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1.
BMC Med Ethics ; 23(1): 45, 2022 04 19.
Article in English | MEDLINE | ID: covidwho-1798405

ABSTRACT

BACKGROUND: Commentators believe that the ethical decision-making climate is instrumental in enhancing interprofessional collaboration in intensive care units (ICUs). Our aim was twofold: (1) to determine the perception of the ethical climate, levels of moral distress, and intention to leave one's job among nurses and physicians, and between the different ICU types and (2) determine the association between the ethical climate, moral distress, and intention to leave. METHODS: We performed a cross-sectional questionnaire study between May 2021 and August 2021 involving 206 nurses and physicians in a large urban academic hospital. We used the validated Ethical Decision-Making Climate Questionnaire (EDMCQ) and the Measure of Moral Distress for Healthcare Professionals (MMD-HP) tools and asked respondents their intention to leave their jobs. We also made comparisons between the different ICU types. We used Pearson's correlation coefficient to identify statistically significant associations between the Ethical Climate, Moral Distress, and Intention to Leave. RESULTS: Nurses perceived the ethical climate for decision-making as less favorable than physicians (p < 0.05). They also had significantly greater levels of moral distress and higher intention to leave their job rates than physicians. Regarding the ICU types, the Neonatal/Pediatric unit had a significantly higher overall ethical climate score than the Medical and Surgical units (3.54 ± 0.66 vs. 3.43 ± 0.81 vs. 3.30 ± 0.69; respectively; both p ≤ 0.05) and also demonstrated lower moral distress scores (both p < 0.05) and lower "intention to leave" scores compared with both the Medical and Surgical units. The ethical climate and moral distress scores were negatively correlated (r = -0.58, p < 0.001); moral distress and "intention to leave" was positively correlated (r = 0.52, p < 0.001); and ethical climate and "intention to leave" were negatively correlated (r = -0.50, p < 0.001). CONCLUSIONS: Significant differences exist in the perception of the ethical climate, levels of moral distress, and intention to leave between nurses and physicians and between the different ICU types. Inspecting the individual factors of the ethical climate and moral distress tools can help hospital leadership target organizational factors that improve interprofessional collaboration, lessening moral distress, decreasing turnover, and improved patient care.


Subject(s)
Attitude of Health Personnel , Intention , Child , Cross-Sectional Studies , Hospitals , Humans , Infant, Newborn , Intensive Care Units , Job Satisfaction , Morals , Stress, Psychological , Surveys and Questionnaires
2.
Scand J Trauma Resusc Emerg Med ; 29(1): 173, 2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-2098403

ABSTRACT

BACKGROUND: The coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The purpose of the study was to investigate the proportion and characteristics of COVID-19 patients with limitation of life-sustaining treatment decisions and the degree of patient involvement in the decisions. METHODS: A retrospective observational descriptive study was conducted in three Danish regional hospitals, looking at all patients ≥ 18 years of age admitted in 2020 with COVID-19 as the primary diagnosis. Lists of hospitalised patients admitted due to COVID-19 were extracted. The data registration included age, gender, comorbidities, including mental state, body mass index, frailty, recent hospital admissions, COVID-19 life-sustaining treatment, ICU admission, decisions on limitations of life-sustaining treatment before and during current hospitalisation, hospital length of stay, and hospital mortality. RESULTS: A total of 476 patients were included. For 7% (33/476), a decision about limitation of life-sustaining treatment had been made prior to hospital admission. At the time of admission, one or more limitations of life-sustaining treatment were registered for 16% (75/476) of patients. During the admission, limitation decisions were made for an additional 11 patients, totaling 18% (86/476). For 40% (34/86), the decisions were either made by or discussed with the patient. The decisions not made by patients were made by physicians. For 36% (31/86), no information was disclosed about patient involvement. CONCLUSIONS: Life-sustaining treatment limitation decisions were made for 18% of a COVID-19 patient cohort. Hereof, more than a third of the decisions had been made before hospital admission. Many records lacked information on patient involvement in the decisions.


