Search

Objectives: The present mixed-method systematic review identifies facilitators and barriers in palliative care communication among health professionals and older people.Methods: The review process was conducted by three reviewers who searched studies in four different databases (January 2009-January 2022), exploring experiences of communication among health professionals and older people without cognitive impairments. Relevant articles were quality assessed with a standardized tool.Results: Twenty-eight articles were included and the following 5 clusters were identified: 1) training and education for health professionals, 2) team working and coordination among health professionals, 3) communication skills, 4) time and availability, 5) emotional, cultural and psychological factors. The articles highlighted the need for greater preparation of health professionals around the management of palliative care communication with older people.Conclusion: Palliative care communication among health professionals and older people are characterized by several challenges. However, there are facilitating aspects that may be considered to improve the quality of communication.Practice Implications: Facilitators are promising approaches to support health professionals in providing high-quality palliative care communication to older people, developing a person-centred practice. Facilitators include palliative care training and educational opportunities for health professionals, like ELNEC Geriatric Curriculum, permitting them to develop specific competences in communication and aging. [ABSTRACT FROM AUTHOR]

Living standards capabilities are an important determinant of healthy ageing. The Living Standards Capabilities for Elders scale (LSCAPE) is the main instrument available to assess living standards capabilities among older adults based on Sen's Capability Approach. The objectives of this study were: (a) to adapt and validate LSCAPE for use in the Spanish population; (b) to examine the dimensionality, validity and reliability; and (c) to establish the convergent validity of LSCAPE using self-reported measures of quality of life and income. The LSCAPE was administered to 441 Spanish seniors aged 65 and over. Confirmatory Factor Analysis (CFA) was used to analyse the dimensionality, validity and reliability. Discriminant and convergent validity of the model were assessed using Average Variance Extracted (AVE). Reliability was shown by Composite Reliability (CR) and Cronbach's alpha. Convergent validity was tested by correlating the LSCAPE scales and sub-scales with the Short-form Health Survey (SF-12) sub-scales. CFA showed that the LSCAPE Six-factor Model fits well to the data, showing Standardised Root Mean Square Residual < 0.09 (0.084), Comparative Fit Index and Tucker–Lewis Index > 0.9 (0.925 and 0.917, respectively). LSCAPE showed also good reliability (CR indices > 0.7) and validity (AVE > 0.5) measures. Finally, LSCAPE had moderate to strong associations with SF-12 sub-scales (>0.6) and a moderate relationship with income (>0.3). Thus, LSCAPE has been demonstrated to be a reliable and valid instrument in measuring living standards capabilities among the Spanish older population. [ABSTRACT FROM AUTHOR]

Frailty is one of the most challenging issues among older adults, and the relationship between frailty and falls has already been assessed numerous times in literature. In the present study, we explored the mediating role of self-efficacy related to falls (FSe) in the relationship between frailty and fall risk. In a cross-sectional design, 1080 community-dwelling older adults from Rotterdam (Netherlands) and Valencia (Spain) completed a questionnaire and data were then analyzed via mediation analysis using a bootstrapping approach. Results show that higher frailty is associated with higher fall incidence, and higher FSe is a partial mediator of this association, with a confidence interval for the indirect effect of 0.131–0.247. Moreover, results showed gender differences in FSe levels; women had lower FSe scores. Deepening research on the construct of FSe may give potential explanations that account for the emerged gender differences, and it could be more targeted in fall prevention programs. [ABSTRACT FROM AUTHOR]

