Netta Bentur

Validation of the McGill Quality of Life Questionnaire in home hospice settings in Israel

Given that the meaning and significance of ‘quality of life’ can differ among language and cultural groups, it is incumbent upon researchers to assess whether the tool they have chosen is appropriate to the population under study. This study aimed to test the reliability and validity of the McGill Quality of Life Questionnaire (MQOL) translated into Hebrew for use with palliative care patients in Israel. In this, as in previous studies, the 16 questions of the tool clustered into four domains (physical, psychological, existential well-being and support), although the distribution of items among them differed somewhat. The existential well-being and psychological domains had an independent effect on the overall quality of life of patients in Israel, as in other countries. It seems that this tool produces similar responses in metastatic cancer patients around the world, and hence can be used to compare palliative care services in different countries.

The Cost of Home Hospice Care for Terminal Patients in Israel

This study examined and compared the cost of care provided to terminal metastatic cancer patients by home hospices and by conventional health services. The study population included 146 patients with metastatic cancer. Half received home hospice services, and the other half received conventional services. The average overall per-patient cost of care was, respectively,

Progress in palliative care in Israel: comparative mapping and next steps

4761 (operating costs included) and

Coping strategies for existencial and spiritual suffering in Israeli patients with advanced cancer

12 434. On average, the costs were lower for older patients. A multiple regression analysis revealed that treatment units per patient, care framework, and patient age significantly contributed to explaining the cost variance. The findings suggest a financial advantage for home hospice care for terminal patients. This should be investigated further, as should the cost of informal caregivers and patient and caregiver satisfaction with the quality of care in both frameworks.

Challenges and achievements in the development of spiritual-care training and implementation in Israel

Palliative care was established rapidly in some countries, while in other countries its establishment has taken a different trajectory. This paper identifies core steps in developing a medical specialty and examines those taken by Israel as compared with the US and England for palliative care. It considers the next steps Israel may take.Palliative care aims to provide quality of life for those with serious illnesses by attending to the illness-prompted physical, mental, social, and spiritual needs of patients and their families. It has ancient roots in medicine; its modern iteration began against the backdrop of new cures and life-sustaining technology which challenged conceptions of how to respect the sanctity of life.The first modern hospice was created by Saunders; it provided proof that palliative care works, and this has occurred in Israel as well (the first step). Another key step is usually skills development among clinicians; in Israel, few education and training opportunities exist so far. Specialty recognition also has not yet occurred in Israel. Service development remains limited and a major shortage of services exists, compared to the US. Research capacity in Israel is also limited. Policy to develop and sustain palliative care in Israel is underway; in 2009, the Ministry of Health established policy for implementing palliative care. However, it still lacks a financially viable infrastructure.We conclude that palliative care in Israel is emerging but has far to go. Adequate resource allocation, educational guidelines, credentialed manpower and specialty leadership are the key factors that palliative care development in Israel needs.

Attitudes of stakeholders and policymakers in the healthcare system towards the provision of spiritual care in Israel

Coping with existential and spiritual concerns is inescapable in end-of-life care although not enough is known about the strategies and mechanisms involved. This pilot study focused on identifying the strategies for coping with existential and spiritual suffering at the end of life of secular Jews with advanced-stage cancer. Using the phenomenological approach to data collection, in-depth interviews were conducted with 22 patients receiving symptom relief care at a daycare oncology clinic. The interviews were recorded and transcribed verbatim, and the content was analyzed.Advanced-stage cancer patients employ several approaches to cope with existential and spiritual concerns. The themes emerging from the interviews present five dimensions of coping strategies: openness and choosing to face reality, connectedness and the significance of family, pursuit of meaning, the connection of body, mind and spirit and, lastly, humor and a positive outlook.ConclusionsSince these concerns cause suffering and distress, intervention models targeting existential and spiritual suffering should be disseminated among professionals involved in caring for people with life-threatening illnesses.

