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Chen L, Sleeman KE, Bradshaw A, Sakharang W, Mo Y, Ellis-Smith C. The Use of Person-Centered Outcome Measures to Support Integrated Palliative Care for Older People: A Systematic Review. J Am Med Dir Assoc 2024; 25:105036. [PMID: 38796168 DOI: 10.1016/j.jamda.2024.105036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES The aim was to synthesize evidence on the use of person-centered outcome measures to facilitate integrated palliative care for older people and build a logic model depicting the mechanisms through which person-centered outcome measures support integrated care. DESIGN Mixed methods systematic review using a data-based convergent synthesis design. SETTING AND PARTICIPANTS Older people aged ≥60 years who are approaching the end of their lives in multiple settings. METHODS The study was underpinned by a conceptual framework of integrated palliative care, which informed the search strategy, data extraction, analysis, and synthesis. A hybrid search strategy was implemented, with database searches (PsycINFO, MEDLINE, CINAHL, and ASSIA) complemented by snowball searches. Qualitative and quantitative data were analyzed by narrative synthesis to summarize and explain the findings. The findings informed a logic model depicting the mechanisms of using person-centered outcome measures to support integrated palliative care. RESULTS Twenty-six studies were included. Three mixed methods studies, 2 qualitative studies, and 21 quantitative studies were included. There was evidence that person-centered outcome measures could support integrated palliative care through informing palliative care policy development (n = 4), facilitating joint working across settings (n = 5), enabling close collaboration of multidisciplinary teams (n = 14), promoting joint education (n = 1), facilitating timing and specialist referral (n = 6), and enhancing patient-centered care (n = 3). CONCLUSIONS AND IMPLICATIONS This review makes an important, novel, and theoretically informed contribution to the delivery of scalable and sustainable integrated palliative care into the care of older people using person-centered outcome measures. The constructed logic model provides a conceptual framework and practical approach to how person-centered outcome measures support multilevel integration. A future area of research is the development of person-centered outcome measure interventions informed by the logic model to meet clinical needs.
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Affiliation(s)
- Linghui Chen
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Andy Bradshaw
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Wilailak Sakharang
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Yihan Mo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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Ploukou S, Papakosta-Gaki Ε, Panagopoulou E, Benos A, Smyrnakis E. Unmet Needs in the Process of Chemotherapy Provision in Pancreatic Cancer Patients from the Healthcare Provider Perspective: A Phenomenological Study in Greece. Zdr Varst 2024; 63:73-80. [PMID: 38517148 PMCID: PMC10954243 DOI: 10.2478/sjph-2024-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/05/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Pancreatic cancer is the fourth leading cause of cancer death overall, with 1.5 years life expectancy and minimal therapeutic progress in the last decades. Despite the burden it causes, there is little research on the needs of this specific population. This study aimed to explore healthcare professionals' views on providing care and patients' unsatisfied needs. Methods This qualitative descriptive study was carried out at a cancer hospital in Northern Greece. A total of 12 participants (6 physicians and 6 nurses), treating patients with pancreatic cancer undergoing chemotherapy, were recruited through purposive sampling and underwent face-to-face semi-structured interviews. Data were analyzed through the thematic analysis method in NVivo12 software. Results The analysis highlighted two themes: "needs of patients with pancreatic cancer" consisted of 6 subthemes ("daily activities", "symptoms management", "psychological support", "information needs", "multidisciplinary care" and "end-of-life care") and "needs of healthcare professionals" had 3 subthemes ("psychological support", "education" and "organizational support"). Several symptoms are identified and affect the daily activities of these patients, and psychological support is important for the majority of them, even at the time of diagnosis. The participants express dissatisfaction with the absence of palliative care structures and services and stated that an interdisciplinary approach would improve the quality of care. Conclusions Healthcare professionals report a wide range of unsatisfied needs of patients with pancreatic cancer, with the majority expressing their concerns about the complete lack of patient support in the last stages of their lives.
