Palliative care team visits. Qualitative study through participant observation
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Objectives:
To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants.
Methods:
A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room) were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed.
Results:
The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources.
. Clayton JM, Butow PN, Tattersall MH, Devine RJ, Simpson JM, Aggarwal G, et al. Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care. J Clin Oncol. 2007;25(6):715–723
Van den Block L, Deschepper R, Bossuyt N, Drieskens K, Bauwens S, Van Casteren V, et al. Care for patients in the last months of life: The Belgian sentinel network monitoring end-of-life care study. Arch Intern Med. 2008;168(16):1747–1754
Bloomer MJ, Endacott R, O'Connor M, Cross W. The 'disease' of dying: Challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study. Palliat Med. 2013;27:757–764
Schmidt J, Montoya R, García MP, Cruz F. Dos procesos de fin de vidaCuando la intervención de los profesionales marca la diferencia. Index de Enfermería. 2008;17(4):256–260
Aabom B, Kragstrup J, Vondeling H, Bakketeig LS, Stovring H. Defining cancer patients as being in the terminal phase: Who receives a formal diagnosis, and what are the effects? J Clin Oncol. 2005;23(30):7411–7416
Thompson KF, Bhargava J, Bachelder R, Bova-Collis R, Moss AH. Hospice and ESRD: Knowledge deficits and underutilization of program benefits. Nephrol Nurs J. 2008;35(5):461–505
Workman S. A communication model for encouraging optimal care at the end of life for hospitalized patients. QJM. 2007;100(12):791–797
Dalgaard KM, Thorsell G, Delmar C. Identifying transitions in terminal illness trajectories: A critical factor in hospital-based palliative care. Int J Palliat Nurs. 2010;16(2):87–92
Hui D, Con A, Christie G, Hawley PH. Goals of care and end-of-life decision making for hospitalized patients at a canadian tertiary care cancer center. J Pain Symptom Manage. 2009;38(6):871–881
Pickens ND, O'Reilly KR, Sharp KC. Holding on to normalcy and overshadowed needs: Family caregiving at end of life. CJOT. 2010;77(4):234–240
Mack JW, Weeks JC, Wright AA, Block SD, Prigerson HG. End-of-life discussions, goal attainment, and distress at the end of life: Predictors and outcomes of receipt of care consistent with preferences. J Clin Oncol. 2010;28(7):1203–1208
Jeong SY, Higgins I, McMillan M. The essentials of advance care planning for end-of-life care for older people. J Clin Nurs. 2010;19(3-4):389–397
Earle CC. Do unto others. J Clin Oncol. 2006;24(21):3331–3332
Matsuyama R, Reddy R, Smith TJ. Why do patients choose chemotherapy near the end of life? A review of the perspective of those facing death from cancer. J Clin Oncol. 2006;24(21):3490–3496
Thorne S, Oliffe JL, Stajduhar KL, Oglov V; Kim-Sing Ch.Hislop TG. Poor communication in cancer care. patient perspectives on what it is and what to do about it . Cancer Nurs. 2013;36(6):445–453
Danet A, Escudero MJ, Prieto MA, Cerdá JC. Comunicación paciente-médico y toma de decisiones en salud en Andalucía. Expectativas de pacientes crónicos del SSPA. RCyS. 2012;2(2):63–77
Mayring P. Qualitative content Analysis. Forum: Qualitative Social Research. 2000;1(2):Art. 20
Polit DF, Hungler BP. Investigación científica en Ciencias de la Salud. México DF: McGraw Hill Interamericana Editores, S.A; 2000
Selltiz Cl. El Trabajo de Campo y la Observación Participante. Modelo de guión de observación. Available from: https://rodas5.us.es/file/79eb3b51-157d-a866-7d3b-dc8bba49f158/1/tema4_SCORM.zip/page_01.htm . 15 March 2015