Introduction: A significant amount of research on palliative care (PC) has demonstrated the benefits of identification for a timely referral as well as enabling an integrated care approach. However, the prompt identification of PC in clinical practice has been a challenge. Despite PC needs may differ widely between patients, a short survival prediction is one of the most common proxies to start PC conversations, therefore predicting if the death will occur within the next year has a real value when screening for patients who may benefit from PC. Our objective was to create a clinical decision support system called Aleph to support healthcare providers in their screening for patients with PC needs. Aleph incorporates different quantitative and data-driven predictive services based on machine learning technology and electronic health records (EHR) data. Methods: Two machine learning services have been developed using retrospective hospital admission data from the EHR (39,310 episodes from 19,753 different patients; age >= 65). The first service incorporated three models: t models: a one-year mortality classifier, a mortality regressor, and a one-year frailty status classifier. The second service incorporated a compact and minimalist version of the one-year mortality models using only common variables. We validated Aleph's usability and user experience using a user-centred methodology involving 21 healthcare providers from six countries. Results: The models on the first service reported an area under the ROC curve (AUC-ROC) of 0.87 for the one-year mortality classifier, 94.67 days of mean absolute error for the regression model, and 0.89 of AUC-ROC for the one-year frailty classifier. The compact model on the second service reported an AUC-ROC of 0.83. Aleph made a great impression among the validation participants and scored 65 over 100 points on System Usability Scale and 1.5 over 3 in the User Experience Questionnaire-Short. Discussion: Aleph was developed as a multi-purpose clinical decision support system web application. Its design allows the incorporation of further integrated care services, even out of the realm of the PC. We have incorporated two PC services based on powerful predictive models. Documentation to create a new predicted service will be openly distributed to encourage researchers to contribute to the Aleph so their predictive models could be incorporated immediately into a usability-validated platform. Conclusion: Our contribution to the identification of patients who may benefit from PC are two predictive services with high predictive power models and a user-centred validated platform. These allow the integration of this outcome with other services available to address patients' needs as well as to 'plug and play' other predictive services. Implications for applicability and limitations: The use of Aleph can improve the detection of patients in need of PC, helping physicians and hospital administrators to address the growing demand for PC and improving the patient's care. The main limitation of the study is the lack of validation of the predictive model with other data sources. [ABSTRACT FROM AUTHOR]

Introduction: Early palliative care (PC) has proven to be effective on improving patients' quality of life and symptoms control. However, most of the research has been focused on oncological patients. In this sense, the InAdvance project (825750) addresses early PC among older patients with non-malignant diseases. A needs assessment (NAT:PD) intervention is being performed under a clinical trial in four European sites (ISRCTN24825698): Valencia-Spain, Thessaloniki-Greece, Lisbon-Portugal and Highland-Scotland. The aim of this study is to explore the acceptability, feasibility and attitudes of key health and care professionals (HCPs) around the implementation of the NAT:PD. Methods: HCPs involved in the implementation of the NAT:PD intervention participated in this qualitative study through individual interviews or focus groups. The interview guide was designed using the Consolidated Framework for Implementation Research (CFIR), which is a robust model for systematically assessing potential barriers and facilitators in preparation for the implementation of an intervention. Data was analysed using grounded theory. Results: 29 HCPs participated in this study, which were mostly women (62%) and the average age was 42.6 years. All respondents replied positively to the implementation of the NAT:PD intervention in their settings. All considered it as useful and necessary to improve their work with chronically ill patients to timely detect their needs in a systematic manner. Some sites already had resources or services that the intervention could be aligned with and for others the NAT:PD would be a notable resource to fill gaps in their current work. Lack of integration with other services and multidisciplinary professionals - such as primary care or psychologists - was detected as a relevant concern. Also, all HCPs highlighted potential time constraints and fatigue due to COVID19 pandemic as barriers as most of the participants felt exhausted after these complicated months. However, most of them expressed enthusiasm with this new intervention as it was considered of great relevance for their units and patients. Conclusions: In general, the four sites considered the early intervention as relevant to address the needs of their patients and also as an asset to reinforce their current resources. However, there were significant differences between sites in the level of information provided and the detail on implementation plans that HCPs disposed to run the trial. Additionally, addressing the needs detected under the NAT:PD require integrated, comprehensive and continuity care throughout the whole care system and with the involvement of multidisciplinary and multilevel services. Implications for transferability, sustainability and limitations: We recommend that clear and detailed materials and trainings are offered to those HCPs in charge of the implementation of NAT:PD that can increase their confidence and decrease anxiety. Also, it is crucial to have proper connections and alliances with different health and care services and stakeholders to make effective referrals of patients in accordance to their needs. [ABSTRACT FROM AUTHOR]

