Quality and Patient Safety in Palliative Care

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Nursing".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 19140

Special Issue Editor

Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital and University of Turin, 10126 Turin, Italy
Interests: nutrition support in cancer and critically ill patients; vascular access devices; palliative care (screening and symptom control) in advanced cancer patients and seriously ill patients with end-stage organ failure; healthcare service management (in-hospital admission and management; safe discharge)
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Special Issue Information

Dear Colleagues,

Palliative care is care that optimizes quality of life (QoL) by anticipating, preventing, and treating suffering. Patients and families are primarily concerned with the quality of the care they receive. Care should be guided by QoL as defined by the individual. Therefore, healthcare professionals should enter into a therapeutic relationship with patients and families based on dignity and quality of care.

Patient safety issues should be a crucial component of inpatient palliative care and hospice care programs. Attention to safety issues can improve the quality of care and reduce patient and family distress, as long as they are tailored to the patient’s will and preferences at the end of life (EoL). Patients at their EoL are frail and consequently are at high risk for safety issues such as errors, adverse effects, and complications. Because a high percentage of palliative care patients hospitalized for medical conditions have limited prognosis, these patients are at higher risk of significant harm from inappropriate or unnecessary interventions. Decision making must consider the special needs and frailty of this population and coordinate with the palliative care team to address the goals of care and burdens of all procedures and treatments.

This Special Issue seeks articles (original clinical studies and reviews) related to the quality and safety of management for patients in need of palliative care that investigate the following suggested topics. This invitation is addressed to all healthcare professionals (i.e., physicians, nurses, pharmacists, psychologists, dieticians, respiratory therapists, physical therapists, occupational therapists, physical and behavioral therapists, social workers) who are involved in the care of patients in the end-stage of their illness. 

Suggested topics:

  • Acute palliative care unit;
  • Artificial nutrition in palliative care patients: quality and safety;
  • Healthcare costs for palliative care;
  • Healthcare service organization for palliative care;
  • Hospice care quality;
  • Impact of palliative care on quality of life;
  • Impact of palliative care on survival;
  • Making palliative care safer;
  • Measuring the quality of palliative care;
  • Medical futility (overtreatment) at the end of life;
  • Palliative care team;
  • Prognosis communication in end of life;
  • Role of palliative care in patients receiving chemoradiotherapy;
  • Safe practices for better palliative care;
  • System assessment and management;
  • Team-training and team-work in palliative care;
  • Timing for referral to palliative care consultation. 

Dr. Paolo Cotogni
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • quality of care
  • quality of life
  • patient safety
  • end of life care
  • home care
  • palliative care
  • ethics
  • management
  • symptom control

Published Papers (9 papers)