The Attitudes of Physicians Toward the New "Dying Patient Act" Enacted in Israel

In recent years, pioneering spiritual-care training programs and services have been developed in Israel. This paper examines the implementation of the training programs and the challenge of integrating program graduates in the healthcare services. The information was collected through in-depth interviews with 12 students and graduates and the directors of the three training programs. All the interviews were transcribed in full and analyzed using qualitative study methods. The interviewees emphasized the importance of practical experience, although many of them encountered some degree of antagonism during their training or placement. Continuation of personal counseling and supervision after the conclusion of the program is also essential. Some were worried that they would not find work or were concerned about negotiations with potential employers. Evidently, the implementation of spiritual-care education must continue apace and careful consideration be given to optimizing its acceptance by the establishment.

The contribution of comprehensive geriatric assessment to primary care physicians

INTRODUCTION AND AIM Spiritual-care services and chaplaincy in the medical system are provided to people with serious illnesses, aiming to help them achieve moments of peace and acceptance while contending with illness or facing death. Chaplaincy has been available in Europe and in the U.S. for many decades, but such programs started to develop in Israel only few years ago. This paper examines the attitudes of stakeholders, directors and policymakers in the healthcare system towards the provision of spiritual care and the development of such programs. METHOD We conducted in-depth face-to-face interviews with 16 individuals in the healthcare system. All the interviews were transcribed in full and analyzed using qualitative study methods. FINDINGS Most of the interviewees had little knowledge of spiritual care and many mentioned barriers and challenges to its implementation in the healthcare system. These issues include: lack of knowledge and understanding about spiritual care precluding impeded their ability to evaluate its suitability for the healthcare services; confusion between spiritual care and religion; concerns about potential conflict with other professionals, especially social workers; barriers to funding of the new services; barriers to the successful integration of new ideas; and concerns about formal training and accreditation of the new profession. IMPLICATIONS FOR POLICY Spiritual care has begun to take root in Israels health system, but it is still at an early stage of development. Implementation must continue apace and careful consideration must be given to optimizing its acceptance by the establishment.

Utilization and cost of services in the last 6 months of life of patients with cancer - with and without home hospice care.

This study aims to determine what clinicians know about Israels new “Dying Patient Act” and its recommendations, to examine their attitudes and perceptions about it, and to assess their willingness to increase their involvement in advance care planning. In-depth face-to-face interviews with 10 stakeholders and specialists in the health care system, and 4 focus groups with family physicians and geriatricians working in the hospital system and the community, were conducted. There was general agreement that most people, including those in the medical profession, have little exposure to end-of-life discussion and few write advance care planning documents. The medical establishment is aware of the issue of the dying patient but is concerned about the barriers facing it in implementing the Dying Patient Act. These barriers can be divided into three main categories: the medical system, the law itself, and the characteristics of the Israeli population. The results may help augment educational programs on related subjects and increase the use of advance care planning.

Participation and quality of life of cognitively impaired older women in Israel following hip fractures.

BackgroundTo provide quality care to the growing number of older patients, primary care physicians (PCPs) will require support from geriatric specialists. Multidisciplinary comprehensive geriatric assessment (CGA) has been found to improve outcomes in older people. This study explored the contribution of CGA to the management of older patients by their PCPs; PCP attitudes to CGA; and PCP satisfaction with CGA.MethodsTwo hundred PCPs in an Israeli Preferred Provider Organization were interviewed as part of an evaluative study of the contribution of a national outpatient CGA program to older patients, their families and physicians.ResultsThe main reasons for referral to CGA were cognitive impairment and rapid functional decline. Three domains described the contribution of CGA to PCPs: medical treatment, support in counseling patients, and treatment of cognitive impairment. About 69% of PCPs definitely agreed that CGA more fully addressed the physical, mental and social needs of patients than other consultative clinics. About half were very satisfied with the CGA staff’s attitudes to patients, their families and to the PCP.ConclusionsCGA contributed significantly to the care provided to older patients by PCPs. The expansion of CGA services deserves consideration.