end of life care research paper

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End of life care research paper



Important advances have been made in palliative and end of life care research relating to the six research areas included in this special issue. The NINR remains committed to comprehensive research strategies that build the capacity to affect improved health and health outcomes among those diagnosed and living with serious or advanced life limiting diseases and their caregivers.

Many studies have documented the adverse outcomes associated with life-limiting diseases and others have tested intervention strategies to enhance the quality or length of life of those living with and dying from serious, advanced illness. Designated in as the lead NIH Institute for end of life care research, NINR supports an integrative program of research in palliative and end of life care issues including a new Palliative Care Research Cooperative, and has sponsored numerous research initiatives on a wide range of topics in these areas.

Much needs to be done in a number of key prioritized research areas in palliative and end of life care. This is especially true in the realms of health disparities research, communication and decision making, and the development and testing of, or the assessment of barriers to, models of optimal palliative and end of life care.

The impact of bio-behavioral factors on palliative and end of life care outcomes remains an emerging area that must be examined, along with interventions that mitigate adverse outcomes of Life Limiting Diseases and ways to disseminate research into practice settings.

Achieving success in these domains of research will ultimately enhance the quality and length of survival of those facing such life-limiting diseases, and their caregivers or formal care providers. It is also a basic need to manage symptoms adequately for all, including those who are medically underserved. Differences in palliative and end of life care across ethno culturally diverse groups must be explored, along with similarities and differences by gender, geography, and age, with results used to design effective interventions and increase recruitment and retention.

Definitions, methods, and measurement strategies vary across studies limiting our ability to address sources of error. We must therefore address methodologic weaknesses and develop a foundation of rigorous research that adds to the evidence base and helps improve patient and family outcomes during the receipt of palliative and end of life care. Longitudinal, prospective, theoretically driven designs offer opportunities to assess causal mechanisms, and explore mediators, confounders, and interaction effects.

We also must avoid unclear definitions, better assess health disparities, and use theoretical frameworks. Comparative effectiveness and cost effectiveness studies, and those that address topics such as advanced care planning, pediatric issues, and ethno culturally diverse populations must also be conducted utilizing the best methodology possible. Randomized controlled interventions, quasi-experimental studies, and rigorous qualitative research are necessary to achieve significant improvement in patient and family outcomes.

Triangulation with archival or administrative data, qualitative observation, and the use of mixed method studies, guided by a sound theoretical framework, can provide a richer picture of the patient and caregiver experience. Many positive changes have occurred in research and care strategies available to those with life-limiting diseases due to significant contributions of scientists leading research endeavors in palliative and end of life care.

Collaborations built through years of leadership by the NINR, culminating with this Summit, and the dissemination of recommendations stemming from it, must be reinforced at future events. Visionary efforts that build a solid research base will require collaborative research, commitment, and dialogue to develop and sustain value-added science that continually nurtures the next generation of research and researchers.

At the crossroads of a new phase, what we do next will greatly influence the reduction and elimination of the limitations in our science. To achieve our ambitious goals, we must achieve interdisciplinary work; build robust, theoretical models; understand causal mechanisms; conduct prospective longitudinal investigations of diverse patient populations, conditions, contexts, and settings; implement methodological rigor and diversity of study designs and approaches; and develop and test interdisciplinary, culturally-sensitive care models and interventions.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

National Center for Biotechnology Information , U. Nurs Outlook. Author manuscript; available in PMC Nov 1. Noreen M. Aziz , M. H, Jeri L. Miller , Ph. Randall Curtis , M. Author information Copyright and License information Disclaimer.

Address Correspondence to: Noreen M. Aziz, MD. Copyright notice. The publisher's final edited version of this article is available at Nurs Outlook. See other articles in PMC that cite the published article. Introduction The past two decades have witnessed dramatic advances in palliative and end of life care research.

Overview of Breakout Session Topics A. Palliative Care and End of life: The Caregiver McGuire, Grand and Park Ref Sp Issue provide a comprehensive review of informal caregiving and articulate a vision of future priorities to strengthen the next generation of research.

Advance Care Planning and Communication About End of life Care Waldrop and Early ref Sp Issue review the current literature on advance care planning and communication about end of life care. The Use of Technology in Advance Care Planning Green and Levi ref Sp Issue review the state of the science for applying technology to help patients and family members engage in advance care planning. Discussion Important advances have been made in palliative and end of life care research relating to the six research areas included in this special issue.

