Palliative Care for Patients in the Acute Hospital Setting

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Palliative Care for Patients in the Acute Hospital Setting

Preliminary Literature Review

Palliative Care for Patients in Acute Hospital Settings

  1. Rodriguez, K. L., Barnato, A. E., & Arnold, R. M. (2007). Perceptions and Utilization of Palliative Care Services in Acute Care Hospitals. Journal Of Palliative Medicine, 10(1), 99-110.

The study explores the different perceptions among healthcare providers on palliative care in hospital acute care settings to identify the barriers that prevent the use of palliative care in the early care of illnesses. The study makes use of semi-structured interviews of 131 healthcare providers in Pennsylvania, and quantitative analysis of the transcripts. The results indicate that healthcare providers do not use palliative care in the early care of patients in the acute setting since they perceive palliative care as meant for end-of-life or hospice care. The providers are not aware of the use of palliative care in the management of symptoms or the caring of psychosocial needs of chronically ill patients. The results also indicate that palliative care is often associated with nurses and is out of the scope of surgeons. The study indicates to increase and broaden palliative care in these settings requires the training and education of healthcare providers, increasing financial reimbursement, creation of a hospital culture.

  1. Sandgren, A., Fridlund, B., Nyberg, P., Strang, P., Petersson, K., & Thulesius, H. (2010). Symptoms, care needs, and diagnosis in palliative cancer patients in acute care hospitals: A 5-year follow-up survey. Acta Oncologica, 49(4), 460-466.

The study sought to study and describe the symptoms, types of cancer, and the care needs required for patients in acute hospital settings. The study made use of a cross-sectional survey of the medical, oncology, and surgical wards of 2 hospitals between 2002 and 2007 of 1,352 and 2,972 patients respectively. The results of the survey indicate that within the five years the number of patients had reduced, had aged to reach the ages between 70 and 74. These patients indicate that the most common symptoms were deterioration and pain, with the most common cancers being colorectal and prostate cancer. The study shows that there was a very weak association between symptoms, care of needs, and cancer sites. The study shows that lack of care led to a high occurrence of infections, high need for infusions and blood transfers. The study shows that the main care given to the patients during the five-year study period was cancer diagnosis and treatment. This is the cause of the increased need for the infusions, associated nausea, and nutritional needs among patients. The study shows there is a need for palliative care for patients with cancer in the acute care setting of hospitals.

  1. Mori, M., Parsons, H. A., De La Cruz, M., Elsayem, A., Palla, S. L., Liu, J., & … Fadul, N. A. (2011). Changes in Symptoms and Inpatient Mortality: A Study in Advanced Cancer Patients Admitted to an Acute Palliative Care Unit in a Comprehensive Cancer Center. Journal Of Palliative Medicine, 14(9), 1034-1041.

The study focuses on the need for management of symptoms as a means to improve the patient’s care and survival in the acute care setting of hospitals for cancer patients. To prove this the study sought to investigate the relationship between inpatient mortality and changes in symptoms for patients with advanced cancer under acute palliative care centers in hospitals. This made use of observation research method, where the researchers reviewed the medical records for 166 cancer patients admitted between June 2006 and December 2007. To estimate the odds of inpatient death, the research made use of univariate and multivariate analyses. The results indicate that 19.3% of the patients died by the end of the study. The study shows that symptoms like high levels of dyspnea were associated with dying, drowsiness, low level of anxiety and a transfer from EC. Moreover, worsened depression was directly linked with death in the palliative care units.

  1. Llamas, K. K., Pickhaver, A. A., & Piller, N. N. (2001). Mainstreaming palliative care for cancer patients in the acute hospital setting. Palliative Medicine, 15(3), 207-212.

The study shows that though palliative care is emerging as part of healthcare delivery, healthcare providers require discussing and communicating with patients over the choice of place of dying. The study shows that this gap in palliative care makes the acute hospital setting inappropriate for caring for dying patients. The situation is worse for patients with terminal illnesses like cancer, whose diagnosis and treatment occurs in these acute settings, making them the most common place for patients to die. The observation of acute settings indicates the need for improved palliative care. This especially requires an increase in the number of skilled and compassionate caregivers for dying patients in acute settings. The study recommends the need for educating and training healthcare providers to acquire required skills and compassionate care of palliative training to increase the level of integrity in the acute care settings of hospitals.

