Barry R Ashpole is a Communications Consultant, Educator and Media Specialist from Ontario, Canada, who contributes a bi-annual post for the blog. This contribution focuses on three distinct aspects of end-of-life care: the hospice and palliative care workforce, research priorities, and spirituality with summaries of selected journal articles published during the past year.
The Hospice and Palliative Care Workforce
The global nursing workforce: Realising universal palliative care
The Lancet: Global Health, 2020;8(3):E327-E328. The authors identify how global healthcare systems can encourage the nursing workforce to implement recommendations of The Lancet Commission and WHO guidance on palliative care (PC). Specifically, the skill set, experience, and perspectives of nurses are crucial to optimum PC policy development, strategic planning, service implementation, and research. The vision of WHO’s Global Strategic Directions for Strengthening Nursing & Midwifery is “accessible, available, acceptable, quality and cost-effective nursing and midwifery care for all in support of universal health coverage and the sustainable development goals.” Full text.
Workforce planning for community-based palliative care specialist teams using operations research
Journal of Pain & Symptom Management | Online – 14 September 2020 – The authors developed a population-need, workforce planning model for community-based palliative care (PC) specialist teams and applied the model to forecast the staff needed to care for all patients with terminal illness over the next twenty years, with and without the expansion of primary PC. To meet the PC across Nova Scotia, Canada, in 2019, the model generated an estimate of 70.8 nurses, 23.6 physicians and 11.9 social workers, a total of 106.3 staff. The model indicated a 64% increase in specialist PC staff was needed immediately; a further 13.1% increase would be needed over the next 20 years. Full text.
Prioritising workforce wellbeing and resilience: What COVID-19 is reminding us about self-care and staff support
Palliative Medicine, 2020;34(9):1137-1139. The physical and psychosocial suffering associated with the impact of the COVID-19 pandemic has brought unprecedented operational and ethical challenges for palliative care (PC) providers, bringing workforce considerations into sharp focus. To maintain the provision of quality PC in the wake of such challenges, there is a clear need to prioritise wellbeing and resilience in the PC workforce. It has also been important to offer such opportunities to the broader health workforce who also have been plunged into a steep learning curve to provide PC, outside their usual scope of clinical practice.Full text.
PSST! I need help! Development of a peer support program for clinicians having serious illness conversations during COVID-19
JOURNAL OF GENERAL INTERNAL MEDICINE | Online – 24 January 2021 – Clarifying patients’ values and priorities is always important but especially so during a pandemic when many people will rapidly become seriously ill. The authors describe the design and implementation of a novel service, the PSST[Peer SIC Support Team], which utilized non-palliative care, volunteer peer supporters who offered rapid, confidential assistance to clinicians working to clarify the values and priorities of their patients across settings from ambulatory care to the ICUs. This service required moderate, upfront, administrative time but was otherwise a low-cost program. It gave an opportunity for clinicians with advanced communication skills to build a community through which they could offer important support to frontline clinicians which the peer supporters found rewarding. PSST took place in a hospital with an established program in serious illness conversation training and leveraged its staff with skills in this space, which may limit its replicability in other settings. However, serious illness conversation training materials are open access and many hospitals have access to social workers and others with interests and skills in communication who could participate in such a service. Thus, this service could be replicated in other institutions for this or future crises. Full text.
‘The impact of COVID‐19 on the hospice and palliative care workforce,’ Public Health Nursing, published online 27 October 2020. Abstract.
‘Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: A systematic literature review,’ published online 15 October 2020. Abstract (with list of references).
‘Looking back, and ahead: A call to action for increasing the hospice and palliative medicine specialty pipeline,’ Journal of Palliative Medicine, 2020;23(7):895-899. Abstract.
‘Palliative care in nephrology: The work and the workforce,’ Advances in Chronic Kidney Disease, 2020;27(4):350-355. Full text.
‘Expanding the interdisciplinary palliative medicine workforce: A longitudinal education and mentoring program for practicing clinicians,’ Journal of Pain & Symptom Management, 2020;60(3):602-612. Abstract (with link to references).
Research Priorities in End-of-Life Care
International palliative care research priorities: A systematic review
BMC Palliative Care | Online – 3 February 2020 – The authors call attention to the need for more end users in research priority setting exercises. Researchers and funding bodies should develop new strategies to ensure meaningful participation of palliative care (PC) patients and families, building in structures and processes to account for the vulnerability often present within this population. Findings provide an initial blueprint for PC research funders and policymakers to contribute to the future research agenda for PC from a patient and healthcare professional perspective. Given that funding resources are limited the importance of collaboration and international approaches to PC is growing. Full text.
Gaps in hospice and palliative care research: A scoping review of the North American literature
Journal of Aging Research | Online – 5 November 2020 – Despite the importance of the topic and an increase in hospice and palliative care utilization, there still are gaps in research and evidence within the field. Major themes were identified: 1) Clinical; 2) System access to care; 3) Research methodology; and, 4) Caregiving related research gaps. Findings include strategies for engaging stakeholder organizations and funding agencies, implications for other stakeholder groups such as clinicians and researchers, and highlight implications for policy (e.g., national framework discussion) and practice (e.g., healthcare provider education and training and public awareness). Full text.
