Background: A transitional care pathway (TCP) could improve care for older patients in the last months of life. However, barriers exist such as unidentified palliative care needs and suboptimal collaboration between care settings. The aim of this study was to determine the feasibility of a TCP, named PalliSupport, for older patients at the end of life, prior to a stepped-wedge randomized controlled trial. Methods: A mixed-method feasibility study was conducted at one hospital with affiliated primary care. Patients were ≥ 60 years and acutely hospitalized. The intervention consisted of (1) training on early identification of the palliative phase and end of life conversations, (2) involvement of a transitional palliative care team during admission and post-discharge and (3) intensified collaboration between care settings. Outcomes were feasibility of recruitment, data collection, patient burden and protocol adherence. Experiences of 14 professionals were assessed through qualitative interviews. Results: Only 16% of anticipated participants were included which resulted in difficulty assessing other feasibility criteria. The qualitative analysis identified misunderstandings about palliative care, uncertainty about professionals' roles and difficulties in initiating end of life conversations as barriers. The training program was well received and professionals found the intensified collaboration beneficial for patient care. The patients that participated experienced low burden and data collection on primary outcomes and protocol adherence seems feasible. Discussion: This study highlights the importance of performing a feasibility study prior to embarking on effectiveness studies. Moving forward, the PalliSupport care pathway will be adjusted to incorporate a more active recruitment approach, additional training on identification and palliative care, and further improvement on data collection.
Every healthcare professional (HCP) in the Netherlands is expected to provide palliative care based on their initial education. This requires national consensus and clarity on the quality and goals of palliative care education and accessible education opportunities nationwide. These requirements were not met in the Netherlands, posing a major obstacle to improving the organization and delivery of palliative care. Therefore, a program, Optimizing Education and Training in Palliative Care (O2PZ), was established to improve palliative care education on a national level.
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Background: Transmural palliative care interventions aim to identify older persons with palliative care needs and timely provide advance care planning, symptom management, and coordination of care. Nurses can have an important role in these interventions; however, their expertise is currently underused. A new transmural care pathway with a central role for the community care registered nurse in advance care planning aims to contribute to the quality of palliative care for older persons. Objective: To examine the perspectives of community nurses on the feasibility of a new transmural care pathway for advance care planning for older persons. Design: A qualitative study design using semi-structured interviews. Setting(s): Interviews were performed with community nurses of three participating homecare organizations in the Netherlands between March and May 2023. Participants: 19 community nurses. Methods: A topic guide was based on (1) challenges in advance care planning identified from the literature and (2) concepts that are important in assessing the feasibility of complex healthcare interventions provided by the Normalisation Process Theory framework. A combined inductive and deductive thematic analysis was performed. Results: Four themes were identified: views on the transmural care pathway, community nurses’ needs to fulfil their role, key points regarding implementation, and evaluation of the new practice. In general, community nurses were positive about the feasibility of the new practice as it provided a more structured work process that could facilitate interprofessional collaboration and improve the quality of palliative care. Overall, the feasibility of the new practice, from community nurses perspective, was determined by (1) clear roles and responsibilities in the transmural care pathway, (2) standardized registration of advance care planning, and (3) close involvement of community nurses in the whole implementation process. Conclusions: We highlighted important factors, from the perspectives of community nurses, that need to be considered in the implementation of a new transmural care pathway for advance care planning. A clear division of roles and responsibilities, standardized registration of advance care planning, and involvement of community nurses during the whole implementation process were mentioned as important enabling factors. This knowledge might contribute to successful implementation of a transmural care pathway that aims to enhance the quality of palliative care for older persons. Tweetable abstract: Community nurses’ perspectives on the feasibility of a transmural care pathway for advance care planning for older persons.