Subject(s)
COVID-19 , Denmark/epidemiology , Humans , Patient Participation , Retrospective Studies , SARS-CoV-2
3.
Qual Health Res ; : 10497323221131692, 2022 Oct 16.
Article in English | MEDLINE | ID: covidwho-2079288

ABSTRACT

This article explores the experiences of young adults with a life-shortening condition in the first wave of the Coronavirus (COVID-19) pandemic in the UK. It presents the findings from an inclusive qualitative research study using constructivist grounded theory which aimed to examine the unintended consequences of pandemic control measures (lockdown and 'shielding') on this population. Purposive and theoretical sampling methods were used to recruit young adults with a life-shortening condition, employing a range of recruitment methods such as social media, advertising in newsletters and snowballing. Twenty-six young adults (aged 22-40 years), with a wide range of life-shortening conditions participated in the study. Seventeen participants were female and nine male. The majority identified as White British/Other and the remainder as Black British (2), Mixed Race (2) or Latin American (1). Data were generated iteratively using in-depth guided interviews and analysed collectively by an inclusive research team using the constant comparative method. The article explores a theory of embodied precariousness of living with a life-shortening condition during the first wave of the Coronavirus pandemic in relation to three categories: the rationing of life-saving treatment, the deterioration of health and retraction of healthcare provision, and the disruption of typical care arrangements. The findings show that the pandemic control measures introduced to keep people safe have intensified the precarity of this group promoting inequalities in healthcare and health outcomes. The article identifies some implications for practice to support the future management of unexpected and unwanted change.

4.
Hastings Cent Rep ; 50(3): 12-13, 2020 May.
Article in English | MEDLINE | ID: covidwho-2074981

ABSTRACT

In a field that strives to care for patients and families together, what can palliative care clinicians do when patients' families are physically absent? The Covid-19 pandemic has put both literal and figurative walls between health care professionals and families. How health care workers respond to these disconnections might have a lasting impact on patients, on families, and on our practice. Recently, I saw this in the case of a patient our palliative care team was consulted to see. Mr. B was minimally responsive and dying from multisystem organ failure of unclear etiology. As in other cases during this pandemic, our team became a facilitator of interaction between the patient and the physically absent family, seeing an intimacy we normally would not, in this case, by being present while our intern held the phone to Mr. B's ear for an end-of-life call from his wife, son, and daughter. Such moments force us clinicians to be even more present for our families and patients, and they allow us to bear witness to the strength and sadness and love that we might otherwise miss.


Subject(s)
Coronavirus Infections/epidemiology , Family/psychology , Palliative Care/organization & administration , Palliative Care/psychology , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Ethics Consultation , Humans , Pandemics , SARS-CoV-2
5.
Dissertation Abstracts International: Section B: The Sciences and Engineering ; 83(12-B):No Pagination Specified, 2022.
Article in English | APA PsycInfo | ID: covidwho-2072875

ABSTRACT

Background: Half of the population with cancer who are aged 20 to 54 years old will die from cancer with African Americans being 1.2 times more likely to die (NCI, 2019a;2021b). Parents with advanced cancer (PWAC) have concerns about their future and their remaining family's future, which causes suffering. Dying concerns are conscious/unconscious thoughts about death by a person facing a terminal illness or a family member coping with the impending death of a loved one (Arndt et al., 2006;Caparso et al., 2020;Kakuta et al., 2015). Purpose: Examine recruitment feasibility in PWAC and their co-parents.;and (2) Gain a shared understanding of the perspectives of the PWAC about the dying concerns family life before and after advanced cancer diagnosis and family resources to manage the crisis of advanced cancer for the co-parent following Gadamer's phenomenology and McCubbin and McCubbin's Family Resiliency Model.Methods: Four PWAC were recruited from Karmanos Cancer Center and Comprehensive Breast Care. Participants were diagnosed with advanced cancer, scored less than a 3 on the Eastern Cooperative Oncology Group (ECOG) scale, had at least one dependent child 18 years old or younger, identified a co-parent involved in care of the patient and children, and spoke English. Two semi-structured interviews were conducted, audio- video-recorded, and transcribed. The first interview was summarized and given to the participants for member-checking. Data analysis used the hermeneutic rule. All data was coded and verified between coders until consensus was reached.Results: Due to unforeseen circumstances and hospital restrictions of COVID-19, recruitment was challenging. Of 32 potential participants, 11 were approached and 4 consented. Completion of all study procedures for one participant took a little over a month. Completion of both interviews ranged about an hour and a half. Four themes regarding dying concerns emerged. Additional themes emerged which may have mediated the dying concern themes. Participants expressed co-parent concerns of "Uncertainty in End-of-Life Decisions", "Effectless Communication", "Parental Skepticism" and "Psychological Well-Being".Conclusions: PWAC have concerns for their co-parent in the event they die. Qualitatively understanding dying concerns from family members may improve communication between family members and healthcare providers. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