Gomez-Batiste X, Ferris F, Paz S, Espinosa J, Porta-Sales J, Esperalba J. How to ensure good quality palliative care: a Spanish Model. Eur J Palliat Care. 2008;15:142–147
Millas J, Hasson N, Aguiló M, Lasagabaster I, Muro E, Romero O. Programa de atención social domiciliaria sobre la atención a los cuidados paliativos en el País Vasco. Experiencia Saiatu Med Pal. 2015;22(1):3–11
Pérez FT, Gallego JA, Jaén P. Análisis de la actividad de un equipo de soporte de cuidados paliativos. Med Pal. 2011;18(4):129–134
Sociedad Española de Cuidados Paliativos. Libro blanco sobre normas de calidad y estándares de cuidados paliativos de la Sociedad Europea de Cuidados Paliativos. Madrid: 2012. Available from: http://www.eapcnet.eu/Themes/Organisation/tabid/261/ctl/Details/ArticleID/475/mid/1150/SPANISH-Libro-blanco-sobre-normas-de-calidad-y-estandares-de-cuidados-paliativos-de-la-Sociedad-Europea-de-Cuidados-Paliativos.aspx . 27 December 2014
Klarare A, Hagelin CL, Fürst CJ, Fossum B. Team interactions in specialized palliative care teams: A qualitative study. J Palliative Medicine. 2013;16(9):1062–1069
Kirby E, Broom A, Good P. The role and significance of nurses in managing transitions to palliative care: a qualitative study. BMJ Open. 2014;4:e006026
Codorniu N, Bleda M, Alburquerque E, Guanter L, Adell J; García F et al. Cuidados enfermeros en cuidados paliativos: análisis, consensos y retos. Index Enferm. 2011;20:1–2
Wiebe LA, Von Roenn JH. Working with a palliative care team. Cancer J. 2010;16(5):488–492
Yoshioka S, Moriyama M. Factors and structural model related to end-of-life nursing care in general ward in Japan. Am J Hosp Palliat Care. 2012;30(2):146–152
Silbermann M, Pitsillides B, Al-Alfi N, Omran S, Al-Jabri K, Elshamy K, et al. Multidisciplinary care team for cancer patients and its implementation in several Middle Eastern countries. Ann Oncol. 2013;24 Suppl 7:vii41
Kaasalainen S, Ploeg J, McAiney C, Schindel Martin L, Donald F, Martin-Misener L, et al. Role of the nurse practitioner in providing palliative care in long-term care homes. Int J Palliat Nurs. 2013;19(10):477–485
Aguirre-Duarte N. Increasing collaboration between health professionals. Clues and challenges. Colomb Med (Cali). 2015;46(2):66–70
Abaunza A, Jaio N, Landa V, Irurzun E, Galarraga ML, Balentziaga AR, et al. Departamento de Salud.Gobierno Vasco. et al. Atención a los pacientes en la fase final de la vida: revisión sistemática sobre modelos organizativos en los cuidados paliativos y encuesta a los profesionales sanitarios sobre la situación de los cuidados paliativos en una comarca del País Vasco. Vitoria-Gasteiz: 2013. D-13-10. Informe Osteba. Available from: http://www.osakidetza.euskadi.eus/contenidos/informacion/2013_osteba_publicacion/es_def/adjuntos/Informe%20D-13-10.pdf . 21 March 2015
Observatorio "QUALY". Evaluación de indicadores organizativos, de proceso y de resultados del Programa para la Atención Integral a Personas con Enfermedades Avanzadas de la Obra Social "la Caixa". Informe de resultados. Institut Català d'Oncologia; 2011. Available from: http://prensa.lacaixa.es/obrasocial/show_annex.html?id=25519 . 21 March 2015
Gómez-Batiste X, Caja C, Espinosa J, Bullich I, Martínez-Muñoz M, Porta-Sales J, et al. The Catalonia World Health Organization Demonstration project for palliative care implementation: Quantitative and qualitative results at 20 years. J Pain Symptom Manage. 2012;43(4):783–794
Espinosa J, Gómez-Batiste X, Picaza JM, Limón E. Equipos de soporte domiciliario de cuidados paliativos en España. Med Clin (Barc). 2010;135(10):470–475
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Accepted 2015-12-22
Published 2016-03-30
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