The eShift Model of Care: Informal Caregivers\u27 Experience of Caring for a Family Member who Received Palliative Care at Home

Amidst concerns about the capacity to meet the care needs of community dwelling clients, the South West Community Care Access Centre in London, Ontario piloted a new model of home care delivery to palliative care clients. The purpose of this interpretive description study was to describe the experiences of informal caregivers who have lived with and cared for a family member who received palliative care as part of the eShift model of home care. In this study, eight participants were purposively sampled and narrative data were collected through individual, audio-taped interviews using a semi-structured interview guide. The analysis and interpretation of the interviews revealed four main themes. The main themes include: The Health Care Family; Making the Invisible Visible; There’s No Place Like Home; and Burden of Love. Overall, informal caregivers indicated they were very satisfied with care delivery, felt supported by health care providers, and were able to support their family member to die at home. Findings from this study contribute a greater understanding to what is known about informally caring for a family member who is receiving eShift palliative home care. This study offers implications regarding the use of technology and health human resources for nursing practice, education, research and future policy development in the home care sector

Problem-Solving Therapy for Informal Hospice Caregivers: A Randomized Controlled Pilot Study

Abstract Problem-Solving Therapy for Informal Hospice Caregivers: A Randomized Controlled Pilot Study Christin Ann Gregory, LCSW, DSW Candidate, University of Pennsylvania Problem: U.S. Hospice care is a growing service for the terminally ill, ever more important as our aging population expands. Informal caregivers are integral to the hospice philosophy, considered to be a part of the hospice unit of care. These caregivers are the major providers of hands-on and emotional care for the dying. They face shift in family role, loss of employment and personal time, and have been shown to suffer from increased mental and physical health issues as a direct effect of caregiving. The predominant unmet need of the hospice caregiver is psychological. The hospice social worker is the major provider of psychological services for the hospice caregiver, but at present, there is a lack of evidence-based research on caregiver interventions in this clinical setting. Objectives: This study examined the feasibility and efficacy of Problem-Solving Therapy (PST) in improving mood, quality of life, and problem-solving skills for primary (informal) caregivers of home-based hospice patients. Design: This study employed a randomized controlled design, comparing the effects of brief problem-solving therapy for hospice caregivers (PST-Hospice) and usual care plus caregiver education (UC+CE) on hospice caregiver outcomes. A baseline survey was collected after informed consent, followed by five weekly forty-five minute sessions of PST treatment or the provision of caregiver coping educational materials. Post-test surveys were administered post intervention completion (6 weeks). Qualitative interviews were also conducted to give voice to the caregiver experience. Setting: This study was conducted between November 15th, 2013 and May 16th, 2014. Participants were gathered from home-based admissions at two South Jersey hospice agencies: one for-profit agency, and one not-for-profit agency. Inclusion Criteria: (1) Primary informal caregivers, (2) Caring for patients who reside in a home residence or assisted living, (3) age 18 or older, (4) able to speak English, (5) willing to participate. Measures: Demographic information (age, sex, gender, relationship to patient, marital status, ethnicity, employment, education, income, household number, patient diagnosis, assistance with care) was gathered pretreatment. Outcomes measured at pre-treatment and post-treatment (5 weeks post randomization) were: (1) The Brief Patient Health Questionnaire Mood Scale (PHQ-9), (2) The Caregiver Quality of Life Index- Cancer (CQOLC), (3) The Social Problem Solving Inventory-Revised Short Form (SPSI-R Short). Data Analysis: 1) Descriptive statistics were gathered for demographic information. 2) T-tests and Chi-Squares were used to determine differences between groups. 3)To determine mean differences between conditions for primary outcome variables, t-tests were conducted. 4) Qualitative interviews with 3 study participants were completed to gain information about their experience being a part of this study. Keywords: social work, hospice, palliative care, caregivers, problem-solving therapy, randomized trial, quality of life, social work interventions, evidence-based practice (EBP

Study protocol: optimization of complex palliative care at home via telemedicine. A cluster randomized controlled trial

Contains fulltext : 97378.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Due to the growing number of elderly with advanced chronic conditions, healthcare services will come under increasing pressure. Teleconsultation is an innovative approach to deliver quality of care for palliative patients at home. Quantitative studies assessing the effect of teleconsultation on clinical outcomes are scarce. The aim of this present study is to investigate the effectiveness of teleconsultation in complex palliative homecare. METHODS/DESIGN: During a 2-year recruitment period, GPs are invited to participate in this cluster randomized controlled trial. When a GP refers an eligible patient for the study, the GP is randomized to the intervention group or the control group. Patients in the intervention group have a weekly teleconsultation with a nurse practitioner and/or a physician of the palliative consultation team. The nurse practitioner, in cooperation with the palliative care specialist of the palliative consultation team, advises the GP on treatment policy of the patient. The primary outcome of patient symptom burden is assessed at baseline and weekly using the Edmonton Symptom Assessment Scale (ESAS) and at baseline and every four weeks using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes are self-perceived burden from informal care (EDIZ), patient experienced continuity of medical care (NCQ), patient and caregiver satisfaction with the teleconsultation (PSQ), the experienced problems and needs in palliative care (PNPC-sv) and the number of hospital admissions. DISCUSSION: This is one of the first randomized controlled trials in palliative telecare. Our data will verify whether telemedicine positively affects palliative homecare. TRIAL REGISTRATION: The Netherlands National Trial Register NTR2817

