Experience of Patients in a Consult Model versus an Integrated Palliative Care and Medical Oncology Co-Rounding Model: A Qualitative Study.

Background: Research on different models of palliative care should include evaluation of the patients' experience of care. Objectives: To understand the patients' experience regarding care received in a consult model versus an integrated palliative care and medical oncology co-rounding model during a hospital admission. Design: Qualitative study using thematic analysis. Setting/Subjects: Seventeen patients with stage 4 solid tumor admitted to a tertiary hospital in Singapore. Results: Although experiences of care during the hospital stay were similar in both models, patients in the integrated model were able to better articulate the benefits of palliative care involvement alongside oncologists-to facilitate better communication and a more holistic understanding of the clinical context, with a view to effectively addressing the patient's needs. Conclusions: An integrated co-rounding model may possibly smoothen the transition for advanced cancer patients to palliative care, and could perhaps be considered for implementation to foster reach of palliative care services and improve patient experience.

Life Beyond Heart Failure-What Are the Long-Term Challenges, Supportive Care Needs, and Views Toward Supportive Care of Multiethnic Asian Patients With Left Ventricular Assist Device and Their Caregivers?

CONTEXT: Challenges experienced by patients with the left ventricular assist device (LVAD) and their caregivers during the early period after LVAD implantation are well documented. However, little is known about long-term challenges, supportive care needs, and views toward supportive care of Asian LVAD patients and caregivers. OBJECTIVES: We aimed to explore the experiences of multiethnic Asian LVAD patients and caregivers so as to identify their long-term challenges, supportive care needs, and views toward supportive care. METHODS: Semistructured interviews with LVAD patients and caregivers were conducted based on the grounded theory approach. Participants were purposively recruited from the inpatient and outpatient settings of the National Heart Center Singapore. RESULTS: A total of 30 patients and 11 caregivers participated. More than half of the participants were Chinese (patients 63%; caregivers 64%). Most patients (83%) were males, whereas most caregivers were females (91%). The median duration on support was 31 months and 46 months for patients and caregivers, respectively. The implantation of the LVAD was a significant milestone in their lives and caused long-term changes in multiple domains (physical, financial, social, psychoemotional, and spiritual). Experiencing permanent and recurrent losses over time was particularly challenging. Participants expressed the need for mutual support between patient and caregiver and connectedness with others and society at large. Participants desired holistic supportive care from their health care team. CONCLUSION: Asian LVAD patients and caregivers experienced long-term challenges and had unique supportive care needs. Our findings have implications on the design of future interventions and supportive care models.