presentation on end of life care

Resources for

Palliative & End-of-Life Care

Palliative care in acute & critical care settings.

The goal of palliative care is to address the impact of serious illness by managing symptoms, improving quality of life, providing emotional support and ensuring that the plan of care aligns with patient and family goals. Under usual circumstances, there is significant overlap between nursing basics — interaction between patient and disease — and palliative care.

AACN offers resources to support nurses as they care for patients with serious illnesses and those nearing the end of their lives, as well as education for staff members who don’t usually provide this kind of care. In addition, several respected organizations offer widely recognized resources on these topics, including the End-of-Life Nursing Education Consortium/ELNEC (palliative care training), Center to Advance Palliative Care (toolkits) and Vital Talk program (communication skills) .

Facts & Figures

Remember that (palliative care) can be offered simultaneously with curative, aggressive, lifesaving treatments. People do not have to wait. They do not have to choose. Clareen Wiencek, PhD, RN, ACHPN, ACNP, AACN past president

What’s the Difference?

There are sometimes subtle distinctions between palliative, end-of-life and hospice care, including patient prognosis, goals of care and insurance reimbursement.

Palliative Care

Palliative care is appropriate at any time in the trajectory of serious illness or injury and does not replace curative interventions.
Palliative care communication skills can be used to explain prognosis or uncertainty about prognosis and to elicit patient and family perspectives even if a change in the plan of care does not occur.
Insurance reimburses for specialty palliative care in the same way other consultative services are paid for and does not depend on a specific prognosis.
In some instances, palliative care is delivered by the primary care team instead of as an additional service. This is called primary palliative care.
Palliative care is given in many settings, including ICU, PCU, acute care or outpatient.

End-of-Life Care & Hospice

End-of-life care generally refers to patient care before death, either while undergoing curative treatment or after deciding to focus on comfort rather than cure.
With some serious illnesses, prognosis is uncertain and it is unclear if the care provided is end-of-life or life sustaining.
When patients have a prognosis of six months or less, they are eligible to enroll in hospice through their insurance coverage.
Hospice organizations provide a comprehensive set of services aimed at promoting comfort, and providing emotional support and education on what to expect during the dying process.
Hospice services can be delivered to patients at home, in a skilled nursing facility or in a hospital.

Key Resources

Communication skills and education can increase your confidence when discussing goals of care with patients and families. Keep up with the latest developments in palliative care with this selection of AACN resources, designed to help you deliver the best possible evidence-based care.

Palliative Care and Moral Distress: An institutional Survey of Critical Care Nurses

Do you or your colleagues experience moral distress providing curative treatment to patients with a poor prognosis? Read this journal article to learn about the association between palliative care skills and moral distress.

A Passion for Palliative Care

Palliative care nurse practitioner and AACN past president Clareen Wiencek answers common questions about the intersection of palliative and critical care in this Q&A article. Consider how her insights and expertise from four decades of nursing could apply to your practice.

Palliative Care in the ICU

Examine end-of-life patterns in chronically and critically ill patients, and identify the pharmacologic methods for providing comfort in this recorded session.

Providing Primary Palliative Care in the ICU

Learn key skills every critical care nurse should have to talk with patients about palliative care and collaborate with the team for family meetings.

Palliative Care in the ICU: Communication Skills in Practice

View videos demonstrating essential communication skills for providing primary palliative care in this interactive case-based webinar.

AACN Position Statement: Ethical Triage and End-of-Life Care

AACN’s position statement gives specific actions for nurses and organizations when triage guidelines apply to the allocation of scarce resource.

Additional Resources

Access AACN’s complete library of programs and publications on palliative and end-of-life care. This compilation of resources includes journal articles, webinars and CE activities to improve your understanding of palliative and end-of-life care, and enhance your practice.

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Nursing Management: End-of-life Palliative care, Comfort Care, Hospice

Published by Gyles Doyle Modified over 8 years ago

Presentation on theme: "Nursing Management: End-of-life Palliative care, Comfort Care, Hospice"— Presentation transcript:

Emotional and Physiologic Elements of Death and Dying

1240 College View Drive, Riverton, WY Phone A non-profit organization 5 I MPORTANT H OSPICE F ACTS 1.Hospice is NOT only for the last.

EPECEPECEPECEPEC EPECEPECEPECEPEC Elements and Models of End-of-life Care Elements and Models of End-of-life Care Plenary 3 The Project to Educate Physicians.

UNDERSTANDING HOSPICE. WHY IS IT IMPORTANT FOR US TO UNDERSTAND HOSPICE? Our care and services overlap Continuity of Care Passing the baton.

Intervening with Death and Dying Anita Rhodes, RN, MSN.

Unit 4 Chapter 22: Caring for People who are terminally ill

DEATH AND DYING Emotional and Physiologic Elements of Death and Dying.

EPECEPECEPECEPEC EPECEPECEPECEPEC Last Hours of Living Module 12 The Education in Palliative and End-of-life Care program at Northwestern University Feinberg.

EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours Osteopathic EPEC Osteopathic EPEC Education for Osteopathic Physicians.

EPECEPECEPECEPEC EPECEPECEPECEPEC Physician- Assisted Suicide Physician- Assisted Suicide Module 5 The Project to Educate Physicians on End-of-life.

Insert your organization’s logo here. Understanding Hospice, Palliative Care and End-of-life Issues This presentation is intended as a template. Modify.

Presented by Julie Stanton, BCH.  A two part legal document ◦ Healthcare Decisions- a person’s wishes for end of life medical treatment. ◦ Durable Power.

Advance Directive & End of Life Care City-Wide Orientation Reviewed 10/2014.

Understanding Hospice, Palliative Care and End-of-life Issues  This presentation is intended as a template  Modify and/or delete slides as appropriate.

Nursing Assistant Death & Dying.

1 Nursing Facility and Hospice Collaborative Training Presented by Care Initiatives Hospice, Hospice of Central Iowa, Iowa Health Hospice, Iowa Hospice,

Understanding Hospice, Palliative Care and End-of-life Issues

Hospice A philosophy of care to assist those in the end stage of life Model of care originated in England First hospice in United States was in New Haven,

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END-OF-LIFE

“Life lives, life dies, Life laughs, life cries. Life gives up and life tries, But life looks different through everyone’s eyes.” What does this mean?

REVIEW What is palliative care? What is the goal? What is hospice care? What aspects of care are essential to providing a comprehensive and humane approach at end-of-life?

Something To Think About What is the impact of technological advances in health care? Should medical professionals prolong life through the use of technology just because they can? Has attention to care of the dying been overlooked because of improved ability to prolong life?

Barriers Interest in the care of individuals at end-of-life has surged in the past 30 – 40 years, but still falls short of what is needed. What are the barriers to improving end-of-life care?

Questions What is the prevalent social context of illness and disease in the United States? What is the care/cure dichotomy? What is most valued? Why?

Assisted Suicide Legal only in Oregon Opposed by nursing and medical organizations Would you ever be tempted to assist a patient who requests your assistance? How does the ANA define the role of the nurse?

End-of-Life Care Provider What skills are essential to providing end-of-life care? What must a nurse (student) do in order to effectively communicate and provide care at end-of-life?

Communication Reflect on your own experiences and values concerning illness and death Deliver and interpret technical information without hiding behind medical terminology Realize the best time for the patient to talk may be at the least convenient time for you Be fully present during all communication Allow the patient and family to set the agenda regarding the depth of the conversation

Communication Be comfortable with silence Allow patient/family time to reflect and respond Prompt gently Avoid distractions Do not give advice Avoid canned responses Ask questions Assess understanding, both your own and the patient’s

Dr. Kubler-Ross on dying “Those who have the strength and the love to sit with a dying patient in the silence that goes beyond words will know that this moment is neither frightening or painful, but a peaceful cessation of the functioning of the body.”

How will you spend your Dash? “Somebody should tell us, right at the start of our lives, that we are dying. Then we might live life to the limit, every minute of every day. Do it! I say. Whatever you want to do, do it now! There are only so many tomorrows.” Pope Paul VI “Live as if you were to die tomorrow. Learn as if you were to live forever.” Mahatma Gandi

End-of-life care: Palliative care

Jul 19, 2014

470 likes | 1.53k Views

End-of-life care: Palliative care . Abid Iraqi, M.D Geriatric & Palliative Medicine Syracuse VA. The opinions expressed are those of the presenter and do not necessarily represent the opinion/position of Veterans Affairs. What is End of Life Care. Preaching to choir—

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Presentation Transcript

End-of-life care:Palliative care Abid Iraqi, M.DGeriatric & Palliative MedicineSyracuse VA

The opinions expressed are those of the presenter and do not necessarily represent the opinion/position of Veterans Affairs.

