I. Health Status
Distress among patients often arises from the diagnosis and being informed that they have a serious health issue. Cancer patients have an increased distress prevalence ranging from normal feelings such as sadness and vulnerability to severe difficulties such as existential crisis and depression (World Health Organization, 2020; Kirk & Kabdebo, 2021). Some patients become hesitant to disclose their distress concerns, viewing them as insoluble or inevitable and not wanting to burden health care practitioners. According to Los Angeles Jewish Home (2016), patient distress increases with a lack of control over treatment decisions and living in a sadness-filled environment. Patients with significant distress may end up having significant emotional problems such as depression.
Los Angeles is one of the places with widespread mild to moderate distress who experience higher anxiety and depression rates. If the distress is not managed, it reduces associated life quality, leads to poorer clinical outcomes, and increases symptom burden (Kerr, 2018a). Long-term management of various patient conditions and diseases requires that the distressed patients be supported hence the need for palliative or hospice care services.
II. Community Description
The proposed program of increasing quality palliative and hospice care to decrease distress will be undertaken in Los Angeles. Los Angeles is a city located to the south of California with approximately 3.8 million people living in its 462 square miles of landmass sprawling between mountains and the Pacific Ocean. In the United States, it is the second most populated city after New York. According to Pulse TMS (n.d.), the rate of depression among the general population of Los Angeles has risen by 50% since 1999. Due to several cultures and religions existing within Los angeles, one of the prevalent barriers to hospice and palliative care in the area is the differences in beliefs (Pulse TMS, n.d). Different cultures have different understandings of dying and death. The program will need to consider each culture’s beliefs. The other barrier includes misconceptions regarding the palliative services, such as the services are only meant for cancer patients.
III. Needs Assessment
a. Qualitative assessment
Although several hospice and palliative care services are being offered around Los Angeles, the services are not as satisfactory or do not have the required quality aspects (Sebelius & Thompson, 2017). The proposed program aims to improve the patient’s quality of life and the patient’s family members (Sebelius & Thompson, 2017). The objective is to ensure patients live as enthusiastically as possible until their death (Sebelius & Thompson, 2017). The program will be offered through integrated health and person-centered services that give superior attention to persons’ particular preferences and needs. The program will address specific spiritual, emotional, and physical suffering by assessing patients’ comfort and collaborating with primary healthcare providers (Faith and Hope Hospice & Palliative Care, 2021). The existing programs do not offer holistic pain management treatment forms such as music therapy. Thus the current proposed program will make it mandatory for the forms to be included. The Los Angeles city requires a hospice and palliative care program that reduces patient-level stress to transform a dark period into a period filled with meaning and fulfillment.
b. Quantitative assessment
There is a high availability of healthcare organizations that offer hospice and palliative care services. According to Davis (2021), there were 618 hospice providers in Los Angeles County as of 2020. Robles, Thomas, Lai, & Kuo (2019) notes that there are enough hospice and palliative care in hospitals and communities around Los Angeles, but the problem is that the demand surpasses the supply. Considering the large population that the city accommodates, several individuals need palliative and hospice care services but cannot get them. For instance, in 2015, the study done by Stephens (2015) indicated that the Los Angeles city had a shortage of inpatient palliative care since it could only handle 21,228 patients while the community-based patients needing palliative care are 21,261. Demand surpasses supply due to the disparity between the benefits the systems receive from providing enough and satisfactory services and the compensation that they are given.
IV. Community Link
Several organizations offer Los Angeles population hospice and palliative care services. Some prominent organizations include Faith & Hope Hospice and Palliative Care, Five star home Hospice, Agape Hospice and palliative care, maximum care hospice, mi hospice and palliate care, in the arms of grace hospice, and Hospice of grace. The organizations have care plans to manage pain and relieve patient symptoms by offering essential palliative equipment, therapies, medical supplies, and drugs. Some organizations also offer personal care for patients incapable of undertaking daily activities such as bathing and grooming. They also support and ensure chaplain visits to offer spiritual conduct to those who want.
Since there are already several organizations in Los Angeles offering palliative and hospice services, the proposed program will complement and thus rival the already developed programs. However, the proposed program will be different from other programs since it will focus on quality care and providing a customized approach for every patient. The significant gap of the current programs is that they have pre-made care plans, thus forcing patients to choose from already made care plan lists. The proposed program is different since care plans will be designed according to the requirements of the patients. Each time a new patient is received, their requirements and circumstances will be considered, and a care plan designed to match their exact needs. Quality will also be improved through having skilled facility staff that tends to the patients (Lau et al., 2014). Citizens living in Los Angles city will also be included in designing the program to ensure it has all quality aspects. Having input from the community is important since they are the people who will use the program. The community members will be frequently allowed to make suggestions on the program, and the program will be taken into consideration and implemented.
