ABSTRACT
Background/aims: COVID-19 has compounded the lack of access to palliative care described in the Lancet Commission. COVID-19 patients and their families report distressing multidimensional symptoms and concerns. South Africa faced a high burden of COVID-19, and due to restrictions in facility access there was need for upskilling of healthcare professionals to deliver home palliative care irrespective of diagnosis. Aim: To develop and evaluate online training of palliative home care. Methods: We developed: 1) guidelines for health care professionals and family caregivers using a multidisciplinary team of stakeholders from across South Africa, 2) online training covering palliative care management of COVID-19 and non-COVID-19 patients at home, completed over 4 weeks and 3) training evaluation using an online questionnaire and qualitative interviews. Results: Between March and May 2021, n=950 participants were registered for online asynchronous training. Of these, n=247 engaged with the training materials, n=141 completed assessments, receiving a certificate of completion with CPD accreditation for professionals. Survey data were collected from 53 participants: n=27 health professionals (n=13 nurses, n=5 doctors, n=3 social workers, n=3 counsellors;n=2 rehabilitation sciences, and n=1 emergency medicine), and n=26 non-professionals. Thirty-one (58.9%) had no previous palliative care training;n=22 (41.5%) had no previous experience in providing palliative care. Implementation outcome measurement: agreement with being able to apply the training clinically was 4/5 for 27 (51.0%) and 5/5 for 19 (35.8%) on a 5-point Likert scale;and 34 (64.2%) completely agreed (5/5) to welcoming the opportunity to develop palliative care knowledge and skills. Conclusions: The interest shown in the guidelines and training reflect an awareness of the importance of these skills, and the delivery method offers enormous potential to builds skills and knowledge in an accessible format.
ABSTRACT
Background/Aims Nailfold capillaroscopy has a key role in the assessment of patients with Raynaud's phenomenon (RP) providing a window of opportunity for the early diagnosis of systemic sclerosis (SSc). Anecdotal evidence indicates that this opportunity is not being fully realised across UK rheumatology centres. Reasons for apparent discrepancies in use of capillaroscopy may relate to a lack of expertise, confidence or equipment. Exploratory work has demonstrated the potential for an internet-based standardised system for clinical reporting of nailfold capillaroscopy images to mitigate current inequities in care provision. The overall aim of this study was to understand current practices in the diagnosis of SSc in UK rheumatology centres with specific reference to identifying barriers to the use of nailfold capillaroscopy. A secondary aim was to understand rheumatologists' views on a standardised system to facilitate the timely diagnosis of SSc. Methods An online survey comprising closed and free-text questions was developed using expert (n=7) opinion from clinicians, scientists and health service researchers. The survey was piloted (n=5) and sent to UK-based rheumatologists using established electronic mailing lists between 2nd October 2020 and 8th March 2021. Respondents were asked to describe workloads and practices typically seen before the COVID-19 pandemic. Data were analysed using descriptive statistics and thematic analysis. Results Survey responses were received from 104 rheumatologists representing centres across the UK. Wide variation in terms of workloads and practices were described (See Table 1). Only 41% (n=43) of respondents reported using nailfold capillaroscopy provided at their centres. Key barriers were access to equipment and a lack of expertise in terms of acquiring and analysing images. Respondents indicated that a centralised internet-based system for storing images and sharing diagnoses would provide access to expertise and the possibility of timely diagnoses Conclusion Substantial variation in approaches to the diagnosis of SSc across the UK was identified. Potential benefits of a standardised system were described by respondents including the improved diagnosis and management of SSc, realising potential patient benefits and reducing current health inequalities. Survey findings provide evidence to help develop future studies to develop and evaluate the proposed new system.