Beruflich Dokumente
Kultur Dokumente
Linlin
Ical
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Background
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symptom control
Improves QOL
(Huang, 2013; R. Harding & Higginson, 2005 )
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Models • Hospital-based 11% wanted to
palliative care die in hospital
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Palliative care in Indonesia
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Epidemiology HIV in Indonesia
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Inclusion Criteria
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Search methods for identification of studies
Language:
English
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Searching Strategies
Keyword
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Keyword combination
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Results of the search
Electronic search
(n=906)
Exclude duplicate records
(n=191)
4 include :
• 1 RCT
• 4 prospective
study
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Included studies
1 1 RCT
1. A palliative-care intervention and death at home: a cluster
randomized trial
4 Prospectively controlled study
1.Nurse Practitioner-Based Models of Specialist Palliative Care at
Home: Sustainability and Evaluation of Feasibility
2.Effectiveness of Palliative Day Care in Improving Pain, Symptom
Control, and Quality of Life
3.Clinical Impact of a Home-Based Palliative Care Program: A
Hospice-Private Payer Partnership
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A palliative-care intervention and death at home: a cluster randomized trial
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Critical appraisal
Kerr,W.,E, 2t 2C 2014 Included A prospective study Intervention Included: The site of death was home for 47% of
patients with Secondary data : pain and symptom those who died during or after
al
HIV/AIDS database study of HC management directed by participation in the program.
499 Home program participants the palliative care Six of eight symptom domains (anxiety,
Connections physician appetite, dyspnea, wellbeing, depression
participants patient education and nausea) showed improvement.
enrolled supportive discussions Patients, caregivers and physicians gave
between July 1, about health care high program satisfaction scores (93%-
2008 and May decision making and goals 96%).
31, 2013 social work visit to Home Connections participants who
facilitate access to subsequently enrolled in hospice care had a
community support longer average length of stay of 77.9 days
services, respite care as compared to all other hospice referrals
through volunteers (average length of stay 56.5 days).
24/7 on call palliative
care nurse support.
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Critical appraisal
Using CEBM
•
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Nurse Practitioner-Based Models of Specialist Palliative Care at Home:
Sustainability and Evaluation of Feasibility
Bookbinder 3e 2011 Included Observational • NP was linked with significant decline in symptom distress
patients prospective study a social worker (SW) during the initial two weeks after
, M, et.al to create a new
with The new palliative referral (P = 0.003)
palliative home care
HIV/AIDS home care team 100% compliance with advance care
team (PHCT-NP-
499 Home included an NP and SW), which would planning
an SW (PCHT-NP- provide consultation
SW), both of whom and direct care to
had advanced referred homebound
training in palliative patients with
care. advanced illnesses.
• In a second model,
an NP was assigned
to a hospice
program (Hospice-
NP) for the purpose
of enhancing the
reach and impact of
a home care team.
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Critical appraisal
(CEBM,2009)
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Effectiveness of Palliative Day Care in Improving Pain, Symptom Control,
and Quality of Life
Goodwin, 2C 2003 Included Prospectively Palliative day care At baseline, the day care group were (non-
patients with controlled study including home significantly) worse than the comparison
D.W., et al
HIV/AIDS To evaluate the palliative care group in the MQOL support domain
Interventio effectiveness of (P=0.065).
n n=120 palliative day care for The comparison group had marginally more
Control a group of new severe pain at baseline (P=0.053) and more
n=120 referrals attending severe symptoms at second assessment
five centers. Day care (P=0.025).
patients were Both patient groups maintained overall
compared over time health-related quality of life during the three
with a comparison months of the study
group.
Measuring the
domains of palliative
day care is
highly complex and a
non-randomized trial
a
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Critical appraisal
Using CEBM
•
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Conclusion
• Primary outcome
1.↑ site of death at home
2.↑ survival time
• Secondary outcome
1.Effective to control and reduce symptoms: pain,
anxiety, appetite, dyspnea, wellbeing, depression and
nausea
2.Satisfaction of care
3.The model a Home-Based Palliative Care Program,
have given satisfaction among Patients, caregivers
and physicians
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Clinical implication
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THANK YOU
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