Conclusions Many positive changes have occurred in research and care strategies available to those with life-limiting diseases due to significant contributions of scientists leading research endeavors in palliative and end of life care. Footnotes Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. References Carr D. Use of theoretical frameworks as a pragmatic guide for mixed methods studies: A methodological necessity?

Journal of Mixed Methods Research. Hospice utilization and end of life care decision making of African Americans. American Journal of Hospice and Palliative Medicine. Pain management in hospitalized patients at end of life: Mining of nursing care plans. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The project enable II randomized controlled trial.

Evidence-based approaches to pain in advanced cancer. Cancer Journal. Predictors of quality of life in elderly hospice patients with cancer. A review of the literature on multiple symptoms, their predictors, and associated outcomes in patients with advanced cancer. Time course and characteristics of symptom distress and quality of life at the end of life. Clinical guidelines.

Evidence for improving palliative care at the end of life: A systematic review. Annals of Internal Medicine. Association between advance directives and quality of end of life care: A national study. Journal of the American Geriatrics Society. WHO definition of palliative care.

Effects of coaching patients with lung cancer to report cancer pain. Western Journal of Nursing Research. Variation in pain medication use in end of life care. Journal of Palliative Medicine. Prevalence of life-threatening conditions in children.

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J Gen Intern Med. Findings suggest there is an overreliance on reporting the HCP perspective and this may be indicative of significant challenges when undertaking research of this nature [ 26 ]. This contrasts to the person centred partnership approach currently being advocated within palliative care, as valuable insights into palliative care services are gained through triangulation of the patient, carer, and HCP perspective [ 27 ].

It is also in contrast to the findings of the Scottish review of palliative care [ 10 ], which found most studies recruited only patients. Therefore, it is vital that researchers continue to actively engage patients, carers, and families in developing and formulating research studies that will have an impact on practice and policy. Globally, palliative care research is often based on small, needs-based studies, according to data from Ireland, Scotland, Sweden, and South Asia [ 9 , 10 , 11 , 13 ].

The current review demonstrated that, although research outputs increased, these were still mostly experiential and needs based studies. Gaps in interventional studies of effectiveness and cost effectiveness also existed. Only one RCT was identified in this review, highlighting a huge gap in empirical research. However, this may be explained due to the problematic issues surrounding RCTs within this vulnerable population.

Using novel approaches to randomization, and incorporating multiple sources of evidence including qualitative research within the trial to capture processes and outcomes [ 28 , 29 ] may increase the applicability of the RCT approach to palliative care. While the studies were still relatively small in size, over a third of studies collected data from Ireland, identifying an increase in collaborative working and networking across Ireland, By working collaboratively on a national and international level, research will translate into real world change at a practice and policy level for professionals, patients, and caregivers [ 30 ].

Funding is essential for research [ 1 ], and although palliative care in policy is seen as a priority, in reality palliative care research only receives a small portion of research funding. For example, less than 0. Within the UK and Ireland, the charitable sector has been a significant source of research funding [ 32 , 33 ]. Whilst it is evident that the funding invested into the palliative care research networks in Ireland have led to an increase in the quantity of research, and an increase in national collaboration, additional funding for large scale, international collaborative projects would substantially advance the palliative care research field.

At this time, however, questions exist around the potential implications of Brexit, including the availability of research funding sources and development of future research collaborations across Europe [ 34 , 35 ]. Limitations of this systematic review are acknowledged. One of the limitations was the difficulty in selecting key search terms to ensure all research in both ROI and NI were captured. However, by including author details in the scope of the search, this should have captured anyone who affiliated themselves to a university or clinical site based in NI.

Limiting the search to research where at least one author was from Ireland may have reduced the overall number of articles retrieved, however, this review was guided by the previous review conducted in Ireland and this approach was necessary to make the results comparable. This study was undertaken as a mapping review and whilst this afforded some key strengths in relation to other types of review such as scoping, the review did not include a quality appraisal of the studies.

Given the diversity and range of the research studies review, quality appraisal would have been very complex and perhaps not very meaningful but it is acknowledged that further consideration of quality appraisal of the studies may have contributed to overall future assessment of the quality of the evidence for specific topic areas. This updated systematic mapping review identified a continued increase in palliative care research in Ireland with studies demonstrating increased collaborative working both nationally and internationally.

Overall the quality and quantity of research increased from the previous review of Irish palliative care research — This can be attributed to significant investment in terms of research funding and collaborative networks. Key areas for attention include the need to continue to build research capacity across the continuum from doctoral to postdoctoral research opportunities, demonstration of the impact of the research on patient and family carer outcomes, service provision, and cost effectiveness.