‘The role of research in improving responsiveness of palliative care to migrants and other underserved populations in The Netherlands: A qualitative interview study,’ BMC Palliative Care, published online 6 January 2021. Full text.
‘Economics of palliative care for cancer: Interpreting current evidence, mapping future priorities for research,’ Journal of Clinical Oncology, 2020;38(9):980-986. Abstract.
‘Do journals contribute to the international publication of research in their field? A bibliometric analysis of palliative care journal data,’ Palliative Medicine, 2020;34(4):541-546. Abstract (with list of references).
Spiritual Aspects of End-of-Life Care
What is spiritual care? Professional perspectives on the concept of spiritual care identified through group concept mapping
BMJ Open | Online – 28 December 2020 – Because spirituality in the common understanding is a fundamental aspect of each individual human being, spiritual care (SC) should be an integral aspect of healthcare. Paradoxically, precisely because of this fundamentality, it is nevertheless also challenging to practise SC, as it involves the individual spirituality of the healthcare professional (HCP), tuning in on the individual spirituality of the patient (or relative), and engaging care for needs for which there are no quick fixes but that require personal attunement and investment. The benefits of engaging in SC nevertheless seem plentiful, both for HCPs, patients and relatives. Full text.
Humanize death in a time of sanitary crisis: Accompanied die, farewell and receive spiritual care
Cuadernos de Bioética, 2020;31(102):203-222. The crisis in the health system caused by COVID-19 has left some important humanitarian deficits on how to care for the sick in their last days of life. The humanization of the dying process has been affected in three fundamental aspects, each of which constitutes a medical and ethical duty necessary. The author analyzes why dying accompanied, with the possibility of saying goodbye and receiving spiritual assistance, constitutes a specific triad of care and natural obligations that should not be overlooked if we do not want to see human dignity violated and violated some fundamental rights derived from it. Full text (via Europe PMC).
How can existential or spiritual strengths be fostered in palliative care? An interpretative synthesis of recent literature
BMJ Supportive & Palliative Care | Online – 14 September 2020 – The ‘Propeller’ framework can help professionals working in palliative care (PC), especially those not specialised in spiritual care, in a number of ways. The 5 strengths and 16 approaches identified are only a preliminary configuration, to which existing, non-scientific but pragmatic approaches, for instance, of experienced nurses in PC, can be added. The framework, however, must not be seen as a way to simply assess a patient’s strengths. Professionals should be mindful of the finding that existential or spiritual strengths emerge out of and build on creative relationships between that individual and his or her environment. Full text.
A European Association for Palliative Care white paper on multi-disciplinary education for spiritual care in palliative care
BMC Palliative Care | Online – 15 January 2020 – Staff need to recognise the importance of spirituality in the life of the patient with the taking of a spiritual history and screening for spiritual need. In the event of spiritual distress, it is recommended the patient be referred to a spiritual care (SC) specialist – a trained healthcare SC worker, for personalised intervention. SC should be integrated into patient and caregiver care plans, with initial assessment and ongoing interventions recorded clearly in the patient notes. All staff should be on guard to avoid prejudice interfering with universal SC. This document is offered as an aspirational level of SC education to be offered to palliative care patients. Full text.
‘Spiritual care practices in hospices in the Western Cape, South Africa: The challenge of diversity,’BMC Palliative Care, published online 10 January 2021. Full text.
‘The role of religion in physician outlook on death, dying, and end-of-life care,’ Journal of Religion & Health, published online 2 January 2021. Abstract (with list of references).
‘Lessons on older LGBTQ individuals’ sexuality and spirituality for hospice and palliative care,’ American Journal of Hospice & Palliative Medicine, published online 3 December 2020. Abstract (with list of references).
‘A survey of hospice and palliative care nurses’ and holistic nurses’ perceptions of spirituality and spiritual care,’ Journal of Hospice & Palliative Nursing, published online 16 November 2020. Abstract.
‘Sikh religion and palliative care,’ BMJ Supportive & Palliative Care, published online 2 November 2020. Full text.
‘Methodological and ethical challenges while conducting qualitative research on spirituality and end of life in a Muslim context: A guide to novice researchers,’ International Journal of Palliative Nursing, published online 28 October 2020. Abstract.
‘The existential dimension of palliative care: The mirror effect of death on life,’ Omega – Journal of Death & Dying, published online 16 September 2020. Abstract (with list of references).
‘The urgency of spiritual care: COVID-19 and the critical need for whole-person palliation,’ Journal of Pain & Symptom Management, 2020;60(3):E7-E11. Abstract (with list of references).
‘“Give them the door but don’t push them through it”: Family attitudes toward physician-led spiritual care in pediatric palliative medicine,’
Journal of Religion & Health, 2020;59(6)2899-2917. Abstract.
‘A new perspective on spiritual care: Collaborative chaplaincy and nursing practice,’ Advances in Nursing Science, 2020;43 (2):147-158. Abstract.
Barry R Ashpole is a Communications Consultant, Educator and Media Specialist. He publishes Media Watch, a weekly compilation of articles and reports in the fields of healthcare, social services, ethics and law focused on end-of-life care. You can access Media Watch on the International Palliative Care Resources Center website.
Browse the archive of Abstract Watch posts from Barry R Ashpole on the EAPC blog.
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