Background Chronic patients are frequent users of healthcare services and are prone to hospital admissions. In Valencia (Spain) the Valcronic programme aims to manage chronic patients through different levels of telemonitoring and telecare. This paper examines the impact of the Valcronic programme on self-perceived HRQOL in a one-year period and on perceptions of satisfaction and usefulness in a sample of older adults with chronic diseases. Methods The sample ( n = 74) was randomly selected from Valcronic users and was stratified considering different variables. HRQOL was assessed using the EQ-5D questionnaire at two points in time: before the beginning of the Valcronic programme and after a one-year follow-up. Satisfaction and usefulness were evaluated one year after users’ inclusion. Results The whole sample experienced improvement, although not significant, of its HRQOL; patients over 75 showed impairment. Patients with at least one problem in the EQ-5D dimensions decreased after one year (82.43% vs. 74.32%). Users’ perceptions of satisfaction and usefulness were highly positive. Conclusions Our sample benefited from the Valcronic programme, experiencing an improvement in their HRQOL, a decreased use of health resources or high satisfaction levels. Implications Further adjustments are needed to address a comprehensive response to the needs of the global population of reference. [ABSTRACT FROM AUTHOR]

The Sustainable Social and Healthcare Model (SSHM) is aimed to establish new care pathways in primary care systems contributing to the decrease of health services use and costs and improve the integration and efficiency of social and health care for elderly people with long-term care (LTC) needs. One of these strategies is the segmentation of population in risk groups through standardized tools. This paper is a retrospective study aimed to determine the viability of the implementation of the screening tools Probability of Repeated Admission - Pra - and The Community Assessment Risk Screen - CARS - to detect patients at risk of hospital readmission in a sample of 500 elderly people (65+) from the VHS in Spain. Patients were recruited from three Health Departments. Data from selected tools and predictive variables were collected through the healthcare database from the VHS. The most important results indicate that both instruments predict with high efficacy the proportion of patients not readmitted (negative predictive value between 91% and 92%). Moreover, the tools performed with a moderate efficiency being the Pra less sensitive (54%) and more specific (81%) than CARS (with a sensitivity and specificity of 64%). Results from this study suggest that the application of instruments as Pra and CARS are of interest to the Valencian Health Administration as they can be a good strategy to improve the management of elderly patients at risk with comorbidities and guiding clinical decision. [ABSTRACT FROM AUTHOR]

Background: The last WHO definition of palliative care (PC) recognizes the integration of early PC in the course of illness and in conjunction with other therapies that are intended to treat disease as the way to provide optimal care. There is wide literature highlighting the benefits of early implementation of PC in oncological patients and there is a growing recognition of PC as an integral aspect of cancer treatment with the establishment of a range of specific guidelines concerning palliative cancer care. Nevertheless, these advances are not developed to the same extent in the approach of non-oncological chronic conditions. In this regard, patients of non-cancer diseases are rarely offered these services and even when they are admitted to a PC unit they are typically closer to death and have a lower functional level than those with cancer. It is important to highlight this situation as the great majority of adults in need of PC die from non-oncological diseases - such as cardiovascular diseases, chronic respiratory diseases or diabetes - accounting a higher percentage than those with cancer. Aims and objectives: INADVANCE project (funded under the H2020 Programme) seeks an earlier, integrated and more effective implementation of PC to adequately address the needs of nononcological chronic patients. Thus, this workshop is focused on early PC among patients with chronic conditions. This analysis will be encouraged by presenting the current state of early PC among this profile of patients, some experiences in their management at different healthcare systems. Finally, at the end of the workshop a common discussion between all presenters and attendants will be performed in order to analyze main barriers and facilitators to organize and implement PC services addressed to chronic complex patients. Format: A 90-minutes workshop session will be organized in order to achieve the aforementioned objectives. Two people from INADVANCE project will be in charge of organizing and running the workshop with the participation of the following speakers in these topics: "Introduction" (5min): outline of the main objectives and structure of the session (Ascensión Doñate). "Early PC for patients with complex chronic conditions" (10min): presentation of INADVANCE project, the current state of the art of PC services among non-oncological chronic conditions, how to identify patients in need of PC (Ascensión Doñate). "Experiences in the provision of PC among non-oncological conditions" (40min): five presentations of local experiences (Soledad Giménez, Vania Dimitrova, Panagiotis Bamidis, Adriano Fernandes & Gordon Linklater). Time for questions. "Barriers and facilitators to effectively implement PC" (30min): open discussion with speakers and attendants to the workshop (Soledad Giménez). For this session several materials will be arranged, such as a boards, markers or post-it. "Sum up" (5min): main conclusions (Ascensión Doñate). Target audience: People interested in PC, care and management of chronic conditions at clinical and organizational level. Learnings: Workshop participants will learn about differences in the provision of integrated PC between cancer vs. non-cancer diseases, real experiences improving the PC of chronic complex conditions and challenges for future improvement. [ABSTRACT FROM AUTHOR]