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Research

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12 pages, 301 KiB  
Article
Clinicians’ and Advanced Cancer Patients’ Estimates of Treatment Efficacy and Toxicity in Oncologic Treatment
by Eun Mi Lee, Paula Jiménez-Fonseca, Alberto Carmona-Bayonas, Raquel Hernández, Patricia Cruz-Castellanos, Berta Obispo, Mónica Antoñanzas-Basa, María Palacín-Lois, Oscar A. Castillo-Trujillo and Caterina Calderon
Healthcare 2023, 11(15), 2222; https://doi.org/10.3390/healthcare11152222 - 7 Aug 2023
Viewed by 1037
Abstract
The purpose of the study was to compare curability expectations between clinicians and patients and examine the influence of sociodemographic and clinical variables on these expectations and satisfaction within the clinician-patient relationship. This prospective study, conducted from February 2020 to May 2023, involved [...] Read more.
The purpose of the study was to compare curability expectations between clinicians and patients and examine the influence of sociodemographic and clinical variables on these expectations and satisfaction within the clinician-patient relationship. This prospective study, conducted from February 2020 to May 2023, involved 986 advanced cancer patients. The patients completed questionnaires assessing treatment efficacy and toxicity predictions and the Scale to Assess the Therapeutic Relationship (STAR). Seventy-four percent of advanced cancer patients had an inaccurate perception of treatment curability. Clinicians perceived male patients with lung or digestive cancer without adenocarcinoma at locally advanced stages, with fewer comorbidities and better functional status (ECOG), as having higher curability expectations. Clinicians tended to have more realistic expectations than patients, since they had to consider the presence of treatment’s side effects, while patients underestimated the possibility of experiencing these adverse effects. Patients who had more favorable expectations regarding survival and quality of life were found to be more satisfied with the care provided by their oncologists. It is crucial for patients to understand the treatment goals and establish realistic expectations in order to actively participate in decision-making and achieve a better quality of life at the end of life. Full article
(This article belongs to the Special Issue Quality and Patient Safety in Palliative Care)
13 pages, 261 KiB  
Article
Specialist and Primary Physicians’ Experiences and Perspectives of Collaboration While Caring for Palliative Patients—A Qualitative Study
by Siri Andreassen Devik and Gunhild Lein Lersveen
Healthcare 2023, 11(15), 2188; https://doi.org/10.3390/healthcare11152188 - 2 Aug 2023
Cited by 1 | Viewed by 1273
Abstract
Increasing numbers of people living with chronic and life-limiting diseases are actualising a greater need for palliative care. Physicians are an important provider for identifying the need for palliation, and effective follow-up requires physician collaboration across different service levels. This study aimed to [...] Read more.
Increasing numbers of people living with chronic and life-limiting diseases are actualising a greater need for palliative care. Physicians are an important provider for identifying the need for palliation, and effective follow-up requires physician collaboration across different service levels. This study aimed to explore and describe how physicians in hospitals and municipalities experience their roles and interactions in the care of palliative patients. Pair interviews were performed with seven physicians working in hospitals, primary care and nursing homes in Mid-Norway. Systematic text condensation was used to analyse the data, resulting in three main themes: The boundaries of palliative care, Alternating understandings of roles and Absence of planning. The physicians’ interactions with palliative patients appeared as a fragmented distribution of tasks rather than a real collaboration with shared responsibility. At both levels, the physicians seemed to assume withdrawn roles as a reaction to unclear and unspoken expectations and to avoid interfering with others’ responsibilities. Moreover, their understanding of palliative care and which groups should be included varied. Realising a collaboration between physicians that is beneficial for both patients and physicians, greater openness and real arenas for discussion and decision-making support are required. Full article
(This article belongs to the Special Issue Quality and Patient Safety in Palliative Care)
12 pages, 466 KiB  
Article
Measuring Knowledge of Healthcare Providers on Pediatric Palliative Care with an Online Questionnaire Based on the National Core Curriculum in Italy
by Elisa Zanello, Roberta Vecchi, Giulia Zamagni, Maria Celeste Biagi, Irene Bruno, Elisa Cragnolin, Elisabetta Danielli, Silvia Paoletti, Marco Rabusin, Luca Ronfani and Emanuelle Pessa Valente
Healthcare 2023, 11(13), 1971; https://doi.org/10.3390/healthcare11131971 - 7 Jul 2023
Viewed by 972
Abstract
There is a lack of highly reliable tools evaluating healthcare professionals’ competences on Pediatric Palliative Care (PPC) and Pain Therapy (PT). The aim of this study is to document the development of an online questionnaire to assess Perceived, Wished and Actual Knowledge of [...] Read more.