6.
Chest ; 2022 Oct 15.
Article in English | MEDLINE | ID: covidwho-2068775

ABSTRACT

BACKGROUND: Death from COVID-19 in a hospital during the pandemic has meant death in isolation. Although many healthcare providers have struggled with end-of-life care for these patients, the various strategies across hospitals are not well known. RESEARCH QUESTIONS: What end-of-life care did healthcare providers give dying COVID-19 patients and their families in hospitals during the COVID-19 pandemic? What were the key themes in care? STUDY DESIGN AND METHODS: This qualitative study used individual, semistructured, internet and face-to-face interviews. We recruited healthcare providers who provided end-of-life care to COVID-19 patients dying in hospitals and their families. Purposive sampling was used through the academic networks at the School of Public Health, Kyoto University. Anonymized verbatim transcripts were thematically analyzed. RESULTS: Fifteen doctors and 18 nurses from 23 hospitals in 13 regions across Japan participated; 16 (48%) were female, with an age range of 20-59 (most were 30-39). Participants described 51 strategies, including providing physical and psychological-spiritual care, making connections, providing death care, and arranging care environments and bereavement care for patients and their families. Four themes emerged as prominent efforts in COVID-19 end-of-life care: maintaining relationships with isolated patients, connecting patients and families, sharing decision-making in isolation, and creating humanistic episodes. INTERPRETATION: Proper application and awareness of the four themes may help healthcare providers implement better end-of-life care. To compensate for limited memories due to isolation and rapid progression of the disease, communicating and creating humanistic episodes are emphasized. ICU diaries and the HCPs' arrangements based on cultural funerary procedures could be provided as grief care for the family and to build trust. End-of-life education and building partnerships among palliative care staff and nonmedical personnel on a regular basis may enhance the capacity to deliver the necessary support for end-of-life care.

7.
Int J Environ Res Public Health ; 19(19)2022 Sep 28.
Article in English | MEDLINE | ID: covidwho-2065957

ABSTRACT

During the COVID-19 pandemic, the care of critically ill and dying patients in isolation wards, intensive care units (ICUs), and regular wards was severely impaired. In order to support physicians in communicative and palliative care skills, an e-learning tool was developed as part of the joint project "Palliative Care in Pandemic Times" (PallPan). This study investigates the feasibility of this e-learning tool. Secondly, we aim to analyze changes in knowledge and attitude upon completion of the e-learning tool. A 38-item questionnaire-based evaluation study with assessment of global and specific outcomes including ICU and non-ICU physicians was performed. In total, 24 questionnaires were included in the anonymous analysis. Feasibility was confirmed by a very high rate of overall satisfaction (94% approval), with relevance reaching 99% approval. Overall, we detected high gains in knowledge and noticeably lower gains on the attitude plane, with the highest gain in naming reasons for incorporating palliative care. The lowest learning gain on the attitude plane was observed when the participants were confronted with their own mortality. This study shows that e-learning is a feasible tool for gaining knowledge and even changing the attitudes of physicians caring for critically ill and dying patients in a self-assessment evaluation.