Introduction and policy context: In the Valencian Region social services and the healthcare system are not connected. Also there is not any normative jointly regulating resources, services or aid benefits that would mean an integrated care IC portfolio. Primary care PC centres are the closest and most trustworthy care facility for patients in the Spanish context. Also, PC is one of the most suitable resources to address needs of complex patients, as elderly and/or those with chronic conditions, through an IC approach, but there are some barriers that block its real and effective deployment. Objective and target population: Authors have studied the viability, implementation and development of stratification tools at PC as a promoter of IC within the Valencian Healthcare System VHS. On the basis of their work and close interaction with PC multidisciplinary staff and patients, some gaps were detected. So, this paper presents three main policy recommendations that the VHS - and other healthcare systems with similar characteristics - may take into consideration to facilitate the introduction of an IC approach. Highlights and transferability: Implementation of systematized, automatized and computerized stratification strategies at the VHS by including predictive algorithms within electronic health records EHR. Early identification of patients at risk through stratification tools provides useful information to carrying out appropriate preventive and intervention actions aimed at reducing the probability of adverse events at short or medium term. Design of a unique portfolio with health and social care services specifically addressed to complex patients. The connection between health and social care systems is possible by establishing agreements on specific administrative activities between decision-makers from each system. On the basis of this regulation, common action plans and guidelines should be launched including healthcare resources and social services at local level. Multidisciplinary case-management teams at PC centres are a relevant pillar to manage and take decisions regarding complex patients. Moreover, specific training for staff and new functions at EHR should be implemented in order to assure effective coordination and communication flows between these professionals. Strengthening of the role of EHR in the VHS by promoting their correct use by care professionals and raising awareness of electronic records research. Firstly, a unique electronic clinical history system should be available at Spanish level or, at least, interoperability between the different EHR used in each Autonomous Community must be introduced. Moreover, the VHS should promote using electronic records to carry out live, dynamic and smart monitoring of population health and to develop small/large scale predictions of patients' health outcomes and needs. Conclusions: PC multidisciplinary teams have a fundamental role in the approach of chronic conditions and older people since an IC perspective. New work cultures must be fostered to facilitate the coordination between professionals and the introduction of new technological infrastructures through EHR for an effective exploitation of data available in. Stratification and predictive systems are only an example of the potentiality of electronic records to plan preventive actions, interventions and policies in order to respond challenges that complex population mean. [ABSTRACT FROM AUTHOR]

