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Titre : | Comparative Analysis of Palliative Care Needs Identified in Inpatient Rehabilitation and Skilled Nursing Facilities by Multidisciplinary Team Members (2023) |
Auteurs : | Erin Kelly ; Elizabeth Spina ; John Liantonio |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 104, n° 12, 2023) |
Article en page(s) : | p. 2027-2034 |
Note générale : | https://doi.org/10.1016/j.apmr.2023.06.003 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Équipe soignante ; Réadaptation ; Soins de longue durée ; Soins de suite ; Soins palliatifs |
Résumé : | Objective Assess access to, need for, and beliefs surrounding specialized palliative care (PC). Design Observational, comparative analysis needs assessment survey. Setting Four inpatient rehabilitation facilities (IRFs) or skilled nursing facilities with long-term care (SNFs/LTC) that provide subacute rehabilitation within 1 tertiary care system. Participants Allied health professionals, physicians, nursing, case managers, social workers, spiritual care (n=198). Interventions Not applicable. Main Outcome Measures Frequency of patient needs, attitudes about current systems, individual beliefs, and barriers to PC. Confidence in management, communicating, and navigating primary PC competencies among clinical pathway employees. Results Of 198 respondents, 37% said PC was available at their facility. Those in IRF reported higher frequencies of grief/unmet spiritual needs of patients compared with SNF/LTC (P?.001). Conversely, SNF/LTC reported higher frequencies of agitation, poor appetite, and end-of-life care (P?.003). Respondents in SNF/LTC felt more confident managing end-of-life care, explaining what hospice and PC are and appropriateness for referral to each, discussing advance directives, determining appropriate decision-makers, and navigating ethical decisions than in IRFs (P?.007). SNF/LTC participants reported higher effectiveness of their current system involving PC and ease of hospice transition compared with IRFs (P?.008). A majority agreed that PC does not take away patient hope, could prevent recurrent hospitalizations, improve symptom management, communication, and patient and family satisfaction. The most common reported barriers to PC consultation were (1) attitudes and beliefs of staff or patients and families, (2) system issues with access, cost, or prognosis communication, and (3) lack of understanding of PC role. Conclusions A gap exists in PC access in IRF and SNF/LTC despite patient needs and staff beliefs. Future studies should focus on identifying which patients should be referred to PC in the post-acute setting and what outcomes can be used as a guide to meet the needs of this growing area of practice. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999323003520 |