There is a lack of highly reliable tools evaluating healthcare professionals’ competences on Pediatric Palliative Care (PPC) and Pain Therapy (PT). The aim of this study is to document the development of an online questionnaire to assess Perceived, Wished and Actual Knowledge of healthcare workers on PPC/PT. The tool was built on the basis of the Italian Society for Palliative Care PPC Core Curriculum (CC) for physicians, nurses and psychologists. Face validity, internal consistency and the underlying structure were evaluated after a field testing in a referral hospital, Friuli-Venezia Giulia, Italy. One hundred five respondents completed the questionnaire. High internal consistency for both scales of Perceived and Wished Knowledge was found (α = 0.95 and α = 0.94, respectively). Psychologists reported higher levels of self-Perceived skills on the psychosocial needs of the child and family at the end of life (p = 0.006), mourning (p = 0.003) and ethics and deontology in PT/PC (p = 0.049). Moreover, when Actual Knowledge was tested, they also provided the highest number of correct answers (p = 0.022). No differences were found by profession for Wished Knowledge. The questionnaire showed promising psychometric properties. Our findings suggest the need of continuous training in this field and identify contents to be addressed in future training programs. Full article
(This article belongs to the Special Issue Quality and Patient Safety in Palliative Care)
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13 pages, 262 KiB  
Article
Registered Nurses’ Experiences of End-of-Life Care in Nursing Homes of South Korea: A Qualitative Study
by Soo-Jung Chang
Healthcare 2022, 10(11), 2213; https://doi.org/10.3390/healthcare10112213 - 4 Nov 2022
Viewed by 2029
Abstract
This study aimed to qualitatively describe how registered nurses (RNs) experienced and perceived end-of-life (EOL) care for older residents in South Korean nursing homes. The participants included 11 nurses with experience of providing EOL care for older residents in six nursing homes. Data [...] Read more.
This study aimed to qualitatively describe how registered nurses (RNs) experienced and perceived end-of-life (EOL) care for older residents in South Korean nursing homes. The participants included 11 nurses with experience of providing EOL care for older residents in six nursing homes. Data were collected through one-on-one in-depth interviews using semi-structured questions from 27 December 2019 to 22 October 2020. Around 1–2 interviews were conducted for each participant, and each interview lasted between 40 min and two hours. The interview data were analyzed using qualitative content analysis. Eight sub-themes were identified and abstracted under three themes: (a) “feeling fulfilled for doing my best until the last day,” (b) “defensive coping due to legal and institutional limitations,” and (c) “requirements for effective EOL care.” This study suggests that there are many challenges and issues regarding EOL care at nursing homes. In order to provide effective EOL care to older residents, the foundation of the EOL care system, as well as skills training, should be strengthened. Furthermore, securing qualified nursing manpower and achieving institutional improvement by reducing obstacles are warranted. Full article
(This article belongs to the Special Issue Quality and Patient Safety in Palliative Care)
8 pages, 419 KiB  
Article
Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy
by Massimo Romanò, Sabina Oldani, Valter Reina, Michele Sofia and Claudia Castiglioni
Healthcare 2022, 10(6), 1031; https://doi.org/10.3390/healthcare10061031 - 2 Jun 2022
Cited by 3 | Viewed by 2157
Abstract
Patients with irreversible malignant and non-malignant diseases have comparable mortality rates, symptom burdens, and quality of life issues; however, non-cancer patients seldom receive palliative care (PC) or receive it late in their disease trajectory. To explore the characteristics of non-cancer patients receiving PC [...] Read more.
Patients with irreversible malignant and non-malignant diseases have comparable mortality rates, symptom burdens, and quality of life issues; however, non-cancer patients seldom receive palliative care (PC) or receive it late in their disease trajectory. To explore the characteristics of non-cancer patients receiving PC in northern Italy, as well as the features and outcomes of their care, we retrospectively analyzed the charts of all non-cancer patients initiating PC regimens during 2019 in three publicly funded PC departments in Italy’s populous Lombardy region. We recorded the baseline variables (including data collected with the NECPAL CCOMS-ICO-derived questionnaire used since 2018 to evaluate all admissions to the region’s PC network), as well as treatment features (setting and duration) and outcomes (including time and setting of death). Of the 2043 patients admitted in 2019, only 12% (243 patients—131 females; mean age 83.5 years) had non-oncological primary diagnoses (mainly dementia [n = 78], heart disease [n = 55], and lung disease [n = 30]). All 243 had Karnofsky performance statuses ≤ 40% (10–20% in 64%); most (82%) were malnourished, 92% had ≥2 comorbidities, and 61% reported 2–3 severe symptoms (pain, dyspnea, and fatigue). Fifteen withdrew or were discharged from the study PCN; the other 228 remained in the PCN and died in hospice (n = 133), at home (n = 9), or after family-requested transfer to an emergency department (n = 1). Most deaths (172/228, 75%) occurred <3 weeks after PC initiation. These findings indicate that the PCN network we studied cares for few patients with life-limiting non-malignant diseases. Those admitted have advanced-stage illness, heavy symptom burdens, low performance statuses, and poor survival. Additional efforts are needed to improve PCN accessibility for non-cancer patients. Full article
(This article belongs to the Special Issue Quality and Patient Safety in Palliative Care)
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Review