What is End of Life Care • Preaching to choir— Managing patients toward the end of their life

Why End of Life Care is important • The majority of deaths occur in elderly adults • Terminally ill patients spend most of final months at home, but most deaths occur in the hospital or nursing home • More people are living with chronic illness with typically declining condition before the end of earthly journey of life. • For patient who are at end of life, care in acute hospital may have little to offer but may induce unnecessary suffering.

Components of Good end of life care discussion • diagnosis ( of terminal illness) • specific treatments (for illness) • expected outcome of treatment (of illness) • expected outcomes without treatment (of illness) • potential untoward effect of treatment (of illness) • what to anticipate (in illness) with the passage of time. • prognosis • elicit treatment preferences • assess psychosocial support & spiritual needs

Why These Discussions are important • It enables healthcare professionals to recognize their patient’s values and preferences.

How End of Life Care is accomplished Depends on the spectrum of disease process

As disease progresses from • Advance care planning/directive to • Palliative care to • Hospice discussion & referral—Comfort care

What is meant by • Advance care planning • Palliative care • Hospice care • Comfort care

Before we proceed, perhaps we should review what is approach by default

Default care is Traditional care

Traditional care • curative intent • focus is in why • focus is to fix why • full code

Advance directive/care planning • a communication process between a patient and his/her medical providers, which may involve family or friends, about the goals and desired the direction of care at the end of life in an event when patient loses his/her decision making capacity,1,2 • 1 Seymour J., Almack K, Kennedy S. implementing advance care planning; a qualitative study of community nurses views and experiences.BMC palliative care 2010;9:4. • 2. Teno JM. Advance care planning for frail, older persons. In : Morrison RS, Meier DE, eds. geriatric palliative care. New York: Oxford University press, 2003; 307-313.

What is advance care planning • living will • health care proxy • Code status A realistic discussion regarding nutrition and hydration in advance directive is also useful

Why advance directives are important • initiate the discussion for end of life preference/wishes • ensure that patients receive care that is consistent with their preferences • it may prove improve quality of end-of-life care by achieving control over their care when/if they lose decision making capacity

Do Advance directives alone suffice for end of life care?

NO It requires

a mechanism/system where patients’ wishes can be honored Our job is to clarify focus of care, provide education and then follow the decision of our patients- Role of palliative care may come into place

What is palliative care • Palliative care is a specialized medical care that grew out of hospice tradition, and is focused on comfort and quality of life irrespective of the aggressiveness & focus of care regardless of the stage of illness .

What is Hospice care • Hospice is a philosophy of care focusing on holistic care of persons with terminal illness rendering life expectancy less than six months, and forgoing curative treatment.

What is comfort care • Focus is comfort without any aggressive treatment- depending on facility may be when death is imminent to years, and depending on medical providers ( patients still receiving IVF, antibiotics and lab. work, and other medical providers like me – same approach as in hospice with no blood work /antibiotics etc.)

Confusion often arise b/w hospice & palliative care- • Not the same though palliative care grew out of hospice tradition

Differences between Hospice and Palliative Care HOSPICE PALLIATIVE CARE • Appropriate when one has a terminal disease • Life expectancy is less than 6 months • Requires Physician certification • Patient has agreed to stop active/ curative treatment • Payment: per diem payment system • Serious illness regardless of stage of disease • Irrespective of life expectancy/not time limited • Does Not require physician certification • Can be provided with active/ curative treatment • Payment: fee for service model

Similarities between Hospice and Palliative Care HOSPICE PALLIATIVE CARE • Focus on symptom management, & quality of life • Support to patient, family and caregiver • Interdisciplinary in nature • Covered under Medicare, Medicaid and private insurance • Addresses goals of care, focus on symptom management, & quality of life • Support to patient, family and caregiver • Interdisciplinary in nature • Covered under Medicare, Medicaid and private insurance

Hospice is Palliative Care but Palliative Care is not necessarily Hospice Care

Role of Health care providers (MD,NP,PA,CNS) in end of life care • No matter where we work, it is never too early to help patients begin discussion of advance directives including health care proxy, and then as time goes on assist the patients with further end of life care discussion.

Case Description • A 76 year old started having abnormal cognitive deficits at the stage of mild cognitive impairment which over the next 8 years progressed to dementia. Then over the next 3 years worsened to advanced stage where he became dependent for all of his IADLs and required supervision for ADLs. Over the next 2 years dementia further worsened to terminal stage.

How to proceed • MCI stage: managed at home with support of his family, removed fire-arms, completed health care proxy and financial POA • Onset of dementia: family initiated support services and he started exploring assisted living. • At advanced stage: moved to assisted living , and over next 9 months to special dementia unit. • Terminal stage: DNR by surrogate and no feeding tube. Palliative care, and ongoing discussion with HCP regarding burden & benefits of interventions

Conclusion • Palliative care is simply a good medical practice to ensure patients’ comfort and quality of life and keeping in view how patients would like to proceed with their medical care

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End of Life Washington Educational Presentations

End of Life Ready: An Intro to Advance Planning and your End-of-Life Options

For the general public.

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May 22nd, 6:30-7:30pm

June 26th, 12:00-1:00 pm

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To schedule a group presentation of End of Life Ready, in person or over Zoom, please contact our Community Outreach Coordinator, [email protected] or use the presentation request form .

Materials Referenced During this Presentation:

Values Worksheet
Healthcare Directive & Durable Power of Attorney for Healthcare (Healthcare Agent)
Death With Dignity Checklist and Resources
Information on Voluntary Stopping Eating and Drinking (VSED)
Talking with Your Doctor

Click here to access our printable End of Life Ready Made Easy – Checklist and Resources.

Click here to access a printable version of the slides used during the presentation.

Additional Resources

Here are some additional resources to help you get the conversation started and plan ahead:

The Conversation Project
Death over Dinner
Death Cafes
Worry-Free Wednesday
VSED Directive by Northwest Justice Project & National VSED Advance Directive Committee

End of Life Ready presentations are part of an outreach campaign focused on educating the public on the choices available to have autonomy over their death and their right to die with dignity. Our goal is to reach a quarter of a million Washington residents in five years. You can help us achieve this!

Additional End of Life Washington

Presentation topics and focus areas.

End of Life Washington provides presentations for health care professionals, hospice staff and providers, undergraduate and graduate students (including medical, nursing, social work and other healthcare provider programs), caregivers, and support groups. Presentations can be customized to fit your group’s needs and are suitable for the general public and community groups.

Areas of focus can be related to the topics below and/or paired with partner organizations on leaving your legacy for loved ones, financial and legal planning, etc.

Washington’s Death with Dignity Law: How to access Medical Aid in Dying in Washington
Voluntary Stopping Eating and Drinking (VSED): A peaceful end-of-life option
Advance Planning: Choosing a Health Care Agent and Advance Directives for Health Care
Ensuring Medical Interventions follow your wishes and values
How to talk to your health care provider about end-of-life treatment preferences and concerns
Film screening and Q&A/Discussion – How to Die in Oregon, Speaking of Dying, Bob’s Choice
Advocacy for improving Death with Dignity and Advance Directives in Washington
Y our rights at the end-of-life: Stopping Treatment, Death with Dignity and other options
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Hospice and palliative care: A look at ‘absolutely vital’ end-of-life support

Elderly_patient_in_hospice_Credit_Photographeeeu__Shutterstock_1.jpg

By Daniel Payne

CNA Staff, May 19, 2024 / 05:00 am

As assisted suicide and euthanasia continue to grow more common throughout much of the developed world, services like palliative and hospice care serve as a vital counterweight to those trends, offering what one provider calls care for “the whole person” that’s respectful of both a patient’s life — and death.

Assisted suicide and euthanasia have been legalized in countries such as Canada, Australia, Spain, Belgium, and in multiple U.S. states, permitting patients to take their own lives or allowing doctors to kill them outright.

In contrast, services such as palliative care and end-of-life hospice care seek to uphold the dignity of each human life, especially as it nears its end.

What is palliative care? What about hospice?

Dian Backoff told CNA that both palliative and hospice providers are trained to minister to the “psychosocial, spiritual, and financial needs” of patients facing debilitating or terminal illnesses.