Dit onderzoek richt zich op het verbeteren van kwaliteit van leven in de palliatieve levensfase van mensen met kanker. Het onderzoeksvoorstel ABL-PC heeft als doel een verkenning van een interventie voor deze doelgroep. Uiteindelijk kan de inzet hiervan leiden tot vergroting van kennis van persoonlijke behoeftes en vragen van deze doelgroep en draagt zo bij aan verbetering van kwaliteit van de palliatieve zorg. MOTIEF: Er komt steeds meer aandacht voor het belang van de rol van zingeving als onderdeel van kwaliteit van de zorg (Huber et al, 2016; ZonMW, 2016), en ook in de zorg in de palliatieve levensfase (Medische Oncologie, nr 1., 2019). Er zijn richtlijnen ter verbetering van de palliatieve zorg (Kwaliteitskader palliatieve zorg Nederland, IKNL/Palliactief, 2017, O2PZ 2019) en er bestaat een overzicht van instrumenten voor zorgverleners (Goede Voorbeelden, Verbeterprogramma ZonMw 2016). Er ontbreken echter interventies rondom zingeving voor zorgvragers die praktisch zijn georiënteerd en theoretisch en empirisch zijn onderbouwd. RESULTATEN: 1) Een multidisciplinair netwerk vanuit de praktijk, kunsten, de medische en psychologische wetenschap voor het ontwikkelen van een innovatieve interventie, 2) Een opzet voor een praktische interventie voor zingeving vanuit persoonlijke vragen, 3) Een wetenschappelijk artikel over dit onderzoek 4) Inrichting van een grootschalig vervolgonderzoek. INHOUD: Het onderzoek is opgebouwd als een iteratief proces waarbij onderzoekers samen met de praktijk, een bestaande kunstkijk methode Art-Based Learning (ABL) (Lutters, 2012), door- ontwikkelen tot interventie voor de palliatieve zorg: Art-Based Learning-Palliative Care (ABL-PC). Deze interventie genereert door het aandachtig en op systematische wijze kijken naar kunst, nieuwe mentale ervaringen en bewustzijn, vanuit zingevingsvragen bij de doelgroep. PARTNERS: In dit ontwerpgericht onderzoek werken samen: Amsterdam UMC (AUMC/VUmc), de Nederlandse Federatie van Kankerpatiënten organisaties (NFK), ArtEZ, Hogeschool voor de Kunsten (Lectoraat Kunst- en Cultuur Educatie), Universiteit Twente (Narratieve Psychologie), Museum Jan Cunen, Amsterdam Museum.
Being diagnosed with incurable cancer often leads to experiences of contingency and to existential concerns when patients struggle to search for meaning. The aims of this project are to (1) investigate how Art-Based Learning(ABL) – an art education method for experiencing art – has the potential to affect meaning-making processes of cancer patients in palliative care; (2) to investigate how to integrate this in (patient) education programs; (3) to enable health and art professionals to extent their capabilities to care for PC patients. This project builds on previous research on contingent experiences and narrative meaning-making, and on a pilot-study regarding the feasibility of carrying out ABL in PC. Aims and questions have been developed in a long-lasting process of problem analysis with PC and art education professionals, patients, and researchers. We will a) conduct participatory research to make an inventory of considerations that play a role in designing an art exhibition for the purpose of ABL among patients with advanced cancer, resulting in a manual to be used in future practice and research; b) conduct an explorative study and evaluate which factors hinder and promote patients’ meaning- making processes in online/on-site interventions; c) conduct a formal analysis of patients’ experiences with regards to meaning-making; d) formally compile a full list of conclusion and advices and embed the result in a new educational program for PC and art education professionals. This project is led by the professorship Art education as Critical Tactics(ArtEZ University of the Arts) and is carried out by a consortium of experts and complementary partners: University of Amsterdam and University of Twente (research partners); Amsterdam University Medical Centers, Amsterdam Museum, Museum Arnhem, Museum Jan Cunen, Leren van Kunst (public institutional partners); Vrije Universiteit Amsterdam, Radboud University, Story Lab-University Twente (knowledge experts); Living with Hope, SPKS, NFK(experience experts/patients advocacy).