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Affiliation(s)
- Stella Ploukou
- Laboratory of Primary Health Care, General Practice and Health Services Research - Medical School, Aristotle University of Thessaloniki, Greece
| | - Εleni Papakosta-Gaki
- Laboratory of Primary Health Care, General Practice and Health Services Research - Medical School, Aristotle University of Thessaloniki, Greece
| | - Efharis Panagopoulou
- Laboratory of Primary Health Care, General Practice and Health Services Research - Medical School, Aristotle University of Thessaloniki, Greece
| | - Alexios Benos
- Laboratory of Primary Health Care, General Practice and Health Services Research - Medical School, Aristotle University of Thessaloniki, Greece
| | - Emmanoui Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research - Medical School, Aristotle University of Thessaloniki, Greece
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3
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Chung V, Sun V, Ruel N, Smith TJ, Ferrell BR. Improving Palliative Care and Quality of Life in Pancreatic Cancer Patients. J Palliat Med 2022; 25:720-727. [PMID: 34704841 PMCID: PMC9080991 DOI: 10.1089/jpm.2021.0187] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2012] [Indexed: 01/31/2023] Open
Abstract
Background: Pancreatic cancer patients often present with complications, which can impact treatment tolerance. Thus, symptom management is a vital component of treatment in addition to traditional chemotherapeutics. Concurrent palliative care with an emphasis on aggressive symptom management may sustain both clinical and patient-centered outcomes during treatment. The purpose of this article is to explore the impact of a concurrent palliative care intervention in patients with pancreatic cancer treated on phase I clinical trials. Materials and Methods: This is a secondary analysis of a National Cancer Institute (NCI)-funded randomized trial of an advanced practice nurse driven palliative care intervention for solid tumor patients treated on phase I clinical trials. Only pancreatic cancer patients were included in the analysis. Patients received two educational sessions around the quality of life (QOL) domains and completed the Functional Assessment of Cancer Therapy-General (FACT-G), patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE), and the psychological distress thermometer at baseline, 4 and 12 weeks. Mixed model with repeated measures analysis was used to explore outcomes by study arm. Results: Of the 479 patients accrued to the study, 42 were diagnosed with pancreatic cancer (26 intervention, 16 usual care). A trend toward improvement in the physical, social, emotional, and functional FACT-G QOL subscales and psychological distress (baseline to 12 weeks) were observed for the intervention arm. Patients reported moderate severity in psychological and physical stress. Conclusions: In this secondary analysis, a nurse-led palliative care intervention may improve the QOL and psychological distress of pancreatic cancer patients. A phase III trial focused on patients with pancreatic cancer is needed to determine the effectiveness of the intervention.
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Affiliation(s)
- Vincent Chung
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Virginia Sun
- Division of Nursing Research and Education, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Nora Ruel
- Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Thomas J. Smith
- Department of Medicine, Division of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Betty R. Ferrell
- Division of Nursing Research and Education, Beckman Research Institute, City of Hope, Duarte, California, USA
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Bordonaro R, Piazza D, Sergi C, Cordio S, Tomaselli S, Gebbia V. Out-of-pocket costs in gastrointestinal cancer patients: Lack of a perfectly framed problem contributing to financial toxicity. Crit Rev Oncol Hematol 2021; 167:103501. [PMID: 34673219 DOI: 10.1016/j.critrevonc.2021.103501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/15/2021] [Accepted: 10/10/2021] [Indexed: 12/01/2022] Open
Abstract
Fighting cancer is an economically expensive challenge for both health care payers, and the patients and their families and the median costs for cancer care are rapidly increasing in the last decade. Although both direct and indirect costs of medical assistance have been a frequent source of distress and contention, however analysis of the non-medical expenses incurred directly by cancer patients has not received adequate attention. Developing a deeper understanding of so-called "out-of-pocket" costs may be necessary. Out-of-pocket costs for medical care range from 7 % to 11 % of medical costs for all payers. However, the range of out-of-pocket costs shows considerable variability in different studies. In this review, we reviewed available data concerning direct and indirect medical costs, including psychosocial ones.
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Affiliation(s)
- Roberto Bordonaro
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale e Alta Specializzazione (ARNAS), Ospedale Garibaldi, Catania, Italy
| | - Dario Piazza
- GSTU Foundation for Cancer Research, Palermo, Italy
| | - Concetta Sergi
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale e Alta Specializzazione (ARNAS), Ospedale Garibaldi, Catania, Italy
| | - Stefano Cordio
- Medical Oncology Unit - Azienda Ospedaliera Provinciale 7, Ragusa, Italy
| | | | - Vittorio Gebbia
- Medical Oncology and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy; PROMISE Department - University of Palermo, Palermo, Italy.
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Changes in Physical Function and Effects on QOL in Patients after Pancreatic Cancer Surgery. Healthcare (Basel) 2021; 9:healthcare9070882. [PMID: 34356260 PMCID: PMC8304148 DOI: 10.3390/healthcare9070882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 01/22/2023] Open
Abstract
This study examined the changes in physical function and quality of life (QOL) of postoperative patients with pancreatic cancer for 3 months after surgery and examined the factors affecting the QOL at the 3 months after surgery. Methods: This study comprised 32 pancreatic cancer patients who underwent surgery at our hospital. Among these patients, 20 patients for whom data was measured before surgery to 3 months after surgery were selected for statistical analyses: 8 males and 12 females, 69.8 ± 7.4 years. The preoperative and postoperative rehabilitation was given to patients under the guidance of a physiotherapist. Nutritional status, body composition, physical function, gait assessments, and QOL were investigated. Results: Body weight, body fat mass, body fat percentage, body mass index (BMI), and muscle mass significantly decreased 3 months after surgery compared with their respective preoperative values. The mean grip strength at the time of 3 months after the surgery had decreased significantly from 27.3 kg to 24.5 kg. The mean skeletal muscle mass index (SMI) had decreased significantly from 6.3 kg before surgery to 5.9 kg after the surgery. The QOL scores for global health status, physical, and role showed significant decreases 2 weeks after surgery compared with the respective preoperative scores. Significant improvements in these scores were observed 3 months after surgery compared with the respective scores 2 weeks after surgery. Physical function assessments after surgery were associated with QOL 3 months after surgery. Conclusion: Recovery of patients after pancreatic cancer surgery in body weight, BMI, body fat percentage, body fat percentage, muscle mass, SMI, and grip strength was not sufficient at the time of 3 months after surgery. It has been observed that physical function of patients has affected the improvement of QOL.