Backoff, the executive director of Catholic Hospice for Catholic Health Services in Fort Lauderdale, Florida, told CNA that palliative care is meant to address “what the whole patient wants during the treatment of an illness,” whether or not the patient is terminally ill or dealing with a long-term affliction.

Oftentimes a patient suffering from a severe illness has multiple doctors from multiple disciplines, such as neuroscientists and cardiac experts, Backoff pointed out.

“Palliative care has someone bring all that specialty work together so that we don’t forget there’s a person behind the brain, behind the liver, behind the heart,” she said.

Backoff said hospice is a part of palliative care, one that arises at the end of a patient’s life. A significant part of hospice service, she said, involves ensuring that dying patients have medication to alleviate any pain or suffering they may have as death nears.

But, she noted, “all of the services that are applied to the patient, other than clinical, are also applied to the family.”

“How are you going to cope with the death? Is there anticipatory grief? Is there complicated grief pending because there are unresolved family issues?” she said.

Hospice workers “make sure coping mechanisms are appropriate” and that family members are “grieving appropriately instead of dealing with something years down the road.”

Hospice ‘absolutely vital,’ in line with Catholic teaching

Joe Zalot, an ethicist and the director of education at the National Catholic Bioethics Center, said that hospice, when done right, is “very, very important” for both dying patients and families.

“Hospice, when done correctly, is proper accompaniment at the end of life,” Zalot said. “It’s palliating symptoms, it’s providing spiritual care, it’s helping people live the most full possible life that they can given the limitations of their illness. It’s helping them and their family prepare well for death.”

“When done well, it’s absolutely vital and very much in line with Catholic teaching,” he said.

Zalot warned, however, that there are “not-so-good” hospice practices on the market as well.

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“We get calls on our consult line and we hear horror stories, from families and doctors, where people go in and they’re medicated for whatever reason, there’s questions about nutrition and hydration, any number of different things,” he said.

Zalot said the best hospice workers are those who support the family unobtrusively. “If you don’t know what they did, they probably did their job correctly,” he said.

Among the best practices of hospice, he said, are symptom management, relief from pain and nausea, and relief from complications that arise from one’s pain, conditions, or treatments.

“Another essential element is to help family members and support them as they journey with their loved ones,” he said.

“Specifically from a Catholic perspective, a very good-quality hospice is one that provides spiritual care and access to the sacraments, through chaplains,” Zalot noted.

Backoff said their patients are split between home and hospital settings, with the majority in the former. “We have 750 patients, and all but about 120 are at home,” she said. “The rest are in nursing homes or in our hospice facility.”

“The average length of stay for us is about 70 days,” she said. “That’s average for us, and probably it’s fairly consistent around the country.”

(Story continues below)

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Zalot said the Church’s opposition to euthanasia and assisted suicide is because those procedures are quite literally homicide. “You’re killing people,” he said.

“It’s sort of like abortion,” Zalot said. “We have all of these euphemisms — ’reproductive rights,’ et cetera. It’s the same thing with assisted suicide and euthanasia: ‘Death with dignity,’ ‘medical aid in dying.’”

“Euthanasia and assisted suicide are killing people,” he said. “They are actions that kill people. And the Fifth Commandment says that thou shalt not kill. And that’s the bottom line.”

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Paglia on end of life care: The greatest remedy is closeness

By Christopher Wells

The question is not primarily about euthanasia – because when put like that, the issue is ‘too dry, too frigid’. The problem, instead, ‘is how to accompany, how to make this passage as painless as possible and, at the same time, less desperate’.

Archbishop Vincenzo Paglia, speaking with journalists at the headquarters of the Pontifical Academy for Life, reflected at length on the theme of end-of-life care. In a few days, he will leave for North America, travelling first to the United States and later to Toronto, Canada, at the invitation of the local bishops, where he will participate in a symposium on palliative care.

Archbishop Paglia says his main concern and commitment is to provide context for a subject that is sometimes diminished or levelled by legislation. Instead, he maintains, ‘every death is different from every other and therefore should be accompanied in a personal way’.

Read the full interview below:

Archbishop Paglia, how are you preparing for this symposium?

The visit to Canada represents a special moment for me precisely because, in a culture like the western one, the theme of the last stages of life must acquire a relevance that it does not yet have today. There is a risk of producing legislation that basically wants to exclude the problem through laws that are frigid, that tend to unite very different cases, laws that may be somewhat like ‘washing one’s hands’. Instead, I believe it is an issue that we must address very carefully. The term ‘palliative care’ needs to be explained very carefully. If I could use another word, I would say ‘accompaniment’, which removes, for example, the drama of loneliness, which is not a physical pain, but a kind of inner tragedy that must be cured.

Cured in what way?

With closeness, with affection, with interest, with love. The subject of physical pain, then, can be dramatic; and we must fight it. And in my opinion, here we should urge governments to further also the scientific and research aspects of these treatments that accompany the end of life. We should urge the Churches to rediscover the importance of accompaniment for an effective ‘good death’, which for us believers is the passage to life with Jesus.

We should also help all other religions or men of good will, because at that final moment, each of us needs to physically feel closeness. Here, in this sense, it seems important to me that the reflection is not just ‘euthanasia yes [or] euthanasia no’: it is too dry, too frigid. The problem is how to accompany, how to make this transition as painless as possible and, at the same time, less desperate. That is why there is a great challenge ahead of us concerning the very meaning of life.

There is also a path to be charted that looks to the future...

Yes, it is also an important discussion for the generations to come. Reflecting on the end of life means, first of all, understanding this: Is it really the end of life? Quantum philosophy tells us no, because, if anything, we remain energy. Christian Revelation tells us that death is a passage, it is not the end, we could say the end of this earthly life in a certain way, but we know from the Creed that after death human life continues, even if it is resurrected—and unfortunately, this dimension is hardly emphasised in sermons any more, whereas we should rediscover it.

This is why I believe that this reflection around palliative care or the end of life is a huge issue that concerns all the components of society, from medical to scientific and pedagogical, from humanistic to philosophical, theological and psychological.

Pope Francis has said that we must accompany people at the end of life but not provoke death or facilitate assisted suicide. How is this possible?

The Pontifical Academy for Life published a study a few years ago at the end of an international congress on exactly this topic, where we outlined ten points that describe the meaning of palliative care.

Life is a gift and it is a gift that God entrusts to us. So life is also our own, yes, but it is not ours alone. The Lord has given us life with a great gift, for us to multiply it for ourselves and for others. Indeed, if we multiply it for others we will also multiply it for ourselves. That is why Pope Francis also urges us to understand that accompanying each other in this last moment enriches everyone. Even when we cannot heal, we can always provide care, we must always provide. And even when we no longer have the means to block the path of death, which comes for everyone, there is being present. There is no longer acting, but holding hands, there is being present to show that love is stronger than the pain of death, that friendship is stronger even than death, which wants to break ties. What happened on Calvary can in a way be an example of this.

That Jesus had His mother and young disciple at His side was certainly a comfort to Him, and that mother and young disciple heard from the one who was dying: She is your mother and he is your son. It was love that continued. The Resurrection begins there, because the death that wanted to silence Jesus was actually a death that began to generate a new solidarity, a new fraternity. After all, closeness is experienced even at the beginning of life: When a mother gives birth to a child, there are those who welcome him or her, those who cut the umbilical cord, those who care for the child and bring the child up together. So, as together we are born, together we must die.

How can the Church, and the Pontifical Academy for Life in particular, deal constructively with even the most critical views on these issues?

We must continue to reflect and talk to everyone because these perspectives are humanist perspectives. Faith illuminates them, but reason understands them. That is why the Church's task is to try to ‘de-ideologise’ these topics, which are often contaminated precisely by ideologies and not by actual accompaniment. It would only take a little reason to understand that each death is different from the other and should therefore be accompanied in a personal manner. Therefore, each needs its own words, its own gestures, its own presence. And this is what we must make understood. Of course, then there are millions of laws, because if there are no laws, the risk is that a barbarianism will take over.

All this is indispensable, perhaps, but even more indispensable is a culture that unites believers and non-believers, because being born and dying is not a Catholic issue, it is everyone's issue. And so finding an alliance, an understanding that is as broad and as common as possible, is at the very least indispensable, which is why I believe that one of the tasks of the Pontifical Academy for Life is precisely this: to make it credible, to make it reasonable, even that extra gear that we may have on issues that in reality concern everyone, starting precisely from the reasonable dimension.