Introduction: The activation of integrated care pathways is not always easy and is timeconsuming, so the standardized use of stratification tools (ST) can support health care professionals in decision-making processes. Several ST -developed and validated in the United States- have been implemented in the Valencia Region (Spain) at primary care (PC) centres to identify elders with multimorbidity at risk of suffering future hospital admissions (FHA). In spite of the usefulness of these instruments, it would be recommended to apply STs which have been specifically designed on the basis of the Spanish healthcare system and the characteristics of its population. Thus, the objective of this study was to design a ST aimed at the identification of elders at risk of hospital admissions in the following 12 months in the Valencian Healthcare System. Methods: The study started with the organization of focus groups (FG) with six multidisciplinary PC professionals aimed at selecting potential variables to be included in the ST. From the FG's results a retrospective study was carried out with the objective of identifying the most significant variables. These variables were tested in a sample of 107 elders. In the last stage, the combination of variables derived from the previous steps was tested in a sample of 1,000 patients in order to select a final combination of variables and to build a predictive algorithm through binary logistic regression analysis. Results: A set of 13 potential variables to be included in our ST were identified in the FG. These variables comprised data on socio-demographics, clinical and social aspects and registers on the previous use of health resources. As part of the retrospective studies, binary logistic regression analysis determined that the following variables were statistically significant as predictors of FHA: 'chronic respiratory disease' (OR= 2.32, p= 0.015), 'chronic heart disease' (OR= 2.10, p= 0.019), 'palliative care' (OR= 22.53, p= 0.04), and the 'number of previous visits to emergency department at hospital' (OR= 1.82, p< 0.001). The model derived a risk score from 0 to 1 for each patient, classifying patients as high risk of FHA at a risk score threshold of 0.5 or higher. The model had a sensitivity of 42% and specificity of 96% and the AUC was 0.76. Discussions: The model developed within this study has shown an optimal performance, and an acceptable ability to identify patients at high risk of FHA who really were admitted (sensitivity of 42%), an excellent ability to identify patients at low risk who really did not suffer any admission (specificity of 96%). The accuracy detecting patients was similar to other comparable studies or even higher with reported AUC of 0.764. Moreover, the model incorporates variables that can be collected automatically from electronic health information systems (eHIS). Furthermore, the experts participating in the FG highlighted some social variables - usually not registered within eHIS - as determinants of health, especially in elders with chronic conditions (such as availability of knowledge and skills for appropriate self-care, social and/or family support or economic difficulties). Thus, it is proposed a 2-phase stratification system: the first one will calculate the developed algorithm through eHIS, and the second one will assess social variables by consulting the professional of reference. Conclusions: The final predictive model is composed by variables available at eHIS, so it can be easily introduced into health administration system of the Valencia Region. From this screening and decision-making support ST, professionals will be able to implement a wide range of care plans in accordance with patients' health and social needs which can potentially improve quality of care and favor that older people can remain at home longer. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. Methods: We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. Results: Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. Conclusions: The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. Trial registration: This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. Methods: We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. Results: Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. Conclusions: The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. Trial registration: This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687. [ABSTRACT FROM AUTHOR]

Background: The provision of palliative care for severe COPD remains low, resulting in unmet needs in patients and carers.Research Questions: What are the palliative care needs of patients living with severe COPD and their caregivers? What views of accessing and providing palliative care and factors influence these experiences. To what extent have palliative care and COPD services been integrated?Study Design and Methods: A multicentre qualitative study was undertaken in COPD services and specialist palliative care in the United Kingdom involving patients with severe COPD, their carers, and health professionals. Data were collected using semistructured interviews and were analyzed using framework analysis. Themes were integrated using the constant comparison process, enabling systematic data synthesis.Results: Four themes were generated from interviews with 20 patients, six carers, and 25 health professionals: management of exacerbations, palliative care needs, access to palliative care and pathways, and integration of palliative care support. Uncertainty and fear were common in patients and carers, with identified needs for reassurance, rapid medical access, home care, and finance advice. Timely palliative care was perceived as important by health professionals. Palliative care was integrated into COPD services, although models of working varied across regions. Reliable screening tools and needs assessment, embedded psychological care, and enhanced training in palliative care and communication skills were perceived to be important by health professionals for timely palliative care referrals and optimized management.Interpretation: Palliative care increasingly is being implemented for nonmalignant diseases including COPD throughout the United Kingdom, although models of working vary. A theoretical model was developed to illustrate the concept and pathway of the integration of palliative care support. A standardized screening and needs assessment tool is required to improve timely palliative care and to address the significant needs of this population. [ABSTRACT FROM AUTHOR]