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12 pages, 637 KiB  
Review
Immune Checkpoint Inhibitors and Opioids in Patients with Solid Tumours: Is Their Association Safe? A Systematic Literature Review
by Massimiliano Cani, Paolo Bironzo, Ferdinando Garetto, Lucio Buffoni and Paolo Cotogni
Healthcare 2023, 11(1), 116; https://doi.org/10.3390/healthcare11010116 - 30 Dec 2022
Cited by 7 | Viewed by 1606
Abstract
Background: Immune checkpoint inhibitors (ICIs) represent one of the most effective treatments for patients with cancer. As their activity relies on host immune system reactivity, the role of concomitant medications such as corticosteroids and antibiotics has been extensively evaluated. Preclinical data suggest that [...] Read more.
Background: Immune checkpoint inhibitors (ICIs) represent one of the most effective treatments for patients with cancer. As their activity relies on host immune system reactivity, the role of concomitant medications such as corticosteroids and antibiotics has been extensively evaluated. Preclinical data suggest that opioids may influence the immune system. Methods: a systematic literature revision was performed using specific keywords on the major search engines. Two authors analysed all the studies and provided a selection of the following inclusion and exclusion criteria, respectively: 1. data collection of patients older than 18 years old affected by solid tumours; 2. description of ICIs efficacy in terms of PFS, OS, TTF, and ORR; 3. concomitant ICIs-opioids treatment and 1. language different from English; 2. not pertinent analyses. Results: 523 studies were analysed, and 13 were selected and included in our series. A possible negative interaction between oral opioids and ICIs efficacy was observed. Most evidence was retrospective, and studies were heterogeneous. Conclusions: Even if oral opioids seem to impact negatively on ICIs efficacy in cancer patients, to date there is not sufficient evidence to avoid their prescription in this population. Full article
(This article belongs to the Special Issue Quality and Patient Safety in Palliative Care)
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15 pages, 1247 KiB  
Review
Caring for Patients in Need of Palliative Care: Is This a Mission for Acute Care Hospitals? Key Questions for Healthcare Professionals
by Paolo Cotogni and Anna De Luca
Healthcare 2022, 10(3), 486; https://doi.org/10.3390/healthcare10030486 - 6 Mar 2022
Cited by 2 | Viewed by 4348
Abstract
The prevalence of patients affected by end-stage diseases or advanced cancer is increasing due to an aging population and progression in medicine and public healthcare. The burden of symptoms these people suffer in the last months of life often forces them to seek [...] Read more.
The prevalence of patients affected by end-stage diseases or advanced cancer is increasing due to an aging population and progression in medicine and public healthcare. The burden of symptoms these people suffer in the last months of life often forces them to seek aid in an emergency department. In developed countries, acute care hospital-based services are often better designed to treat acute clinical conditions than to manage the needs of patients with serious chronic diseases. Thus, the palliative care (PC) population poses very real clinical challenges to healthcare professionals who care for them in hospital settings. The authors have formulated four key questions (who, why, when, and how) to address in order to identify a model for providing the best care for these PC patients. The questions are related to: (1) defining people living with serious chronic diseases; (2) managing the challenge of unplanned hospital admission of these people; (3) identifying PC patients among people with serious chronic diseases; and (4) determining the appropriate work of caring for this inpatient PC population. Clinicians need the knowledge, tools, and services to care for these PC patients, and acute care hospitals should plan the work of caring for these inpatients. Full article
(This article belongs to the Special Issue Quality and Patient Safety in Palliative Care)
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Other