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Open access
Published: 16 May 2024

Use of the supportive and palliative care indicators tool (SPICT™) for end-of-life discussions: a scoping review

Melanie Mahura 1 ,
Brigitte Karle 2 ,
Louise Sayers 3 ,
Felicity Dick-Smith 3 &
Rosalind Elliott 3 , 4

BMC Palliative Care volume 23 , Article number: 119 ( 2024 ) Cite this article

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In order to mitigate the distress associated with life limiting conditions it is essential for all health professionals not just palliative care specialists to identify people with deteriorating health and unmet palliative care needs and to plan care. The SPICT™ tool was designed to assist with this.

The aim was to examine the impact of the SPICT™ on advance care planning conversations and the extent of its use in advance care planning for adults with chronic life-limiting illness.

In this scoping review records published between 2010 and 2024 reporting the use of the SPICT™, were included unless the study aim was to evaluate the tool for prognostication purposes. Databases searched were EBSCO Medline, PubMed, EBSCO CINAHL, APA Psych Info, ProQuest One Theses and Dissertations Global.

From the search results 26 records were reviewed, including two systematic review, two theses and 22 primary research studies. Much of the research was derived from primary care settings. There was evidence that the SPICT™ assists conversations about advance care planning specifically discussion and documentation of advance care directives, resuscitation plans and preferred place of death. The SPICT™ is available in at least eight languages (many versions have been validated) and used in many countries.

Conclusions

Use of the SPICT™ appears to assist advance care planning. It has yet to be widely used in acute care settings and has had limited use in countries beyond Europe. There is a need for further research to validate the tool in different languages.

Key message

What is already known on this topic?

• The SPICT ™ was developed to assist clinicians to screen patients for palliative care needs.

What this review found.

• The SPICT™ assists conversations about advance care planning and facilitates changes in documented goals of care.

• The SPICT™ is available in at least eight languages (and used in many countries.

How the findings of this review may affect practice and research.

• Evidence suggests that formalising screening for palliative care needs using the SPICT™ is advantageous for advance care planning; clinicians should consider using the SPICT™ to initiate discussions with people with life limiting conditions.

• Further research is required to validate the tool in different languages and extend its use in acute care settings and with other patient cohorts.

Peer Review reports

Introduction

The demand for palliative care services globally has outpaced service availability, particularly in low and middle-income countries [ 1 ]. This is expected to continue as the population ages and the burden of noncommunicable disease increases. Thus, non-specialist palliative care health professionals may be required to manage care. The Supportive And Palliative Care Indicators Tool (SPICT™) [ 2 ] is one instrument available for non-specialist palliative care clinicians which may assist them in assessing unmet palliative needs and care planning.

Evidence suggests that clinicians feel inadequately prepared to conduct end-of-life discussions with patients who are terminally ill [ 3 , 4 , 5 ] and are also unsure of the appropriate time to start these discussions or whether to involve a specialist palliative care team [ 5 , 6 , 7 ]. Clinicians have reported their discomfort when addressing the topic of death with seriously ill patients [ 5 ].

From the perspective of patients with advanced illness, honest information from a trusted health care professional is the preference of most [ 7 ]. A survey study conducted in Canada involving 434 patients with advanced illness found over half of patients felt it was ‘very important’ to have a sense of control over decision-making regarding their care and 56% felt it was ‘extremely important’ not to be kept alive on life support if there was little hope of recovery [ 7 ]. The default medical decision to do everything to save life may be contributing to delays in referral to a specialist palliative care team, burdensome medical treatment and poorer quality of life for many patients [ 8 ]. Thus, a standardised, reliable and validated method of assessing and planning care in collaboration with the patient is required.

The terms ‘end-of-life’ and ‘terminally ill’ have been conceptualised as synonymous and ‘apply to patients with progressive disease with months or less of expected survival.’ [ 9 ]. In the United States there is consensus that referral to specialist palliative care services is required at the time of diagnosis for patients with neurologic disease, frailty, multimorbidity, advanced cancer, organ or cognitive impairment, patients with a high symptom burden and patients with onerous family or caregiver needs [ 10 ]. However with an ageing population and increased levels of dementia and frailty non-palliative care clinicians need a tool with a common language to identify those who are nearing the end of life and to promote a palliative approach to care. According to the High Authority for Health, an independent organisation that promotes quality outcomes in the fields of health, sociology and medicine a palliative approach is, “a way of addressing end-of-life issues early on: make time to talk about ethical questions, psychological support, comfort care, the right care, and give a timely thought to the likely palliative care needs of people approaching the end-of-life.” [ 11 ], p1.

Advance care planning, “a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care” [ 12 ] is one aspect of palliative care often provided by medical professionals which may assist in ensuring people’s needs are met, and care and communication are enhanced. Early advance care planning is vital, particularly for patients with neurodegenerative conditions before they lose capacity to express their wishes [ 8 ] “to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.” [ 12 ] Research has revealed that patients who have had the opportunity to discuss their preferences at the end-of-life are more likely to receive care that is consistent with those preferences. Findings also include greater patient and carer satisfaction and less conflict regarding decision making when end-of-life preferences have been examined [ 13 ].

People who have life limiting conditions may benefit from the delivery of advance care planning using a systematic approach. The SPICT™, although not designed for this purpose may enhance the approach particularly when health professionals who have limited palliative care experience are required to facilitate advance care planning.

The SPICT™ [ 2 ] was designed to identify patients at risk of deteriorating or dying and to screen for unmet palliative care needs. The tool includes general indicators of deterioration and clinical indicators of life-limiting conditions. The accompanying SPICT™ guide provides prompts and tips and a suggested framework (REMAP Ready, Expect, Diagnosis, Matters, Actions and Plan) [ 14 ] for conducting future care planning conversations. The tool is reported to be simple to use and designed for use by all multidisciplinary team members in any care setting [ 13 ].

The SPICT™ was evaluated using a mixed methods participatory approach [ 2 ]. Peer review and consensus was gathered for the 15 revisions of the SPICT™ over an 18-month period. Each iteration of the tool was distributed to clinicians and policy makers internationally until consensus was reached [ 2 ]. The research team worked concurrently with clinicians in four participating units at an acute tertiary hospital in Scotland to screen all patients with advanced organ disease whose admission to hospital was unplanned ( n = 130) using a checklist that included the SPICT™ general indicators, disease specific indicators and the surprise question (SQ), “Would you be surprised if this patient were to die in the next 6 to 12 months?”. Data were gathered over an 8-week period and patients were followed up for 12 months [ 2 ]. A significantly greater number of patients who died at 12-months had two or more admissions in the previous 6 months before being screened. These patients also had increased care needs and persistent symptoms despite optimal treatment. The researchers proposed that better identification, assessment and pre-emptive care planning could reduce the risk of unplanned hospital admission and prolonged inpatient stays [ 2 ]. Of note the patients’ diagnoses were limited to advanced illness which was non-malignant and ethnicity was homogenous [ 2 ]. The SQ was removed from subsequent versions of the SPICT™ and the rationale for removing it remains unclear. The SPICT™ continues to be revised and versions are available in different languages [ 2 ].

The intention of this review was to examine the impact of the SPICT™ on advance care planning and the extent of its use. The patient cohorts, languages, and contexts in which the SPICT™ is available and used were examined.

Review questions

The following primary question was addressed:

How does use of the SPICT™ assist with conversations about advance care planning?

Secondary review questions were:

What is the extent of the use of the SPICT™ (which patient cohorts, contexts, and countries is it used)?

In which languages has the spict™ been validated.

Does use of the SPICT™ facilitate changes in documented goals of care?

Design and methods

This scoping review was performed in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis Scoping Review Framework [ 15 ] and the Meta-Analyses Scoping Review extension for scoping reviews (PRISMA-ScR) checklist [ 16 ] was used to guide the reporting.

Preliminary literature search

An initial search focussed on inpatients with a chronic illness nearing the end of life however the search was expanded to include all care settings where the SPICT™ was being used for adults with a life-limiting chronic illness to evaluate its efficacy in advance care planning. Thus the search reflected the International Association for Hospice and Palliative Care definition of palliative care “the active holistic care of individuals across all ages with serious health-related suffering due to severe illness, and especially of those near the end of life.” [ 17 ]. A life-limiting illness or condition encompasses both malignant and non-malignant diseases as well as the effects of ageing.

