PurposePalliative care improves quality of life of patients and relatives facing life-threatening illnesses; it places their needs central (WHO, 2015). It is however unknown if facility design in Dutch hospice care facilities fulfils these needs. This paper aims to establish if services and spaces of hospice care providers match with needs of users.DesignThis explorative study includes a literature review on needs and supporting services and spaces, using evidence-based design and indoor-environment design literature. Semi-structured interviews were conducted with caregivers and support staff.FindingsPatients in the final stages of life need a last refuge that requires a higher standard when compared to regular healthcare environments. The spaces and service delivery processes at hospices seem to be optimal while in other (hospice) care settings users miss adequate spaces and services. In addition, management in care systems needs to reconfigure accordingly in order to offer flexible customisation e.g. allocation of staff. Several space and service requirements have been identified, like domesticity, lay-out, style of décor, space for loved ones, quiet, and personal artefacts.Practical implicationsThe research findings will be used for follow-up research that will result in aligning the designs of spaces and services with needs of hospice care users.Originality/ValueThe role of facility management in palliative care has rarely been studied. Current findings may be regarded as a starting point for further investigation in this area, allowing hospice care to improve its spaces and services in order to meet patients’ and relatives’ needs.
BackgroundSpecialist palliative care teams are consulted during hospital admission for advice on complex palliative care. These consultations need to be timely to prevent symptom burden and maintain quality of life. Insight into specialist palliative care teams may help improve the outcomes of palliative care.MethodsIn this retrospective observational study, we analyzed qualitative and quantitative data of palliative care consultations in a six-month period (2017 or 2018) in four general hospitals in the northwestern part of the Netherlands. Data were obtained from electronic medical records.ResultsWe extracted data from 336 consultations. The most common diagnoses were cancer (54.8%) and organ failure (26.8%). The estimated life expectancy was less than three months for 52.3% of all patients. Within two weeks after consultation, 53.2% of the patients died, and the median time until death was 11 days (range 191) after consultation. Most patients died in hospital (49.4%) but only 7.5% preferred to die in hospital. Consultations were mostly requested for advance care planning (31.6%). End-of-life preferences focused on last wishes and maintaining quality of life.ConclusionThis study provides detailed insight into consultations of palliative care teams and shows that even though most palliative care consultations were requested for advance care planning, consultations focus on end-of-life care and are more crisis-oriented than prevention-oriented. Death often occurs too quickly after consultation for end-of-life preferences to be met and these preferences tend to focus on dying. Educating healthcare professionals on when to initiate advance care planning would promote a more prevention-oriented approach. Defining factors that indicate the need for timely palliative care team consultation and advance care planning could help timely identification and consultation.
MULTIFILE
Background: Team-based palliative care interventions have shown positive results for patients at the end of life in both hospital and community settings. However, evidence on the effectiveness of transmural, that is, spanning hospital and home, team-based palliative care collaborations is limited. Aim: To systematically review whether transmural team-based palliative care interventions can prevent hospital admissions and increase death at home. Design: Systematic review and meta-analysis. Data sources: MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), PsychINFO (Ovid), and Cochrane Library (Wiley) were systematically searched until January 2021. Studies incorporating teams in which hospital and community professionals co-managed patients, hospital-based teams with community follow-up, and case-management interventions led by palliative care teams were included. Data was extracted by two researchers independently. Results: About 19 studies were included involving 6614 patients, of whom 2202 received an intervention. The overall pooled odds ratio of at least one hospital (re)admissions was 0.46 (95% confidence interval (CI) 0.34–0.68) in favor of the intervention group. The highest reduction in admission was in the hospital-based teams with community follow-up: OR 0.21 (95% CI 0.07–0.66). The pooled effect on home deaths was 2.19 (95% CI 1.26–3.79), favoring the intervention, with also the highest in the hospital-based teams: OR 4.77 (95% CI 1.23–18.47). However, studies had high heterogeneity regarding intervention, study population, and follow-up time. Conclusion: Transmural team-based palliative care interventions, especially hospital-based teams that follow-up patients at home, show an overall effect on lowering hospital admissions and increasing the number of patients dying at home. However, broad clinical and statistical heterogeneity of included studies results in uncertainty about the effect size.
In de palliatieve terminale zorg is men nog erg terughoudend in de toepassing van telehealth technologie, terwijl voorgaande studies wel de potentiele meerwaarde ervan hebben aangetoond. In deze postdoc aanvraag zal daarom nader onderzoek worden gedaan naar de acceptatie van telehealth in de palliatieve terminale zorg. Het doel van het onderzoek is inzichtelijk maken hoe telehealth ingezet zou moeten worden in de palliatieve terminale zorg opdat het van meerwaarde is in het ondersteunen van; 1) de uitwisseling van informatie tussen zorgvragers en zorgverleners, en 2) de sociale interactie van zorgvragers met familie en naasten. De thematiek van het onderzoek sluit aan bij de onderzoekslijn Technology in Society van het lectoraat Technology, Health & Care. Het lectoraat opereert vanuit de pijler Health & Wellbeing dat onderdeel vormt van de corporate onderzoeksagenda van Saxion getiteld Living Technology'. De postdoc zal onder supervisie van de lector het onderzoek nader gaan uitwerken en uitvoeren. Daarbij zal ook nauwe samenwerking worden gezocht met studenten en de praktijk. Tevens zal de postdoc onderdeel uitmaken van een onderwijsteam opdat vervlechting van onderzoek en onderwijs goed tot stand gaat komen. In grote lijnen zal het onderzoek bestaan uit een literatuurstudie en een studie in de praktijk naar het gebruik en ervaringen van telehealth in de palliatieve terminale zorg. Vervolgens zal nader onderzoek zich richten op het ontwerp van een testopstelling voor de toepassing van telehealth in de praktijk van palliatieve terminale zorg. De postdoc zal zorgdragen dat studentopdrachten worden uitgezet bij diverse opleidingen opdat studenten kennis maken met het doen van onderzoek, en dat inspirerende colleges worden ontwikkeld, ingebed en verzorgd in diverse curricula. Daar waar mogelijk gaan studenten en docenten van verschillende opleidingen samenwerken om de gewenste interdisciplinariteit vorm te geven. Tot slot zal de postdoc in het kader van professionalisering zorgdragen voor kennisoverdracht naar docenten.