Subject(s)
COVID-19 , Computer-Assisted Instruction , Physicians , Terminal Care , Attitude of Health Personnel , COVID-19/epidemiology , Critical Illness , Humans , Palliative Care , Pandemics , Surveys and Questionnaires
8.
BMJ Support Palliat Care ; 2022 Oct 13.
Article in English | MEDLINE | ID: covidwho-2064281

ABSTRACT

OBJECTIVES: To narrate the canon of knowledge around symptom control at end of life for patients using, or having recently used, non-invasive advanced respiratory support (NARS) at end of life for respiratory failure. METHODS: A systematic review forming a narrative synthesis from a wide range of sample papers from Medline, Embase, CINAHL, Emcare, Cochrane and OpenGrey databases. A secondary search of grey literature was also performed with hand searching reference lists and author citations. The review was undertaken using the ENTREQ checklist for quality. RESULTS: In total, 22 studies were included in the synthesis and four themes were generated: NARS as a buoy (NARS can represent hope and relief from the symptoms of respiratory failure), NARS as an anchor (NARS brings significant treatment burden), Impact on Staff (uncertainty over the balance of benefit and burden as well as complex patient care drives distress among staff providing care) and the Process of Withdrawal (withdrawal of therapy felt to be futile exists as discrete event in patient care but is otherwise poorly defined). CONCLUSION: NARS represents a complex interplay of hope, symptom control, unnaturally prolonged death and treatment burden. The literature captures the breadth of these issues, but further, detailed, research is required in almost every aspect of practice around end-of-life care and NARS-especially how to manage symptoms at the end of life.

9.
Intern Med ; 2022 Oct 05.
Article in English | MEDLINE | ID: covidwho-2054686

ABSTRACT

Objective The coronavirus disease (COVID-19) pandemic has altered the delivery of medical care. The present study evaluated the impact of COVID-19 on the outcomes of unresectable pancreatic cancer (PC) patients who received end-of-life care. Methods We retrospectively compared the management of PC patients during the COVID-19 pandemic (from April 2020 to March 2021) to the preceding year, which was unaffected by the pandemic (from April 2019 to March 2020), based on a prospectively maintained institutional database. Results A total of 178 patients were included in the COVID-19-exposed group and 201 patients were included in the COVID-19-unexposed group. The median overall survival was similar between the groups (exposed vs. unexposed: 12.6 vs. 11.9 months, p = 0.174). Treatment regimens and relative dose intensities and the progression-free survival of GnP (gemcitabine in combination with nab-paclitaxel) and mFOLFIRINOX as first- and second-line chemotherapy did not differ significantly between the two groups. Only 9.0% of patients died at home in the COVID-19-unexposed group, compared to 32.0% in the COVID-19-exposed group (p <0.001). A multivariate analysis revealed that death during the COVID-19 exposed period was independently associated with home death (odds ratio: 4.536, 95% confidence interval: 2.527-8.140, p <0.001). Conclusions While the COVID-19 pandemic did not seem to influence chemotherapeutic treatment for PC patients at our institution, it had a large impact on end-of-life care. These findings may promote discussion about end-of-life care in Japan.

10.
Ann Fam Med ; 20(5): 481-483, 2022.
Article in English | MEDLINE | ID: covidwho-2054243

ABSTRACT

Many years have passed since I visited Donny in the hospital, where he was admitted with a newly diagnosed and terminal lung cancer. Despite years of separation, his wife Rose took him back into her home and cared for Donny at the end of his life. In the months after his death, I learned more about their relationship; Donny's drinking and infidelities, the emotional and verbal abuse that Rose put up with. At the end of one office visit, I was incredulous in silent amazement and asked her, "Why did you do it?" Rose looked at me and simply said, "Because he was one of us; because he was family." As she repeated this, I saw the face of God gazing at me. Well before caring for Donny and Rose, a spiritual director encouraged me to work on describing my image of God. It was an arid time and place on my interior journey and the activity felt forced and inauthentic. Although Rose died more than 5 years ago, I still think of her and reflect on my life as a physician practicing in the shadow of the COVID-19 pandemic. As she looks at me, my uncertainties scatter and her image draws down and stirs divine wellsprings in me.


Subject(s)
COVID-19 , Pandemics , Female , Humans , Male
11.
The Yale Journal of Biology and Medicine ; 95(3):399-403, 2022.
Article in English | ProQuest Central | ID: covidwho-2047033

ABSTRACT

Early initiation of end-of-life (EOL) conversations has been shown to improve patient agency in dying, increase early access to hospice care, and facilitate a dignified death. Despite the benefits of early initiation, EOL conversations do not occur as readily as physicians or patients wish. While medicine is commonly considered both a science and an art, increasing medicalization may narrow a clinician’s focus towards procedures or specialized clinical frameworks rather than a patient’s end-of-life wishes. Since physicians are ambassadors of clinical knowledge and are trusted patient advocates, it is important they facilitate EOL conversations early in the dying process. Patients desire their physicians to convene these conversations. However, physicians are often hesitant to do so. Notable theologians, philosophers, and physicians offer a broad framework outlining the importance of physician-led EOL conversations.