A preliminary search of EBSCO Medline, the Cochrane database of systematic reviews, Prospero and JBI Evidence Synthesis was conducted in June 2022. No current or planned systematic or scoping reviews specifically on this topic were identified. A systematic review by Teike Luthi, et al. [ 18 ], examining instruments for the identification of patients in need of palliative care in the hospital setting was identified. The current scoping review differs from the systematic review by Teike Luthi, et al. [ 18 ] as the aim was to identify and describe all research related to how the SPICT™ is used in end-of-life discussions and what influence this has on advance care planning and goals of care.

Inclusion criteria

Participants.

The population of interest was adult patients (> 18 years) with a life-limiting chronic illness.

The concept of interest was the SPICT™. Any studies incorporating the SPICT™ were included in this review since its development in 2010. Studies evaluating the SPICT™ for prognostication purposes were excluded as this was not the intent of this review.

Published and unpublished studies in any language for which a translation could be obtained were included. Published and unpublished studies in any setting that met the eligibility criteria were included.

Evidence sources

This scoping review included both experimental and quasi-experimental study designs. In addition, analytical observational studies including prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies were considered for inclusion. Systematic reviews that met the inclusion criteria were included. Qualitative studies, theses and dissertations were also considered if they met the inclusion criteria.

Search strategy

An initial search on this topic in the EBSCO Medline and PubMed databases was reviewed for relevant abstracts and titles to determine keywords and index terms. MESH terms used in the final search strategy included: Communication; Documentation; Palliative Care; Patient Care Planning; Advance Care Plan; Decision Making and Chronic Disease. The research abstract for this scoping review was registered on the Center for Open Science website ( https://doi.org/10.17605/OSF.IO/DN27C ) in August 2022 prior to performing the definitive search in September. The search was conducted on 28th September 2022 and date limited i.e., 2010-September 2022. The database and grey literature searches were updated on 27th January 2024 to identify further studies published beyond this date.

Electronic databases searched included EBSCO Medline, PubMed, EBSCO CINAHL, APA Psych Info, ProQuest One Theses and Dissertations Global. Publications listed on the SPICT website ( www.spict.org.uk ) were cross checked with the records included from the electronic databases, duplicates were removed and further records were added to the Endnote library for screening. Reference lists of included studies were reviewed for additional studies.

All websites searched for additional records (grey literature sources) are included in supplementary file 1 . The expanded search strategy for the EBSCO Medline database is also provided in supplementary file 1 .

Study selection

All records were collated in an EndNote library. Duplicate records were removed manually by RE. The screening process involved two independent reviewers (MM and RE) reading titles and abstracts. Full text screening was conducted independently by the same two reviewers. Any discrepancies between the two reviewers at each stage of the process was resolved following review and consultation of a third reviewer (BK). Studies that did not meet the inclusion criteria were excluded with a reason recorded. Data extracted from included studies has been recorded in the standardised data extraction form (supplementary file 2 ). Critical appraisal of included studies was not performed and thus studies were not excluded based on methodological quality.

Data synthesis

Key aspects of the included studies were summarised in tables. Also consistent with the approach for a scoping review a textual narrative synthesis [ 19 ] was performed with the primary aim of addressing the review questions.

Over 2,000 records were retrieved. Five guidelines and six conference abstracts were found but these either did not relate to the review questions or did not contain sufficient information to be included. After applying the exclusion criteria 26 reports were included in this scoping review. The flow diagram (Fig. 1 ) presents the number of records retrieved, screened, excluded and included.

Flow diagram of number of records retrieved, screened, excluded and included **Abstract and title screening involved assessing each record for relevance to the review questions i.e., if no mention of the SPICT™ or/and advance planning conversation the record was excluded from further consideration

There were multiple study designs including validation and translation ( n = 8) studies [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] and clinical improvement projects ( n = 3) [ 28 , 29 , 30 ]. The focus of the clinical improvement projects was to increase the identification of palliative care needs and care planning through the use of the SPICT™. Two reviews (one of these included a survey study) 18 31 and two theses were included 28 29 (Table 1 ).

Research reveals that the SPICT™ appears to assist clinicians with conversations about advance care planning by providing a proforma for essential aspects of end-of-life care, a framework for end-of-life conversations and a common language to collaborate within the multidisciplinary team.

For example, in a prospective exploratory feasibility study to explore the practical use of the SPICT™ resulted in increased palliative care planning [ 32 ]. In this study general practitioners (GPs) [ n = 10] were trained in the use of the German version of the SPICT™ (SPICT-DE™) and during a two-month intervention period were asked to use the tool with any adult patients diagnosed with a life-limiting disease ( n = 79) and these patients were followed up at 6 months. The GPs’ actions as recommended by the SPICT-DE™ were considered appropriate with the most frequent actions being “Agree a current and future care plan with the person and their family; support family carers” ( n = 59 [75%)),“Review current treatment and medication to ensure the person receives optimal care; minimise polypharmacy”( n = 53 [67%]), and “Plan ahead early if loss of decision-making capacity is likely”(n = 49 [62%]). Of note “Consider referral for specialist palliative care consultation to manage complex symptoms” was considered appropriate for 25 (32%) patients. The effect of the SPICT™ was evident at the 6-month follow-up; the most frequently initiated actions were “Review current treatment and medication to ensure the person receives optimal care; minimise polypharmacy” (n = 36 [46%]) and “Plan ahead early if loss of decision-making capacity is likely” (n = 29 [37%]).

Further implementation research by Afshar et al. [ 33 ] with GPs in Germany revealed that GPs considered that the tool supported the communication and coordination of care and considered it broadened their perspectives of the meeting the needs of people especially those with non-cancer diagnoses. Of note over 50% of patients in this study had their agreed care plan initiated at the 6-month follow-up. Some GPs who had extensive experience and training claimed that the tool had no effect on their practice. However overall more than two thirds of the sample reported that they could envisage using the SPICT-DE™ in everyday practice.

In addition, three studies found that nurses who were trained to use the SPICT™ increased their self-efficacy in identifying patients who may be nearing the end of life and promoted an advance care plan discussion with these patients 28 29 34 . 21−23 In the study set in a renal ward, patients were screened on admission to identify those nearing the end of life by nurses using the SPICT™ [ 34 ]. An alert was added to the ward patient name list when a patient was identified as nearing the end of life (‘SPICT™ positive’) which prompted a review by the physician and multidisciplinary team. In this study 16% (25/152) of newly admitted patients were screened as ‘SPICT™ positive’; all of these patients received a palliative care consult and were discharged with an advance care directive including a resuscitation plan [ 34 ]. Incidentally nurses reported a significant increase in their ability to identify patients approaching end of life.

Similarly high SPICT™ screening rates and end of life conversations and referrals were revealed in a clinical improvement project designed to improve palliative care screening and consultation on admission to the cardiopulmonary unit of a long-term acute care facility using the SPICT™ [ 29 ]. In this project involving patients requiring mechanical ventilation and cardiac monitoring, 83% (59/71) of nurses working in the unit were trained in the use of the tool and screened all 50 newly admitted patients in the study period, 48 of whom were ‘SPICT™ positive’. Only 7 received a palliative care consultation within a week of admission however all 7 of these patients received a resuscitation plan and an advanced directive. Of note the use of the SPICT™ for screening resulted in a doubling of the facility’s monthly average number of palliative care referrals (from 32 to 84). In another clinical improvement project designed to increase screening and referral for palliative care among ambulatory care patients, nurse practitioners found the SPICT™ ‘. opens the door to a discussion of palliation .’ and was ‘. helpful in determining eligibility for palliative care. .’ p 22 28 . This project using both quantitative and qualitative approaches revealed an increase in palliative care referrals from 16% ( n = 8/50) to 50% ( n = 25/50) after the SPICT™ was introduced.

Two studies designed to translate and validate the SPICT-DK™ (Danish) [ 21 ] and SPICT-SE™ (Swedish) [ 24 ] involving focus groups with health care professionals revealed positive responses from doctors and nurses. The tool was described as a linguistic framework among these professionals and that use of the SPICT™ gave them a common language in which to collaborate and focus when treating and caring for patients [ 21 ]. The specificity of the tool was highlighted by nurses and medical doctors [ 24 ].

Conversely the expert committee comprising family physicians and palliative and home care specialists who provided input to the translation and cross-cultural adaptation of the SPICT™ into Japanese were more circumspect [ 27 ]. These experts were concerned that the tool might not be appropriate for framing advance planning conversations as a ‘not-telling the truth’ culture was prevalent and health care was heavily siloed into specialities so that care planning was fragmented.

