Risultati per: Le cure palliative, fascicolo dedicato con linee guida

Rappresenta le aziende a capitale europeo e nipponico

Background
Due to the recognition that people experiencing homelessness (PEH) often die young and unsupported, a growing number of initiatives focusing on palliative care and homelessness are emerging across the UK. However, there has been no systematic exploration of the nature and landscape of this work.

Aims
To understand the range, aims, successes and challenges of current initiatives within the field of palliative care and homelessness in the UK, by exploring existing projects and initiatives.

Method
An online survey was distributed to members of an Extension for Community Healthcare Outcomes network focusing on palliative care and homelessness for a mixed professional audience. The survey collated the aims, successes and challenges of initiatives aiming to improve palliative care for PEH. Responses were summarised using descriptive statistics, and free-text responses were analysed using thematic analysis.

Results
162 professionals completed the survey. Of these, 62% reported involvement in at least one palliative care and homelessness initiative. Initiatives focused on service delivery (59%), training (28%) and research (28%). Themes for success included improved service engagement, relationship formation, housing provision, honouring end-of-life wishes, upskilling staff and enabling safe hospital discharge. The main challenges included stigma around substance misuse, securing funding, staff capacity, equipment and facilities, and engaging communities.

Conclusion
The number and scope of initiatives aiming to support PEH with advanced ill health and palliative care needs across the UK is growing, with a range of professionals engaging in the field. Future research may benefit from exploring initiatives in more detail to understand the specific drivers of impact on PEH and the staff and services supporting them.

Inadeguatezza risorse pubbliche stanziate e disparità regionali

Presidente Perrone: ‘Difendere l’universalismo delle cure’

Sono 224mila i casi diagnosticati, ma si stimano circa 600mila

Sono 224mila i casi diagnosticati, ma si stimano circa 600mila

A relatively low-intensity intervention of nurse and social worker phone calls improved quality of life and health status.

Objectives
To compare the discussions from two panels on the concept of palliative care quality for patients with advanced cancer, exploring the priorities reflected in each group’s perspectives.

Design
We convened two RAND-UCLA appropriateness panel discussions on palliative care quality in advanced cancer. Discussions were audio-recorded and transcribed verbatim. Panel transcripts were analysed thematically using a matrix approach to examine perceptions and experiences of quality.

Setting
Discussions were framed within the context of advanced cancer care and palliative care.

Participants
The patient–caregiver panel had 9 patients with current or a history of cancer and caregivers, and the practitioner panel had 10 expert practitioners representing fields of oncology, primary care, social work, palliative care, nursing, pain management and ethics.

Results
Our analysis identified three thematic categories for understanding quality common across both groups and nine subthemes within those categories. At the highest level, quality was conceived as: (1) the patient and caregiver experience of care, (2) technical competence and (3) the structure of health system. Among the subthemes, four were present in only one of the two group’s discussions: ‘purpose and action’ was specific to the patient–caregiver panel, whereas ‘adhering to best medical practice’, ‘mitigating unintended consequences and side effects’, and ‘health system resources and costs’ were specific to the practitioner panel.

Conclusions
While both panels aligned on the three key domains of quality, the particular dimensions through which they perceived quality varied in relation to their experience and role as a professional provider of care versus recipient of healthcare services. These differences suggest the importance of adopting a collaborative approach to quality measurement and improvement so that the values of all interested parties are represented in improvement efforts.

Il report di Gimbe sulla mobilità sanitaria

At first glance, the 2 palliative care trials in this issue of JAMA may seem a study in contrasts. One was an outpatient intervention, the other inpatient. One included 306 participants, the other 24 065. One was an efficacy study, the other a pragmatic effectiveness study. One of the interventions added resources to expand access to palliative care, the other tried to expand access to palliative care with no additional resources. In one study the primary outcome was quality of life (QOL), in the other length of stay (LOS). In one study the primary outcome was positive, in the other it was negative.

This randomized clinical trial compares differences in quality of life among 306 adults at high risk of death who have COPD, heart failure, or interstitial lung disease and who received nurse and social worker palliative telecare vs usual care.

This cluster randomized trial examines whether the effect of ordering palliative care consultation by default for seriously ill hospitalized patients without requiring greater palliative care staffing increased consultations and improved outcomes.

Annals of Internal Medicine, Ahead of Print.