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Advanced care planning (ACP) involves the discussion of preferences relevant to a possible future time when one’s ability to make decisions may be compromised. ACP is considered as having potential to enhance choice and control and thereby to improve the experience of care for people with dementia and their carers. Care coordinators have been highlighted as possibly playing a central role in facilitating these discussions among people with long-term care needs. However, there is limited evidence of how ACP is facilitated by community mental health professionals who may be supporting people with dementia and carers. The paper aims to discuss this issue.

This exploratory study took the form of qualitative semi-structured interviews to explore the views and experiences of community mental health professionals when discussing ACP with people with dementia and/or their carers. A convenience sample of 14 participants working in community mental health services in one NHS Mental Health Trust in London, England, was recruited and interview data were analysed using a framework approach.

Five themes emerged from the interviews – knowledge and experience, use of ACP, inhibitors of discussion, service influences and the future. The depth of ACP facilitation appeared dependent on the knowledge, confidence and skills of the individual professional. Limited resources leading to service rationing were cited as a major barrier to ACP engagement. Helping people with dementia and their carers with ACP was not viewed as a priority in the face of competing and increasing demands. A further organisational barrier was whether ACP was viewed by service managers as “core business”. Findings indicate that practice was generally to refer people with dementia to other agencies for ACP discussions. However, pockets of ACP practice were reported, such as explaining proxy decision making options for finances.

This exploratory study took place in the community mental health services in one NHS Mental Health Trust that may not be representative of other such teams. Case records were not scrutinised or clinical conversations with people with dementia or carers.

Barriers to initiating ACP discussions were cited, such as limited resources, lack of time and knowledge; unclear role remit, uncertain service direction and poor documentation sharing processes. However, participants held a common belief that ACP for people with dementia is potentially important and were interested in training, a greater team focus on ACP and pathway development. This indicates the potential for staff development and continuing professional development.

Few studies have asked a wide range of members of community mental health services about their knowledge, skills and confidence in ACP and this study suggests the value of taking a team-wide approach rather than uni-professional initiatives.

Care planning is important in the provision of good‐quality care and serves a variety of functions, including acting as a communication tool. An accessible format for care plans is therefore important. The National Minimum Care Standards in England now require that all residents in care homes have a service user plan. This study examined the format and content of 117 blank care plan documents used in Manchester and Cheshire care homes in 2001/02. Sixty‐eight per cent of homes used a problem‐orientated care plan document, 25% used a problem‐orientated care plan with assessment domains defined, 15% used standard care plans and five per cent used daily care plans. Although the government has stressed the importance of involving the user in the care planning process, only 16% of homes had a care plan that specifically asked for a resident's signature or agreement. There were also differences in content of care plans by home type, which may reflect the professional background and training of staff in nursing homes. The variety in types and format of care plans suggests that the interpretation and recording of care planning may not be uniform across homes and there is a need for further detailed work in this area using interviews or observational approaches.

The Model for Dementia Palliative Care Project will develop a service-delivery model for community-based dementia palliative care. Many countries provide dementia palliative care services, albeit with considerable variability within these. However, little is known about what service providers consider to be the most important components of a dementia palliative care model. This study aimed to address this knowledge gap.

An exploratory design using a survey method was used as an initial phase of the wider project. A web-based survey was developed, piloted (n = 5), revised, and distributed within five healthcare jurisdictions: the Republic of Ireland, Northern Ireland, England, Scotland, and Wales. The target population was health and social care professionals, policymakers, and academics interested in dementia and palliative care. Content analysis of open-ended questions identified common themes; descriptive statistics were applied to the closed-ended questions.

Overall, N = 112 complete surveys were received. Key care principles incorporated the philosophies of palliative care and dementia care; many described “holistic” and “person-centred care” as the core. Important individual service components were the support for carers, advanced care planning, information, education and training, activities for “meaningful living”, comprehensive disease management, coordinated case management, and linking with community health services and social activities. Barriers included poor availability and organisation of healthcare services, stigma, misconceptions around dementia prognosis, insufficiently advanced care planning, and dementia-related challenges to care. Facilitators included education, carer support, and therapeutic relationships.

This study, as part of the larger project, will directly inform the development of a novel service delivery Model of Dementia Palliative Care for Ireland. The results can also inform service planning and design in other countries.

The purpose of this study is to inform those who are supporting persons who are dying and are responsible for planning, commissioning or delivering palliative care about the need to support and maximise the decision-making ability and choices of persons with advanced dementia or severe frailty.