The SPICT™ has been used to screen for palliative care needs in many patient cohorts, settings and countries. The cohorts in which the SPICT™ has been used include people over 65 years [ 35 ], those with advanced cancer 32 36 and with chronic diseases including cardiovascular disease [ 28 ], renal disease [ 34 ] and pulmonary disease [ 29 ].

Ten of the included studies were conducted in primary care and general practice settings 20 , 21 , 22 24 25 30 , 31 , 32 37 38 . The SPICT™ was also used in outpatient clinic settings 23 28 39 and residential aged care 29 35 . One cross sectional survey of community households in India used the SPICT™ to identify patients with palliative care needs in two rural communities [ 40 ]. The SPICT™ was originally developed for use in a hospital setting but not formally validated during its development [ 2 ]. All of the contexts in which the SPICT™ has been used are listed in Table 1 .

Of the included records ten were studies conducted in European countries 20 , 21 , 22 24 30 , 31 , 32 , 33 37 38 ; seven in Asia 23 25 27 39 , 40 , 41 , 42 ; three in the USA 28 29 36 ; two in Australia 34 35 ; one in South Africa [ 43 ] one in Chile [ 26 ] and one in Peru [ 44 ], and one paper was a review performed by authors based in Switzerland [ 18 ]. Of note the systematic review and survey of European primary care GP practice to identify patients for palliative care revealed that the United Kingdom was the only European country at the time that incorporated the SPICT™ to identify palliative care needs in primary and secondary care in clinical guidelines [ 31 ].

The SPICT ™ has been translated, cross culturally adapted and validated to identify patients with palliative care needs in Danish [ 21 ] and German [ 38 ] using the Translation, Review, Adjudication, Pre-testing and Documentation (TRAPD) model. Another study by Afshar, et al. [ 32 ] further established the validity of the SPICT-DE ™ in German in general practice with a patient cohort. In addition the SPICT ™ has been translated from English to Italian [SPICT-IT ™ ] [ 22 ], Spanish [SPICT-ES ™ ] [ 20 ], Swedish [ 24 ] and Japanese [SPICT-J ™ ] [ 23 ] using the Beaton protocol for cross cultural adaptation of health measures [ 45 ]. Farfán-Zuñiga and Zimmerman-Vildoso [ 26 ] established the reliability and validity of the SPICT-ES CHTM after culturally adapting the SPICT-ES ™ using the Beaton protocol. Nurses positively evaluated the feasibility of the tool. In addition Oishi et al. [ 27 ] also performed a translation and cross-cultural adaptation of the SPICT ™ into Japanese using a similar approach. The forward-back translated Indonesian version of the tool was found to be highly reliable and valid and greatly assisted in identifying hospital patients’ unmet palliative care needs [ 41 ].

The SPICT™ for low-income settings (LIS) was translated and cross culturally adapted for use in Thailand [ 25 ]. The interrater reliability of the final SPICT-LIS™ Thai version was high when nurses and GPs used it to ascertain palliative care needs of patients in case vignettes.

A Delphi study was used to develop the SPICT™ for the South African context [ 43 ]. Modifications to the original tool included the addition of haematological and infectious diseases and trauma however the SPICT-SA™ has yet to be validated in these patient cohorts. Although not a validated study per se in research comparing the performance of the Dutch version of the tool (SPICT-NL™) and the SQ in general practice ( n = 3,640) the SPICT™ was found to be superior to the SQ in identifying patients with palliative care needs particularly younger people [ 37 ].

Of note the SPICT4-ALL™ [ 46 ] is a simplified version of the original SPICT™ developed for family/friends and care staff to identify individual palliative care needs. It is available to download from the SPICT™ website in English, German, Danish and Spanish. Although Sudhakaran, et al. [ 40 ] successfully used it to identify palliative care needs in two communities in rural India. No studies validating or evaluating it were found in our search.

Does use of the SPICT ™ facilitate changes in documented goals of care?

There is evidence that the SPICT™ by virtue of assisting clinicians to discuss end of life care facilitates changes in documented goals of care. Specifically this was demonstrated in a pre-post intervention study in which GPs trained in palliative care and the use of the SPICT-DE™ were requested to use it in their everyday practice for 12 months with every adult patient diagnosed with a chronic, progressive disease [ 30 ]. This occurred concurrently with a public campaign focused on informing health care providers and stake holders in two counties in Germany about end-of-life care. GPs’ documentation improved after the intervention. Records of care planning increased from 33 to 51% and documentation of preferred place of death towards the end-of-life increased from 20 to 33% and patients’ wishes, and spiritual beliefs increased from 18 to 27%. Incidentally GPs’ self-reported quality of end-of-life care increased after the implementation of the SPICT-DE™ and the information campaign [ 30 ].

In a study including 187 residents in an aged care facility in Australia comparing the SPICT™ and SQ, two Directors of Nursing pre-screened residents using the SQ and if the response was ‘yes’ (SQ+) applied the SPICT™ [ 35 ]. Of the 80 (43%) residents who were SQ+, 100% of these showed signs of nearing end of life according to the SPICT™. Of these residents 39 (49%) had some form of palliative care from either GPs, a specialist palliative care physician or palliative care nurse. Nearly all 39 (97%) had a GP management plan, and 67% had an advance care directive and 67% had discussed treatment options with their care provider [ 29 ]. It is unclear whether the SPICT™ affected care planning or documentation as the study involved pre-screening with the SQ and documentation was not assessed before and after this intervention.

Death and dying are taboo in many countries and thus any discussion about end of life is challenging. However, clinicians are morally and ethically obliged to appropriately initiate discussions about advance care planning towards the end of life when patients are ready [ 47 ]. This review found that the SPICT™ may help the clinician with this conversation. Specifically, evidence suggests that the tool may be a useful proforma and a conversation ‘checklist’ to ensure that the priority areas for advance care planning are addressed. Specifically, the tool may enable an assessment of the person’s readiness to have an advance planning conversation and an exploration of their expectations, the diagnosis, what matters to them, treatment options and future plans [ 14 ]. Importantly extensive specialist training is not required to administer it; the studies in this review employed brief information interventions to prepare clinicians to use the SPICT™. Thus, the SPICT™ provides a method of ‘objectively’ assessing palliative care needs, articulating the requirement for a specialist palliative review if required and advance care planning.

This review found that the SPICT™ was used in mainly primary health care settings and predominately in European countries. Of note there were few published records of its use in countries in the Asian and African continents and North America. The tool has been translated into more than eight languages including Spanish (SPICT-ES™) [ 20 ], Italian (SPICT-IT™) [ 22 ], German (SPICT-DE™) [ 38 ] and Japanese (SPICT-J™) [ 23 ] although not all versions have been formally validated [ 25 , 26 , 27 , 33 ].

Furthermore, there is evidence to suggest that the SPICT™ may facilitate changes in the goals of care and documentation of end of life care planning and patient wishes. Incidentally the SPICT™ appears to be positively received by clinicians with some suggesting that the tool provides a common language for clinicians when collaborating to identify palliative care needs and provide palliative care.

Of note the tool did not meet the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria [ 18 ]. However arguably these criteria may not be the most appropriate criteria on which to base an assessment of the SPICT™ given that it was never meant to be used to objectively measure a parameter such as prognosis; Highet et al. [ 2 ] were clear about the remit of the tool i.e., “help clinicians working in primary and secondary care recognise when their patients might be at risk of dying and likely to benefit from supportive and palliative care in parallel with appropriate ongoing management of their advanced conditions.” [ 2 ], p11.

There is an imperative to improve recognition of palliative care needs particularly in fast paced acute care settings. Evidence suggests that a tool such as the SPICT™ is an important adjunct for initiating a conversation about end-of-life care and ensuring that key palliative care needs are identified. Importantly the SPICT™ requires little training and its brevity may be suited to settings in which there is limited opportunity to engage in lengthy conversations and in which clear unambiguous communication is key to timely referral and treatment. Formalising palliative care needs screening in an end-of-life conversation in acute care settings may reduce distress for patients and their informal care givers [ 48 ] and the SPICT™ is a relevant proforma for such a conversation. Furthermore with the increase in the numbers of people living with chronic illness globally [ 49 ] arguably the formal adoption of palliative care needs screening in all health care settings may not only reduce patient distress but may assist health care managers and policy makers to more appropriately plan services [ 50 ]. Identifying needs early in the illness trajectory may allow appropriate personalised care and services to be provided in a timely and cost effective manner thus avoiding health crises at the end of life [ 51 ].