12.
Generations ; 46(1), 2022.
Article in English | Scopus | ID: covidwho-2046671

ABSTRACT

This article unveils stories from a "lived experience"by frontline medical-surgical nurses caring for SARS-CoV-2 (COVID-19) using a compilation of written and verbal examples. The article intends to enrich the readers' perspective regarding nurses' thoughts, emotions, and actions as they care for patients diagnosed and hospitalized with COVID-19. A culmination of lessons learned via the "lived"knowledge exchange completes the article. © 2022 American Society on Aging.

14.
BMJ Supportive & Palliative Care ; 2022.
Article in English | Web of Science | ID: covidwho-2032545

ABSTRACT

Objectives To describe multinational prescribing practices by palliative care services for symptom management in patients dying with COVID-19 and the perceived effectiveness of medicines. Methods We surveyed specialist palliative care services, contacted via relevant organisations between April and July 2020. Descriptive statistics for categorical variables were expressed as counts and percentages. Content analysis explored free text responses about symptom management in COVID-19. Medicines were classified using British National Formulary categories. Perceptions on effectiveness of medicines were grouped into five categories;effective, some, limited or unclear effectiveness, no effect. Results 458 services responded;277 UK, 85 rest of Europe, 95 rest of the world, 1 missing country. 358 services had managed patients with confirmed or suspected COVID-19. 289 services had protocols for symptom management in COVID-19. Services tended to prescribe medicines for symptom control comparable to medicines used in people without COVID-19;mainly opioids and benzodiazepines for breathlessness, benzodiazepines and antipsychotics for agitation, opioids and cough linctus for cough, paracetamol and non-steroidal anti-inflammatory drugs for fever, and opioids and paracetamol for pain. Medicines were considered to be mostly effective but varied by patient's condition, route of administration and dose. Conclusions Services were largely consistent in prescribing for symptom management in people dying with COVID-19. Medicines used prior to COVID-19 were mostly considered effective in controlling common symptoms.

15.
Sustainability ; 14(17):10478, 2022.
Article in English | ProQuest Central | ID: covidwho-2024172

ABSTRACT

A considerable amount of construction and demolition wood waste (CDWW) is generated, mostly landfilled, contributing to severe environmental effects. The management of CDWW is a significant challenge as it is a hazardous contaminated waste. In this context, the circular economy (CE) concept is a solution as it comprises waste minimisation and efficient recovery of resources. Although much research is found in the literature on CDWW end-of-life management, research on CE implementation considering every life cycle stage is still scarce. In this review, we endeavour to integrate CE in CDWW to identify the waste management strategies involved in the life cycle phases. The databases were searched from 2009 to 2020 and were analysed using CiteSpace version 5.7.R1 software. Forty-nine articles were identified, and the six life cycle stages were explored. The analysis shows that CE for wood waste is essential and has greater growth potential. While the LCA studies are limited to environmental viewpoints, combining economic and social perspectives is necessary for sustainable development. Overall, based on the research findings, a theoretical framework was proposed. This study, as a consequence, promotes the application of recycled wood into multiple valuable products and thus encourages waste management to boost CE and sustainability.

16.
Sustainability ; 14(16):10201, 2022.
Article in English | ProQuest Central | ID: covidwho-2024146

ABSTRACT

The growth of Indonesia’s automotive sector has increased the number of end-of-life vehicles (ELVs), making ELV waste management a major issue. Most countries, such as Japan, China, and Europe, manage ELV waste well, but developing countries still do not. In developing countries, little is known about ELV social admissions. This study analyzes ELV management social acceptance in developing countries. Three hundred nine respondents from Jakarta, Bogor, Depok, Tangerang, and Bekasi (the district in Indonesia) were surveyed in a cross-sectional. A set of questions was designed to determine social acceptance (attitude, knowledge, social influence, institutional trust, health issues, and acceptance). After passing validity and reliability tests, the hypothesized research model was estimated using structural equitation. According to this study, social influence, attitude, knowledge, institutional trust, and health issues influenced public acceptance. The health issues variable was also a good moderator (Adj. R2 = 0.173, p < 0.001, average path coefficient = 0.299). The analysis of social acceptance models related to ELV management found that social influence, attitude, knowledge, and institutional trust play a role in one’s desire to accept a new rule, and health issues can strengthen a person in the admission process.