This article will consider the legal and human rights principles applicable to Scotland, and indeed to other jurisdictions, which govern decisions about care and treatment of persons with and without capacity and the application of these principles to palliative care situations.

It is important that those involved in the care and support of the dying are fully aware of the need to support and maximise their decision-making ability concerning palliative care and treatment choices.

It is a well-established legal and human rights principle that the decisions of a person with capacity must be respected, including decisions about palliative care and treatment at the end of life. Moreover, recent developments in international human rights law reinforce the message that this principle applies equally to all. Applying this principle into persons with advanced dementia or severe frailty therefore requires skilled assessment and supported decision-making in order to optimise capacity and respect autonomy.

The discussion applies the United Nations Convention on the Rights of Persons with Disabilities approach concerning equality of rights enjoyment and supported decision-making to palliative care and treatment situations.

Compassionate release is a process that allows for the early release or parole of some incarcerated people of advanced age, with life-limiting illness, complex medical care needs or significant functional decline. Despite the expansion of State and Federal compassionate release programs, this mechanism for release remains underutilized. Health-care professionals are central to the process of recommending compassionate release, but few resources exist to support these efforts. The purpose of this paper is to provide a guide for health-care professionals requesting compassionate release for patients who are incarcerated.

This study is stepwise guide for health-care professionals requesting compassionate release for patients who are incarcerated.

This study describes the role of the health-care professional in requesting compassionate release and offers guidance to help them navigate the process of preparing a medical declaration or request for compassionate release.

No prior publications have created a step-wise guide of this nature to aid health-care professionals through the compassionate release process.

The wake of the novel coronavirus (COVID-19) pandemic had caused substantial disruptions to the usual delivery of healthcare services. This is because of restrictive orders that were put in place to curb the spread of the infection. Palliative care services in Brunei also face challenges to deliver effective services during this period. However, the impact of advanced illnesses on patients' health and end-of-life care are issues that cannot be planned, postponed or cancelled. Hence, the palliative care team needs to continue to deliver effective palliative care services. As Brunei faced its second pandemic wave in August 2021, crucial adaptations were made to ensure palliative care service was not disrupted. This reflective case study aims to discuss the adaptations made in providing palliative care during this era of disruptions.

The second in a new series about mental health in old age, this article reviews policies and research evidence on services for people with dementia at the end of their lives, and looks at future commissioning priorities

With a rapidly growing population of older adults with chronic illness in US prisons, the number of people who die while incarcerated is increasing. Support for patients’ medical decision-making is a cornerstone of quality care for people at the end of life (EOL). This study aims to identify, describe, and analyze existing policies regarding EOL decision-making in U.S. Departments of Corrections.

This study performed an iterative content analysis on all available EOL decision-making policies in US state departments of corrections and the Federal Bureau of Prisons.

This study collected and reviewed available policies from 37 of 51 prison systems (73%). Some areas of commonality included the importance of establishing health-care proxies and how to transfer EOL decision documents, although policies differed in terms of which patients can complete advance care planning documents, and who can serve as their surrogate decision-makers.

Many prison systems have an opportunity to enhance their patient medical decision-making policies to bring them in line with community standard quality of care. In addition, this study was unable to locate policies regarding patient decision-making at the EOL in one quarter of US prison systems, suggesting there may be quality-of-care challenges around formalized approaches to documenting patient medical wishes in some of those prison systems.

To the best of the authors’ knowledge, this is the first content analysis of EOL decision-making policies in US prison systems.

The purpose of this paper is to describe the Bree Collaborative’s background, history, structure, and work.

The Bree Collaborative was established by the Washington State Legislature to convene public and private health care stakeholders with the goal of identifying specific mechanisms to improve health care quality, outcomes, and affordability. These members are appointed by the Washington State Governor and represent public health care purchasers for Washington State, private health care purchasers (employers and union trusts), health plans, physicians and other health care providers, hospitals, and quality improvement organizations. Members annually select health care services that show high variation in care delivery, that are highly utilized without leading to better care or patient health, or that have known or suspected patient safety issues and develop recommendations for health care improvement.

Recommendations are meant to be implemented by the Washington State Health Care Authority and used to set a community standard across the state. Successful implementation depends on several factors including engaged health care purchasers, support from diverse partners, and a health care community willing to put the patient at the center of care.

Bottom-up, collective action through the Bree Collaborative can help achieve the triple aim for Washington State and should be used as a model nationally and internationally.