Evaluation Study of Australian Telehealth Projects

This paper appeared at the 8th Australasian Workshop on Health Informatics and Knowledge Management (HIKM 2015), Sydney, Australia, January 2015. Conferences in Research and Practice in Information Technology (CRPIT), Vol. 164, Anthony Maeder and Jim Warren, Ed. Reproduction for academic, not-for profit purposes permitted provided this text is included.This paper provides an overview of selected telehealth projects involving pilot or trial implementations, undertaken in Australia in the period since 2000, which have undergone substantial formal evaluations reported in the peer reviewed scientific literature. Barriers and enablers reported for these telehealth projects are identified and the evaluation aspects are presented using a recently proposed generalised evaluation framework

A systematic review of economic analyses of telehealth services using real time video communication

Background: Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery - synchronous or real time video communication - rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area. Methods A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded. Results 36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study. Conclusion Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between hospitals and primary care

A systematic review of health service interventions to reduce use of unplanned health care in rural areas

Rationale, aims and objectives: Use of unplanned health care has long been increasing, and not enough is known about which interventions may reduce use. We aimed to review the effectiveness of interventions to reduce the use of unplanned health care by rural populations. Methods: The method used was systematic review. Scientific databases (Medline, Embase and Central), grey literature and selected references were searched. Study quality and bias was assessed using Cochrane Risk of Bias and modified Newcastle Ottawa Scales. Results were summarized narratively. Results: A total of 2708 scientific articles, reports and other documents were found. After screening, 33 studies met the eligibility criteria, of which eight were randomized controlled trials, 13 were observational studies of unplanned care use before and after new practices were implemented and 12 compared intervention patients with non-randomized control patients. Eight of the 33 studies reported modest statistically significant reductions in unplanned emergency care use while two reported statistically significant increases in unplanned care. Reductions were associated with preventative medicine, telemedicine and targeting chronic illnesses. Cost savings were also reported for some interventions. Conclusion: Relatively few studies report on unscheduled medical care by specifically rural populations, and interventions were associated with modest reductions in unplanned care use. Future research should evaluate interventions more robustly and more clearly report the results

Comparison of a palliative model and geriatric model in the quality of death in a population of a home visitation program with advanced dementia

Introducción: los adultos mayores con demencia avanzada son un grupo de población en crecimiento y que tienen necesidades particulares. No está claro cuál modelo de atención pueda generar una mejor calidad de muerte. Objetivo: comparar el impacto del modelo de tratamiento paliativo contra el geriátrico en la calidad de muerte en los pacientes con demencia avanzada. Metodología: se aplicó el Quality of Dying and Death Questionnaire a los cuidadores de los pacientes que habían fallecido en los años del 2016 al 2018 y que el diagnóstico de ingreso al programa fuera el de demencia avanzada. Se generaron dos grupos dependiendo del programa que realizó la atención en el domicilio, ya sea el programa de cuidados paliativos o el de geriatría. Se realiza un análsis descriptivo de ambos grupos. Se evalúa el total general dentro de las secciones del cuestionario, así como, cada uno de los apartados que las conforman. Resultados: se  registraron 162 entrevistas, 125 del cuidadores del programa geriátrico y 37 del de paliativos. Los pacientes murieron generalmente con dolor controlado, con poca conciencia de lo que pasaba alrededor, respirando cómodamente, tranquilos, sin miedo a morir, sin preocupaciones por ser una carga para la familia, pasando tiempo con sus amigos y recibiendo afecto de sus seres queridos. Los gastos, arreglos funerarios y la visita de un concejero espiritual se dieron de forma adecuada en ambos grupos.  El índice de calidad de muerte y la satisfacción en la atención fue bastante alto. No hubo diferencias significativas entre ambos grupos. Conclusión: el grado de satisfacción en la atención por parte de ambos grupos fue muy bueno sin encontrarse diferencias significativas. Se debe realizar mayores investigaciones en esta población para ofrecer un modelo óptimo apropiado para sus necesidades.Introduction: older adults with advanced dementia are a growing population group with particular needs. It is unclear which model of care can generate a better quality of death. Objective : to Compare the impact of the palliative treatment model against geriatrics on the quality of death in patients with advanced dementia. Methodology: the Quality of Dying and Death Questionnaire was applied to caregivers of patients who had died in the years 2016 to 2018 and that the diagnosis of entry into the program was that of advanced dementia. Two groups were generated depending on the program that performed the homecare, either the palliative care program or the geriatrics program. A descriptive analysis of both groups is performed. The overall total of the questionnaire is evaluated, as well as each of the constituent parts. Results: there were 162 interviews, 125 from the caregivers of the geriatric program and 37 from the palliative program. Patients died usually with controlled pain, with little awareness of what was going on around, breathing comfortably, calmly, without fear of dying, without worries about being a burden to the family, spending time with their friends and receiving affection from their loved ones. Expenses, funeral arrangements, and the visit of a spiritual advisor were given appropriately in both groups. The death quality rate and attention satisfaction were quite high. There were no significant differences between the two groups. Conclusion: the degree of satisfaction in attention on the part of both groups was very good without significant differences. Further research should be done in this population to provide an optimal model appropriate for your needs