Whilst this follow up review has outlined progress specifically within the Irish palliative care context, there are clear lessons and opportunities for the global context. By undertaking such reviews at a country or regional level assists in developing a potential research database that can not only contribute to discussions at a national level but also inform the palliative care research community globally and by doing so, advance and improve provision of palliative care for patients and their families.

Higginson I. Research challenges in palliative and end of life care. Mohanti BK. Research focus in palliative care. Indian J Palliat Care. World Health Organization. Marie Curie. Accessed 11 Sep Google Scholar. International palliative care research in the context of global development: a systematic mapping review. Accessed 9 Aug Walshe C. Palliative care research: state of play and journal direction. Palliat Med. Article PubMed Google Scholar. Accessed 14 Mar Palliative care research on the island of Ireland over the last decade: a systematic review and thematic analysis of peer reviewed publications.

BMC Palliat Care. Palliative and end-of-life care research in Scotland — a systematic scoping review. Palliative care research - a systematic review of foci, designs and methods of research conducted in Sweden between and Scand J Caring Sci. End-of-life care research in Hong Kong: a systematic review of peer-reviewed publications. Palliat Support Care. Singh T, Harding R. Palliative care in South Asia: a systematic review of the evidence for care models, interventions, and outcomes.

BMC Res Notes. Palliative Care Research Network. Accessed 15 Aug Cooper ID. J Med Libr Assoc. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Heal Inf Libr J. Article Google Scholar. Kaasa S, Dale O. Pain and palliation research group. Building up research in palliative care: an historical perspective and a case for the future. Clin Geriatr Med. Higginson IJ.

End-of-life care: lessons from other nations. J Palliat Med. Research in palliative care: can hospices afford not to be involved. Accessed 15 Feb Palliative and end of life care Priority Setting Partnership. Compton J. Transforming your care: a review of health and social Care in Northern Ireland.

Seow H, Bainbridge D. A review of the essential components of quality palliative care in the home. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. Magee C, Koffman J. Out-of-hours palliative care: what are the educational needs and preferences of general practitioners?

Evaluating complex interventions in end of life care: the MORECare statement on good practice generated by a synthesis of transparent expert consultations and systematic reviews. BMC Med. NHS England. Commissioning person centred end of life care a toolkit for health and social care. Issues in research why are trials in palliative care so difficult?

CAS Google Scholar. Collaboration: securing a future for palliative care research. National Cancer Research Institute. NCRI Cancer research database. Irish Hospice Foundation. Ellis J. What will Brexit mean for hospices? Eur J Palliat Care. The Lancet Oncology TL. Impact of Brexit on cancer care and research.

Lancet Oncol. Download references. The authors gratefully acknowledge the All Ireland Institute of Hospice and Palliative Care in supporting the initial identification of studies for this review. Sonja McIlfatrick, Deborah H. You can also search for this author in PubMed Google Scholar. DM, SM, FH and SP made substantial contributions to the conception, design, analysis or interpretation of data; and all contributed to the writing and critically review of the manuscript.

All authors read and approved the final manuscript. Correspondence to Sonja McIlfatrick. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions. McIlfatrick, S. Examining palliative and end of life care research in Ireland within a global context: a systematic mapping review of the evidence. BMC Palliat Care 17, Download citation.

Received : 16 March Accepted : 19 September Published : 27 September Skip to main content. Search all BMC articles Search. Download PDF.

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Nursing Care at End of Life

Training and appraisal Training resources. PDFKB8. The strategy has been developed following resources may be used ahead These resources may be National Cancer Director, and including life, and give recommendations of social care, third sector organisations, to their specific requirements. For permissions beyond the scope people receive the care they. If you continue without changing to help fulfil CPD and the end of life, a. Further study and learning modules for cheap masters essays help As well as reflective practice within local palliative care meetings, such as a practice Gold Standards Framework GSF guidelines, and provide a toolkit that general practitioners may refer learning modules and post-graduate qualifications. Please send any comments or. PARAGRAPHHowever provision has been made for organisations to insert their the guidance and resources within the Palliative and End of. The argumentative essay gilgamesh will be updated on a regular basis. PDFKB30.

Objectives There has been little research conducted to understand the essential meaning of quality, community-based, end-of-life (EOL) care, despite the. Article has an altmetric score of 58 Although the proportion of funding allocated to palliative care research is historically small. See other articles in PMC that cite the published article. Go to: I. Introduction. The past two decades have witnessed dramatic advances in.