Conversely caution should be exercised when recommending a tool to guide advance care planning and end of life conversations particularly in the setting of low health professional skill level. This was highlighted by experienced GP participants in the study by Afshar et al. [ 33 ]. The GPs did not consider that the SPICT-DE™ made any impact on their practice. A proforma or guideline cannot replace the need for exemplary health care professional communication during advance care planning and end of life conversations particularly as studies reporting the use of the SPICT™ were not specifically focused on testing its efficacy in this regard. Flexibility and sensitivity are required to assess and manage people with life limiting conditions to ensure care is individualised. Thus, a sufficiently trained and resourced workforce is vital in addition to aids such as the SPICT™.

In addition, although not the focus of this review we noticed that there was an apparent lack of attention paid to input from the family and consideration of the family context in the included studies. In practice the advance care planning conversation goes beyond using the family to identify palliative care needs and the requirement for referral. The conversation should include addressing family members’ concerns and emotions and facilitate communication between the person who is the focus of advance care planning and their family members [ 52 ].

There are translations of the English version of the SPICT™ available to download from the SPICT™ website for a number of countries including; Brazil, France, Greece, Portugal and South Africa. However, studies reporting the use of many versions of the SPICT™ indicates that formal validation has not been performed. Further validation may strengthen the efficacy and reputation of these versions of the tool. Further studies are required to establish the validity of translated versions of the SPICT™ in Swedish, Danish, Indonesian and the SPICT-LIS™ (Thai), for everyday use in other patient cohorts.

The SPICT™ has scope to be tested in other patient cohorts. Specifically more work is required to extend and test its use in acute care settings where the demand for palliative care is rising and appropriate timely referrals to specialist palliative care are vital to avoid unnecessary distress [ 51 ]. Similarly, there are research opportunities such as reliability and validity testing in relation to the SPICT-4ALL™ version which has been specifically designed to be used by family and informal carers.

Strengths and limitations

This review has strengths which warrant consideration. For example, a systematic approach based on the PRISMA-SCr methodological framework was used, and the search was extensive including 5 electronic databases and many sources of grey literature. A limitation of this review is that we were unable to access a healthcare librarian to assist with the search thus important records may have been missed. In addition, we did not have funding to arrange the translation of two studies which were identified as potentially eligible. Studies included in this scoping review were not appraised for bias thus the level of evidence for the effectiveness of the SPICT™ was not reported. Of note most studies were descriptive and thus evidence for the effectiveness in relation to review question 1 (how does the tool assist with conversations about advance care planning?) is not available.

The current scoping review aimed to assess the impact and extent of the use of the SPICT™. In summary the SPICT™ appears to enable advance care planning, review of care plans and initiation of palliative care in many settings. Previous research suggests that patients and their families greatly appreciate the opportunity to discuss end of life matters. The SPICT™ provides clinicians a proforma on which to base this conversation and a common language to collaborate for palliative care. Clinicians with advance care planning and end of life communication in all settings should consider using the SPICT™ for this purpose. Future research should focus on further validating the SPICT™ in more patient cohorts and acute care settings. Further testing of the tool beyond Europe in countries in Africa, Asia and North America is also warranted.

Data availability

Not applicable.

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We declare that this paper has not been published elsewhere and we have not submitted the paper to any other journal at the time of this submission. In addition, we Rosalind Elliott (RE), Melanie Mahura (MM), Brigitte Karle (BK), Felicity Dick-Smith (F D-S) and Louise Sayers (LS), declare that we have no known conflicts of interest in relation to the review or manuscript.All authors contributed to the research and reporting. MM lead the protocol design with input from all authors (RE, BK, FD-S and LS) and the search. MM and RE screened the search records with BK and LS acting as arbitrator. MM and BK extracted the data. Synthesis and interpretation were performed mainly by MM and BK with input from all authors. The writing was lead by MM with contributions from all authors (RE, BK, FD-S and LS). RE provided mentorship and thoroughly edited the final version. All authors (MM, RE, BK, FD-S and LS) reviewed the final version and gave their final approval for submission of the paper.

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Mahura, M., Karle, B., Sayers, L. et al. Use of the supportive and palliative care indicators tool (SPICT™) for end-of-life discussions: a scoping review. BMC Palliat Care 23 , 119 (2024). https://doi.org/10.1186/s12904-024-01445-z

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Systemic Anticancer Therapy and Overall Survival in Patients With Very Advanced Solid Tumors

1 Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
2 Flatiron Health, New York, New York
3 Department of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts
4 Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles
5 The University of Texas MD Anderson Cancer Center, Houston

Question Is oncologic treatment of very advanced disease associated with improved survival?

Findings In this cohort study of 78 446 adult patients from a nationwide database of patients with 6 common metastatic solid tumors, there was no statistically significant survival benefit for patients treated at practices that used more systemic therapy for very advanced cancer compared with patients treated at practices that used less.

Meaning In seeing no improvements in survival among practices with highest rates of treatment for very advanced disease, oncologists may hesitate before offering additional therapy and focus on open and honest communication about prognosis, allowing patients to make informed decisions.

Importance Two prominent organizations, the American Society of Clinical Oncology and the National Quality Forum (NQF), have developed a cancer quality metric aimed at reducing systemic anticancer therapy administration at the end of life. This metric, NQF 0210 (patients receiving chemotherapy in the last 14 days of life), has been critiqued for focusing only on care for decedents and not including the broader population of patients who may benefit from treatment.

Objective To evaluate whether the overall population of patients with metastatic cancer receiving care at practices with higher rates of oncologic therapy for very advanced disease experience longer survival.

Design, Setting, and Participants This nationwide population-based cohort study used Flatiron Health, a deidentified electronic health record database of patients diagnosed with metastatic or advanced disease, to identify adult patients (aged ≥18 years) with 1 of 6 common cancers (breast cancer, colorectal cancer, non–small cell lung cancer [NSCLC], pancreatic cancer, renal cell carcinoma, and urothelial cancer) treated at health care practices from 2015 to 2019. Practices were stratified into quintiles based on retrospectively measured rates of NQF 0210, and overall survival was compared by disease type among all patients treated in each practice quintile from time of metastatic diagnosis using multivariable Cox proportional hazard models with a Bonferroni correction for multiple comparisons. Data were analyzed from July 2021 to July 2023.

Exposure Practice-level NQF 0210 quintiles.

Main Outcome and Measure Overall survival.

Results Of 78 446 patients (mean [SD] age, 67.3 [11.1] years; 52.2% female) across 144 practices, the most common cancer types were NSCLC (34 201 patients [43.6%]) and colorectal cancer (15 804 patients [20.1%]). Practice-level NQF 0210 rates varied from 10.9% (quintile 1) to 32.3% (quintile 5) for NSCLC and 6.8% (quintile 1) to 28.4% (quintile 5) for colorectal cancer. No statistically significant differences in survival were observed between patients treated at the highest and the lowest NQF 0210 quintiles. Compared with patients seen at practices in the lowest NQF 0210 quintiles, the hazard ratio for death among patients seen at the highest quintiles varied from 0.74 (95% CI, 0.55-0.99) for those with renal cell carcinoma to 1.41 (95% CI, 0.98-2.02) for those with urothelial cancer. These differences were not statistically significant after applying the Bonferroni-adjusted critical P = .008.

Conclusions and Relevance In this cohort study, patients with metastatic or advanced cancer treated at practices with higher NQF 0210 rates did not have improved survival. Future efforts should focus on helping oncologists identify when additional therapy is futile, developing goals of care communication skills, and aligning payment incentives with improved end-of-life care.