17.
Palliat Med ; : 2692163221122269, 2022 Sep 08.
Article in English | MEDLINE | ID: covidwho-2020827

ABSTRACT

BACKGROUND: Loneliness is a prevalent societal issue and can impact on a person's physical and mental health. It is unclear how loneliness impacts on end of life experiences or how such feelings can be alleviated. AIM: To explore the perceived prevalence, impact and possible solutions to loneliness among people who are terminally ill and their carers in Northern Ireland through the lens of health and social care professionals. DESIGN: An explanatory multi-method study. SETTING/PARTICIPANTS: An online survey (n = 68, response rate 30%) followed by three online focus groups with palliative and end of life care health and social care professionals (n = 14). Data were analysed using descriptive statistics and thematic analysis. RESULTS: Loneliness was perceived by professionals as highly prevalent for people with a terminal illness (92.6%) and their carers (86.8%). Loneliness was considered a taboo subject and impacts on symptoms including pain and breathlessness and overall wellbeing at end of life. Social support was viewed as central towards alleviating feelings of loneliness and promoting connectedness at end of life. Four themes were identified: (1) the stigma of loneliness, (2) COVID-19: The loneliness pandemic (3) impact of loneliness across physical and mental health domains and (4) the power of social networks. CONCLUSION: There is a need for greater investment for social support initiatives to tackle experiences of loneliness at end of life. These services must be co-produced with people impacted by terminal illness to ensure they meet the needs of this population.

18.
Health Soc Care Community ; 2022 Sep 06.
Article in English | MEDLINE | ID: covidwho-2019300

ABSTRACT

Access to high-quality and safe evidence-based palliative care (PC) is important to ensure good end-of-life care for older people in residential aged care homes (RACHs). However, many barriers to providing PC in RACHs are frequently cited. The Quality End-of-Life Care (QEoLC) Project was a multicomponent intervention that included training, evidence-based tools and tele-mentoring, aiming to equip healthcare professionals and careworkers in RACHs with knowledge, skills and confidence in providing PC to residents. This study aims to understand: (1) the experiences of healthcare professionals, careworkers, care managers, planners/implementers who participated in the implementation of the QEoLC Project; and (2) the barriers and facilitators to the implementation. Staff from two RACHs in New South Wales, Australia were recruited between September to November 2021. Semi-structured interviews and thematic data analysis were used. Fifteen participants (seven health professionals [includes one nurse, two clinical educators, three workplace trainers, one clinical manager/nurse], three careworkers and five managers) were interviewed. Most RACH participants agreed that the QEoLC Project increased their awareness of PC and provided them with the skills/confidence to openly discuss death and dying. Participants perceived that the components of the QEoLC Project had the following benefits for residents: more appropriate use of medications, initiation of timely pain management and discussions with families regarding end-of-life care preferences. Key facilitators for implementation were the role of champions, the role of the steering committee, regular clinical meetings to discuss at-risk residents and mentoring. Implementation barriers included: high staff turnover, COVID-19 pandemic, time constraints, perceived absence of executive sponsorship, lack of practical support and systems-related barriers. The findings underline the need for strong leadership, supportive organisational culture and commitment to the implementation of processes for improving the quality of end-of-life care. Furthermore, the results highlight the need for codesigning the intervention with RACHs, provision of dedicated staff/resources to support implementation, and integration of project tools with existing systems for achieving effective implementation outcomes.