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9 pages, 267 KiB  
Perspective
Patient Safety in Palliative Care at the End of Life from the Perspective of Complex Thinking
by Nair Caroline Cavalcanti de Mendonça Bittencourt, Sabrina da Costa Machado Duarte, Sonia Silva Marcon, Marléa Crescêncio Chagas, Audrei Castro Telles, Eunice Maria Casimiro dos Santos Sá and Marcelle Miranda da Silva
Healthcare 2023, 11(14), 2030; https://doi.org/10.3390/healthcare11142030 - 15 Jul 2023
Viewed by 1357
Abstract
Actions for patient safety at the end of life must be aligned with the principles of palliative care, such as promoting comfort and quality of life. Faced with this complex process, health professionals need to seek the central relationships of the concepts of [...] Read more.
Actions for patient safety at the end of life must be aligned with the principles of palliative care, such as promoting comfort and quality of life. Faced with this complex process, health professionals need to seek the central relationships of the concepts of safety and palliative care to the end of life, in line with the wishes and expectations of the person and family members/caregivers, as well as with available resources and the capacity of services but, above all, reinforcing the importance of a non-reductionist care approach, which encompasses the various aspects inherent to humans. Hence, we present a new vision of patient safety in palliative care at the end of life based on the complex thinking of Edgar Morin, scientific evidence, and health policies in the global context. We discuss the deficiencies and disjunctions in thought and practice of palliative care at the end of life and patient safety, as well as the challenges for the conjunction of these complex themes, to finally present potential ways to apply complex thinking in the safe care of the patient at the end of life. The problematization of different aspects for the interposition of knowledge about patient safety in palliative care at the end of life portrays the existence of intersubjective connections and the multidimensionality that permeate the guidelines, actions and relationships that sustain the disciplines. Full article
(This article belongs to the Special Issue Quality and Patient Safety in Palliative Care)
11 pages, 414 KiB  
Protocol
Co-Design of an Evidenced Informed Service Model of Integrated Palliative Care for Persons Living with Severe Mental Illness: A Qualitative Exploratory Study
by Marianne Tinkler, Joanne Reid and Kevin Brazil
Healthcare 2021, 9(12), 1710; https://doi.org/10.3390/healthcare9121710 - 9 Dec 2021
Viewed by 2800
Abstract
Background: Globally, close to one billion people are living with a mental health disorder, and it is one of the most neglected areas in Public Health. People with severe mental illness have greater mortality risk than the general population, experience health care inequalities [...] Read more.
Background: Globally, close to one billion people are living with a mental health disorder, and it is one of the most neglected areas in Public Health. People with severe mental illness have greater mortality risk than the general population, experience health care inequalities throughout life and represent a vulnerable, under-served and under-treated population, who have been overlooked in health inequality research to date. There is currently a dearth of evidence in relation to understanding the palliative care needs of people with severe mental illness and how future care delivery can be designed to both recognise and respond to those needs. This study aims to co-design an evidenced informed service model of integrated palliative care for persons living with a severe mental illness. Methods: This qualitative sequential study underpinned by interpretivism will have six phases. An expert reference group will be established in Phase 1, to inform all stages of this study. Phase 2 will include a systematic literature review to synthesise current evidence in relation to palliative care service provision for people with severe mental illness. In Phase 3, qualitative interviews will be undertaken with both, patients who have a severe mental illness and in receipt of palliative care (n = 13), and bereaved caregivers of people who have died 6–18 months previously with a diagnosis of severe mental illness (n = 13), across two recruitment sties in the United Kingdom. Focus groups (n = 4) with both mental health and palliative care multidisciplinary staff will be undertaken across the two recruitment sites in Phase 4. Phase 5 will involve the co-design of a service model of integrated palliative care for persons living with severe mental illness. Phase 6 will develop practice recommendations for this client cohort. Discussion: Palliative care needs to be available at all levels of care systems; it is estimated that, globally, only 14% of patients who need palliative care receive it. Reducing inequalities experienced by people with severe mental illness is embedded in the National Health Service Long Term Plan. Internationally, the gap between those with a mental illness needing care and those with access to care remains considerable. Future policy and practice will benefit from a better understanding of the needs of this client cohort and the development of a co-designed integrated care pathway to facilitate timely access to palliative care for people with a severe mental illness. Full article
(This article belongs to the Special Issue Quality and Patient Safety in Palliative Care)
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