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End Of Life Care. This document discusses palliative care and end-of-life care. It addresses how palliative care aims to improve quality of life for patients facing life-threatening illnesses through pain management and treatment of physical, psychosocial and spiritual problems. The document also discusses communicating with patients about end ...
end of life care
end of life care. Mar 27, 2023 • Download as PPTX, PDF •. 1 like • 149 views. V. vaibhavpaul9. End of life care in detail , with terminologies used in end of life care, theories of grief including kubber ross theory and other , Grief management ,hospice care, care of body after death. Read more.
End of Life Care: An Overview
Presentation Transcript. End of Life Care: An Overview. Objectives • Address issues surrounding end-of-life care and vulnerable older adults - definition of palliative care - logistics of end-of life-care - surrogate decision making and advance directives - symptom management • ACOVE indicators and EOL care.
PALLIATIVE CARE
Palliative care: is for people with life limiting and serious conditions. addresses physical, emotional, spiritual and psychosocial distress is usually provided by a team of doctors, nurses, and social workers, and sometimes includes physical therapists, nutritionists, chaplains, or other professionals. seeks to improve quality of life for the ...
PDF Symptom Management at the End of Life
FIVE Components of Quality End-of-Life Care 1) Adequate pain and symptom management 2) Avoiding inappropriate prolongation of dying 3) Achieving a sense of control 4) Relieving burden 5) Strengthening relationships with loved ones Singer P.A., Martin D.K., Kelner M., Quality End-of-Life Care: Patient's Perspectives, JAMA 1999 281(2) 163-168
Teaching Materials
Teaching Materials. All the teaching materials you will need for each of the Primary Palliative Care Education Modules can be found here. Each module contains: A powerpoint to structure your teaching with brief teaching notes, a high-level Facilitator Guide, and any additional resources (e.g. videos and handouts) you will need. Please remember:
What Are Palliative Care and Hospice Care?
Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson's disease, and many others. Palliative care can be helpful at any stage of illness and is best provided soon after a person is diagnosed. In addition to improving quality of life and ...
Palliative Cares Breakthrough
Palliative Cares Breakthrough Presentation. Free Google Slides theme, PowerPoint template, and Canva presentation template. Palliative care aims to improve the quality of life of people with a serious illness. It is not only important to address the symptoms of the specific disease, but also the social or emotional problems that can result from ...
Palliative & End-of-Life Care
End-of-life care generally refers to patient care before death, either while undergoing curative treatment or after deciding to focus on comfort rather than cure. With some serious illnesses, prognosis is uncertain and it is unclear if the care provided is end-of-life or life sustaining. When patients have a prognosis of six months or less ...
Providing Care and Comfort at the End of Life
End-of-life care is the term used to describe the support and medical care given during the time surrounding death. This type of care does not happen only in the moments before breathing ceases and the heart stops beating. Older people often live with one or more chronic illness and need significant care for days, weeks, and even months before ...
Nursing Management: End-of-life Palliative care, Comfort Care, Hospice
Palliative Care. Life expectancy of six months or less Patients no longer seeking cure or life-prolonging treatments Comfort care at end of life Provides a palliative approach to care. (Hospice, n.d.) As a person enters the final stage of the dying process, the body begins the final process of shutting down, which will end when all the physical ...
Hospice and palliative care
Hospice and palliative care. Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life. Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. Read these articles to learn more about these two types of care.
Palliative Care Center
Palliative Care Center Presentation. Free Google Slides theme, PowerPoint template, and Canva presentation template. Palliative care centers provide a special kind of treatment to people whose illnesses can no longer be treated and they work together closely to provide the patients with the best solutions in order to make their life the most ...
End of Life Care PowerPoint Presentation PPT
Deliver and interpret technical information without hiding behind medical terminology. Realize the best time for the patient to talk may be at the least convenient time for you. Be fully present during all communication. Allow the patient and family to set the agenda regarding the depth of the conversation. Slide 10. Communication.
PDF Overview of Lancaster County and Hospice Services
Hospice Philosophy of Care: Based on the belief that everyone has the right to die pain-free and with dignity. Based on quality, compassionate care. For people facing a serious, life-limiting illness or injury. Affirms life and focuses on quality of life. Neither hastens nor postpones death.
PPT
Bereavement support helps the family cope and start afresh. End-of-life care is about never stopping to care, even when we cannot cure. The care with which we treat the dying affirms that our humanity is living. For more information, please [email protected] [email protected] Read the Joint Position Statement and Guidelines.
PPT
End-of-life care:Palliative care Abid Iraqi, M.DGeriatric & Palliative MedicineSyracuse VA. The opinions expressed are those of the presenter and do not necessarily represent the opinion/position of Veterans Affairs.. What is End of Life Care • Preaching to choir— Managing patients toward the end of their life. Why End of Life Care is important • The majority of deaths occur in elderly ...
Our Presentations
End of Life Washington provides presentations for health care professionals, hospice staff and providers, undergraduate and graduate students (including medical, nursing, social work and other healthcare provider programs), caregivers, and support groups. Presentations can be customized to fit your group's needs and are suitable for the ...
Palliative care: A look at 'absolutely vital' end-of-life support
Backoff said hospice is a part of palliative care, one that arises at the end of a patient's life. A significant part of hospice service, she said, involves ensuring that dying patients have ...
20 Best End Of Life Care-Themed Templates
Below you'll see thumbnail sized previews of the title slides of a few of our 20 best end of life care templates for PowerPoint and Google Slides. The text you'll see in in those slides is just example text. The end of life care-related image or video you'll see in the background of each title slide is designed to help you set the stage ...
Integration of primary care and palliative care services to improve
Population need for community palliative and end of life care is rising, with aging, frailty, rising health-related suffering and increasing numbers of people dying at home. 1,2 Access to good community palliative and end of life care is inconsistent and there are longstanding inequalities (unfair and avoidable differences) in access to specialist palliative care services for people with non ...
Paglia on end of life care: The greatest remedy is closeness
Paglia on end of life care: The greatest remedy is closeness. The president of the Pontifical Academy for Life speaks with journalists ahead of his 17-23 May journey, first to the United States for a series of engagements, and then to Toronto, Canada, to attend an international symposium on palliative care. By Christopher Wells.
Use of the supportive and palliative care indicators tool (SPICT™) for
According to the High Authority for Health, an independent organisation that promotes quality outcomes in the fields of health, sociology and medicine a palliative approach is, "a way of addressing end-of-life issues early on: make time to talk about ethical questions, psychological support, comfort care, the right care, and give a timely ...
Systemic Anticancer Therapy and Overall Survival in Patients With Very
Use of systemic anticancer therapy (SACT) at the end of life (EOL) is associated with higher rates of hospitalization, intensive care unit use, later transition to hospice, worse quality of life, and higher cost. 1-4 Accordingly, the American Society of Clinical Oncology (ASCO) and the National Quality Forum (NQF) endorsed a quality metric, NQF ...
End of Life Outcomes Following Comfort Care Orders: A Single Center
Background: Few studies have explored the outcomes of patients placed on comfort care with respect to hospice disposition. The objective of this study was to perform a retrospective analysis of patients who transitioned to comfort care. Methods: We conducted a retrospective study of patients placed on the comfort care order set between July 1st, 2021, until June 30th, 2022.
Hospice and palliative care: A look at 'absolutely vital' end-of-life
[ May 19, 2024 ] Over 1,000 attend Washington, D.C. Eucharistic procession despite rain News Briefs [ May 19, 2024 ] What is the Holy Spirit like?
End of life care
Download now. 1. End of life care Presented by Pankaj Nurse Practitioner 2nd yr Moderator Dr. sushant Khanduri Associate professor. 2. END OF LIFE CARE Palliative Care Making life as easy as possible for patients and families living with serious illness Hospice care hospice care is given when there is life expectancy of 6 month or less. 3.
Working at The Y (YMCA)
Chicago, IL. 10000+ Employees. 30 Locations. Type: Nonprofit Organization. Founded in 1885. Revenue: $25 to $100 million (USD) Civic & Social Services. Competitors: Big Brothers Big Sisters of America, Girls Inc, Special Olympics Create Comparison. The YMCA was established over 160 years ago as a charity dedicated to the health of both ...

Palliative & End-of-Life Care

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Palliative Care and Moral Distress: An institutional Survey of Critical Care Nurses

A Passion for Palliative Care

Palliative Care in the ICU

Providing Primary Palliative Care in the ICU

Palliative Care in the ICU: Communication Skills in Practice

AACN Position Statement: Ethical Triage and End-of-Life Care

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Nursing Management: End-of-life Palliative care, Comfort Care, Hospice

Presentation on theme: "Nursing Management: End-of-life Palliative care, Comfort Care, Hospice"— Presentation transcript:

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Hospice and palliative care: A look at ‘absolutely vital’ end-of-life support

What is palliative care? What about hospice?

Hospice ‘absolutely vital,’ in line with Catholic teaching

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Use of the supportive and palliative care indicators tool (SPICT™) for end-of-life discussions: a scoping review

Conclusions

Key message

Introduction

Review questions

How does use of the SPICT™ assist with conversations about advance care planning?

What is the extent of the use of the SPICT™ (which patient cohorts, contexts, and countries is it used)?

Design and methods

Preliminary literature search

Inclusion criteria

Evidence sources

Search strategy

Study selection

Data synthesis

Does use of the SPICT ™ facilitate changes in documented goals of care?