V. Measurements
Measurement This project aims to determine how to increase the quality of palliative and hospice care to reduce distress and establish positive health outcomes. Therefore, the project requires a qualitative measurement method. Qualitative measurement aims to acquire information that is not quantifiable (Majid & Vanstone, 2018). Since this project aims to collect data on human behavior, not numerical values, qualitative measurement is the most effective method.
Measures This project looks at the distress among patients, particularly those with cancer. The measures studied in this project revolve around emotional problems, including personal feelings like sadness and vulnerability to severe difficulties such as existential crisis and depression (Kirk et al., 2021).
Instrument The proposed program of increasing quality palliative and hospice care to decrease distress will be undertaken in Los Angeles. Because the project will be centered on palliative care, it will need to consider factors like cultures because different cultures have different understandings of dying and death (Lau et al., 2014).
Sampling strategy Because there are currently multiple organizations in Los Angeles that provide palliative and hospice care, the proposed program will complement rather than compete with those already in place. Some of these companies include Faith & Hope Hospice and Palliative Care, Five Star Home Hospice, Agape Hospice, Palliative Care, Maximum Care Hospice, Mi Hospice, and Palliative Care, in the Arms of Grace Hospice, and Hospice of Grace. On the other hand, the suggested program would be focused on delivering high-quality treatment and a personalized approach for each patient (Los Angeles Jewish Home, 2016). The care plans will be created per the needs of the patients. Each time a new patient arrives, their needs and circumstances will be considered, and a treatment plan will be designed to meet their specific requirements. Having skilled facility workers that care for the patients will help increase quality (Los Angeles Jewish Home, 2016). Residents will be involved in creating the program, and they will be given frequent opportunities to offer comments, which will be reviewed and implemented.
VI. Program Goals
While death is inevitable, healthcare providers often treat it as an illness. Since several terminally ill individuals die in hospitals, palliative care focuses on diagnosing, treating, and preventing life-threatening diseases. Undoubtedly, palliative care helps patients with terminal illnesses and their loved ones to manage symptoms, offers them psychological support, and improves the quality of life (Sebelius & Thompson, 2017). This paper outlines the mission, goals, and objectives for increasing quality palliative and hospice care in Los Angeles.
Mission
This project aims to improve the quality of palliative and hospice care, provide psychological support to terminally ill individuals and their families, and effectuate positive health outcomes.
Primary Goal
Based on the Healthy People 2020 (HP2020) mission, the program’s overarching goals is to promote longer lives free from preventable diseases, premature death, reduce distress, and improve good health for individuals under palliative and hospice care and their loved ones (CDC, 2017). The main change goal is to promote good health and prevent premature death in Los Angeles.
SMART Objectives
Two clear SMART objectives will drive the project to accomplish its mission in Los Angeles. These objectives will guide the project by setting an action plan for improving the quality of palliative and hospice care and promoting good health for all individuals. The smart, measurable, achievable, relevant, and time-bound objectives are:
• To teach and empower at least 80% of individuals and groups under palliative and hospice care in Los Angeles to develop healthy behaviors for three months and urge primary caregivers to proceed with the activities at the end of the project (Dublin, 2011).
• For three months, the program will address specific emotional, spiritual, and physical problems by comforting 90% of patients under palliative and hospice care in Los Angeles and their families collaborating with their primary healthcare providers to continue with the program at the end of the project (Sull & Sull, 2018).
References
Center for Disease Control and Prevention (CDC). (2017, Apr. 25). Writing SMART Objectives. CDC. https://www.cdc.gov/dhdsp/evaluation_resources/guides/writing-smart-objectives.htm
Dublin, S. (2011, Apr. 1). Writing SMART Goals and Objectives Webinar [Video]. APIAHF. YouTube. https://www.youtube.com/watch?v=MAhs-m6cNzY
Faith and Hope Hospice & Palliative Care. (2021, May 13). Comparing palliative services with hospice care in Los Angeles, CA. Faith and Hope Hospice & Palliative Care. https://faithandhopehospice.com/comparing-palliative-services-with-hospice-care-in-los-angeles-ca/
Kerr, K. (2018, June 12). Palliative care in California: Narrowing the gap. California Health Care Foundation. https://www.chcf.org/publication/palliative-care-california-narrowing-gap/
Kirk, D., Kabdebo, I., & Whitehead, L. (2021). Prevalence of distress, its associated factors and referral to support services in people with cancer. Journal of Clinical Nursing, 30(19-20), 2873-2885.
Lau, B., Aslakson, R., Wilson, R., Fawole, O., Apostol, C., Martinez, K., Vollenweider, D., Bass, E.B, & Morss, S.E. (2014). Methods for improving the quality of palliative care delivery: A systematic review. Am J Hosp Palliat Care, 202-210. https://dx.doi.org/10.1177/1049909113482039
Los Angeles Jewish Home. (2016, Oct. 28). Palliative and hospice care: know your options! Los Angeles Jewish Home. https://www.lajh.org/blog/palliative-and-hospice-care-know-your-options
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