  1. Yang, G., Ewing, G., & Booth, S. (2012). What is the role of specialist palliative care in an acute hospital setting? A qualitative study exploring views of patients and carers. Palliative Medicine, 26(8), 1011-1017.

The study carries out a qualitative research to investigate the carer and patient perspective of the palliative care roles in acute care settings for a hospital for patients not imminently dying. The study used semi-structured interviews of 10 carers and 12 patients in palliative care units. The study shows that upon admission in the palliative care unit, patient was bewildered and viewed it as a place for those approaching end-of-life. However, after palliative care, carers, and patients comprehended the role the unit plays as a place to offer psychological support, control physical symptoms, and offer liaison. The patients found that palliative care teams offer sense of value and worth, creating a feeling of care.

  1. Berkowitz, R. E., Jones, R. N., Rieder, R., Bryan, M., Schreiber, R., Verney, S., & Paasche-Orlow, M. K. (2011). Improving Disposition Outcomes for Patients in a Geriatric Skilled Nursing Facility. Journal Of The American Geriatrics Society, 59(6), 1130-1136.

The study seeks to investigate the intervention care given to patients by skilled nursing unit in acute care hospital settings. The study carried out a survey of patients in a fifty-bed unit between June 2008 and May 2010 of 1,725 patients. The results of the survey indicate that during the intervention period patients were more likely to die during the baseline period in the acute care hospital. The study indicates to reduce the number of deaths in the acute care setting requires the use of palliative care among SNU.

  1. Santa-Emma, P. H., Roach, R., Gill, M., Spayde, P., & Taylor, R. M. (2002). Development and Implementation of an Inpatient Acute Palliative Care Service. Journal Of Palliative Medicine, 5(1), 93-100.

The study sought to investigate the level of palliative care for patients in inpatient acute care settings in American hospitals, by analyzing the developments, implementation, effectiveness, and characteristics. The study collected data of 3,712 patients between March 1997 and December 2000 detailing demographics, diagnosis, symptoms, and outcomes. The results indicate the most common symptoms are dyspnea, weakness, and pain. The most common diagnosis was cancer, cardiac disease, pulmonary disease, and stroke. The study shows that the use of palliative care for end-of-life patients prolonged their life as 72.0% of the patients were discharged, 13.8% went to extended care facilities without hospice, and 14.2% went home with home care services.

  1. von Gunten, C. F. (2002). Secondary and Tertiary Palliative Care in US Hospitals. JAMA: Journal Of The American Medical Association, 287(7), 875.

The study investigated palliative care services at the secondary and tertiary levels for patients in the acute care setting. The study made use of an evidence-based approach by observing the palliative care given to Reverend J., a patient with advanced cancer in an acute palliative unit of a teaching hospital. The primary palliative care entailed basic competencies and skills needed by physicians and were present in the care of this patient. Secondary palliative care requires specialist clinicians to organize and offer consultation with physician. As the patient progresses, tertiary palliative care is required where academic medical staff in association with specialists, palliative, and skilled nurses offer care to the patient.

  1. Bryson, J., Coe, G., Swami, N., Murphy-Kane, P., Seccareccia, D., Le, L. W., & … Zimmermann, C. (2010). Administrative Outcomes Five Years after Opening an Acute Palliative Care Unit at a Comprehensive Cancer Center. Journal Of Palliative Medicine, 13(5), 559-565.

The study sought to find if the use of palliative care in acute palliative care units set up in hospitals did meet the administrative objectives. The study made use of data of patients from administrative database covering a 5-year period since 2003. The data collected of 1748 patients on demographics, admissions, primary reason for admission, discharge, inpatient death rate, and the period of stay. The results show that the median age for admission in the palliative care unit was 64, 46% were male and 54% were women. The most common diagnosis was cancer sites gastrointestinal, lung, and gynecologic. The study shows the unit improved the primary endpoints of acute care, outpatient admissions increase, admission for the control of symptoms also increased, and discharged to home stay increased. The unit also improved the secondary endpoints as the length of stay and death rates for acute patients decreased. The results indicate that palliative care units do improve the care given to acute care patients.

