education and research.
PubMed ID
29020846 View in PubMed
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The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data.

https://arctichealth.org/en/permalink/ahliterature294431
Source
Eur J Cancer. 2018 01; 88:101-108
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
01-2018
Author
Magdalena Lycken
Linda Drevin
Hans Garmo
Pär Stattin
Jan Adolfsson
Ingela Franck Lissbrant
Lars Holmberg
Anna Bill-Axelson
Author Affiliation
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: magdalena.lycken@surgsci.uu.se.
Source
Eur J Cancer. 2018 01; 88:101-108
Date
01-2018
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Acetaminophen - therapeutic use
Aged
Aged, 80 and over
Analgesics, Opioid - therapeutic use
Androgen Antagonists - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Cause of Death
Drug Therapy - methods - statistics & numerical data
Educational Status
Europe
Humans
Male
Palliative Care - methods - statistics & numerical data
Prostatic Neoplasms - drug therapy - mortality
Registries - statistics & numerical data
Socioeconomic Factors
Sweden
Abstract
Symptoms of terminal cancer have previously been reported as undertreated. The aim of this study was to assess the use of palliative medications before death from prostate cancer.
This Swedish register study included men who died from 2009 to 2012 with prostate cancer as the underlying cause of death. We assessed the proportion who collected a prescription of androgen deprivation therapy, non-steroidal anti-inflammatory drugs, paracetamol, opioids, glucocorticoids, antidepressants, anxiolytics and sedative-hypnotics and the differences in treatment related to age, time since diagnosis, educational level, close relatives and comorbidities. Data were collected from 3 years before death from prostate cancer.
We included 8326 men. The proportion who received opioids increased from 30% to 72% during the last year of life, and 67% received a strong opioid at the time of death. Antidepressants increased from 13% to 22%, anxiolytics from 9% to 27% and sedative-hypnotics from 21% to 33%. Men without close relatives and older men had lower probability to receive opioids (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.47-0.66 for >85 years versus
PubMed ID
29216521 View in PubMed
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6 records – page 1 of 1.