19.
Medecine Palliative ; 21(5):235-243, 2022.
Article in English, French | Scopus | ID: covidwho-2015846

ABSTRACT

At Paris’ Saint-Louis hospital, the collaboration and organisation of the ER teams and those from the palliative care units was completely transformed, at least for a time, by the brutal arrival of SARS-CoV-2. Faced with the necessity of the moment, and initiated by the mobile palliative care team, the absence of structured exchanges of information was replaced with a daily briefing within the ER hospitalisation unit, with the aim of anticipating a possible request to quantify any patients requiring evaluation and palliative care on-site, as well as accompanying the ER doctors and other medical staff present. Beyond describing the patients taken into care under this system, and the benefits in terms of palliative care, a qualitative study conducted with ER doctors allowed us to evaluate the real and perceived benefits, and to conclude that a greater presence of the mobile accompaniment and palliative care team at ER allows for better use of their resources and a subsequent modification of the care pipeline for certain patients. This work shows the fundamental contribution that a mobile palliative care team can make in receiving and treating ER patients, while also improving the experience of the teams faced daily with individuals at the end of their lives. However, it also brings to light a patent lack of palliative care culture in ER services, as well as the absence of a reflex to make use of this type of expertise systematically, despite the benefits being universally acknowledged, opening the way for the joint development of veritable palliative care for acute cases. © 2022 Elsevier Masson SAS En matière de collaboration entre les équipes d'urgences et celles de soins palliatifs de l'hôpital Saint-Louis (AP–HP, Paris), l'irruption brutale du SARS-CoV-2 et ses conséquences sur l'afflux de patients et l'organisation des soins ont, pour un temps au moins, changé la donne. Contraints par la nécessité du moment, et sous l'impulsion de l’équipe mobile de soins palliatifs, l'absence d’échanges structurés a fait place à un échange quotidien au sein de l'unité d'hospitalisation des urgences afin d'anticiper un éventuel appel, de recenser sur place les patients pouvant bénéficier d'un avis et d'une prise en charge palliatifs, mais également d'accompagner les urgentistes et les soignants présents. Au-delà de la description des patients ainsi pris en charge et du bénéfice en termes de prise en charge palliative, une étude qualitative réalisée auprès des urgentistes nous permet d’évaluer le bénéfice réel et ressenti et d'affirmer qu'une présence renforcée de l'EMASP aux urgences permet une meilleure utilisation de ces ressources et une modification subséquente du parcours de certains patients. Ce travail met en évidence la contribution fondamentale que peut apporter une équipe mobile de soins palliatifs à la prise en charge des patients aux urgences et au mieux-être d’équipes quotidiennement confrontées à la fin de vie. Il fait néanmoins apparaître un défaut patent de culture palliative aux urgences ainsi qu'un manque de réflexe de recours à ce type d'expertise alors que les bénéfices en sont unanimement reconnus, et ouvre ainsi la porte au développement conjoint d'une véritable médecine palliative de l'aigu. © 2022 Elsevier Masson SAS

20.
J Crit Care ; 71: 154115, 2022 10.
Article in English | MEDLINE | ID: covidwho-2015608

ABSTRACT

PURPOSE: Death is common in intensive care units, and integrating palliative care enhances outcomes. Most research has been conducted in high-income countries. The aim is to understand what is known about the type and topics of research on the provision of palliative care within intensive care units in low- and middle-income countries MATERIALS AND METHODS: Scoping review with nine databases systematically searched for literature published in English on palliative care in intensive care units in low- and middle- income settings (01/01/1990 to 31/05/2021). Two reviewers independently checked search results and extracted textual data, which were analyzed and represented as themes. RESULTS: Thirty papers reported 19 empirical studies, two clinical case reports and six discussion papers. Papers originated from Asia and Africa, primarily using observational designs and qualitative approaches, with no trials or other robust evaluative or comparative studies. No studies directly sought data from patients or families. Five areas of research focus were identified: withholding and withdrawing treatment; professional knowledge and skills; patient and family views; culture and context; and costs of care. CONCLUSIONS: Palliative care in intensive care units in low-and middle-income countries is understudied. Research focused on the specific needs of intensive care in low- and middle-income countries is required to ensure optimal patient outcomes.


Subject(s)
Hospice and Palliative Care Nursing , Terminal Care , Developing Countries , Humans , Intensive Care Units , Palliative Care
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