  1. Woo, J., Lo, R., Cheng, J. Y., Wong, F., & Mak, B. (2011). Quality of end-of-life care for non-cancer patients in a non-acute hospital. Journal Of Clinical Nursing, 20(13/14), 1834-1841.

The study tries to document the quality of the life for patients without cancer at the end-of-life stage in hospitals. The study surveyed 80 patients with chronic illnesses, along with their carers and hospital healthcare providers. The study uses questionnaires and shows that the common symptoms and conditions suffered by these patients are lower limb weakness, dysphagia, fatigue, and pain, with their stress levels very high as 45.93. The results indicate the need for the improvement of end-of-life care for patients. The study raises awareness for the need of palliative and end-of-life care through professional training.

Action Item Checklist

  1. The project begins with the identification of the topic, “Palliative Care for Patients in the Acute Hospital Setting.” This is followed by a search for sources.
  2. The next stage is the preliminary literature review.
  3. This is followed by a conclusive literature review to synthesize the sources.
  4. The development of a report on palliative care in acute care settings in a hospital,
  5. The refinement of the report with the assistant of the supervisor, making corrections.

References

Berkowitz, R. E., Jones, R. N., Rieder, R., Bryan, M., Schreiber, R., Verney, S., & Paasche-Orlow, M. K. (2011). Improving Disposition Outcomes for Patients in a Geriatric Skilled Nursing Facility. Journal Of The American Geriatrics Society, 59(6), 1130-1136.

Llamas, K. K., Pickhaver, A. A., & Piller, N. N. (2001). Mainstreaming palliative care for cancer patients in the acute hospital setting. Palliative Medicine, 15(3), 207-212.

Mori, M., Parsons, H. A., De La Cruz, M., Elsayem, A., Palla, S. L., Liu, J., & … Fadul, N. A. (2011). Changes in Symptoms and Inpatient Mortality: A Study in Advanced Cancer Patients Admitted to an Acute Palliative Care Unit in a Comprehensive Cancer Center. Journal Of Palliative Medicine, 14(9), 1034-1041.

Rodriguez, K. L., Barnato, A. E., & Arnold, R. M. (2007). Perceptions and Utilization of Palliative Care Services in Acute Care Hospitals. Journal Of Palliative Medicine, 10(1), 99-110.

Sandgren, A., Fridlund, B., Nyberg, P., Strang, P., Petersson, K., & Thulesius, H. (2010). Symptoms, care needs, and diagnosis in palliative cancer patients in acute care hospitals: A 5-year follow-up survey. Acta Oncologica, 49(4), 460-466.

Yang, G., Ewing, G., & Booth, S. (2012). What is the role of specialist palliative care in an acute hospital setting? A qualitative study exploring views of patients and carers. Palliative Medicine, 26(8), 1011-1017.

 

Santa-Emma, P. H., Roach, R., Gill, M., Spayde, P., & Taylor, R. M. (2002). Development and Implementation of an Inpatient Acute Palliative Care Service. Journal Of Palliative Medicine, 5(1), 93-100.

von Gunten, C. F. (2002). Secondary and Tertiary Palliative Care in US Hospitals. JAMA: Journal Of The American Medical Association, 287(7), 875.

Bryson, J., Coe, G., Swami, N., Murphy-Kane, P., Seccareccia, D., Le, L. W., & … Zimmermann, C. (2010). Administrative Outcomes Five Years after Opening an Acute Palliative Care Unit at a Comprehensive Cancer Center. Journal Of Palliative Medicine, 13(5), 559-565.

Woo, J., Lo, R., Cheng, J. Y., Wong, F., & Mak, B. (2011). Quality of end-of-life care for non-cancer patients in a non-acute hospital. Journal Of Clinical Nursing, 20(13/14), 1834-1841.

 

 

 

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