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Habib JR, He J. Time for a More Holistic Approach to Peri-Pancreatoduodenectomy Care. Ann Surg Oncol 2021; 28:4084-4085. [PMID: 33811305 DOI: 10.1245/s10434-021-09876-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Joseph R Habib
- Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
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De Rosa P, Jewell A. The potential use for patient reported outcome measures in people with pancreatic cancer, with a specific focus on older patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:495-502. [PMID: 32600894 DOI: 10.1016/j.ejso.2020.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 12/27/2022]
Abstract
Pancreatic cancer is one of the most lethal malignancies and is characterised by high-unmet physical and psychological supportive care needs. Patient Reported Outcome Measures (PROMs) represent a patient centred approach to address the high unmet supportive care need and improve the quality of care. PROMs have the potential to inform patients about the quality of life and symptom trajectory for different treatment approaches so that they can fully participate in shared decisions about treatment. Embedding the collection of PROMs into routine practice alongside clinical alerts and directed symptom interventions is acceptable and feasible for people with pancreatic cancer and has the potential to reduce symptom burden. There is also limited information on survival, quality of life and the holistic impact of treatment for older pancreatic cancer patients, therefore, PROMs provide an opportunity to understand the impact of treatment on older patients and better inform shared treatment decision-making.
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Affiliation(s)
- Peter De Rosa
- Pancreatic Cancer UK, 4th Floor Westminster Tower, 3 Albert Embankment, London, SE1 7SP, UK.
| | - Anna Jewell
- Pancreatic Cancer UK, 4th Floor Westminster Tower, 3 Albert Embankment, London, SE1 7SP, UK
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Del Piccolo L, Marinelli V, Mazzi MA, Danzi OP, Bonamini D, Secchettin E, Tuveri M, Bassi C, Rimondini M, Salvia R. Prevalence of depression in a cohort of 400 patients with pancreatic neoplasm attending day hospital for major surgery: Role on depression of psychosocial functioning and clinical factors. Psychooncology 2020; 30:455-462. [PMID: 33247996 DOI: 10.1002/pon.5607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/07/2020] [Accepted: 11/18/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE (1) To determine the prevalence and type of depressive symptoms at day-hospital clinical evaluation, before undergoing major surgery in patients diagnosed with pancreatic neoplasm. (2) To analyze the association between depression and sociodemographic, clinical, and psychosocial variables. (3) To understand how coping strategies, perceived social support, and self-efficacy might affect depressive symptoms in this cohort of patients. METHODS Secondary data analysis collected during the baseline phase of a randomized controlled trial performed at the Pancreas Institute of the University Hospital of Verona, Italy, between June 2017 and June 2018. RESULTS 18.5% of pancreatic patients had a PHQ-9 score ≥10 (cut-off). Depressed patients were basically more often female (p = 0.07), younger (p = 0.06), and married/with a partner (p = 0.02). Depression was associated to high trait anxiety (p < 0.01), the use of anxiolytics (p < 0.01), sleep-inducing drugs (p < 0.01), and painkillers (p < 0.01). Among psychosocial variables, depressed patients showed lower perceived self-efficacy (p < 0.01) and family and friends' social support (p < 0.01) and used significantly more often dysfunctional coping strategies (p < 0.01), compared to nondepressed. A logistic multivariate model using psychosocial variables as explanatory and depression as dependent was calculated and post hoc analyses were conducted to describe the contribution of each psychosocial variable on depression. CONCLUSIONS Our study advocates the need for screening for distress and depression in cancer surgery units and recommends to strengthen patients' adaptive coping, social support, and sense of effectiveness in facing the challenges related to the medical condition and treatment process.
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Affiliation(s)
- Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Veronica Marinelli
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Olivia Purnima Danzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Deborah Bonamini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Erica Secchettin
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | | | - Claudio Bassi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Michela Rimondini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Salvia
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
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Marinelli V, Danzi OP, Mazzi MA, Secchettin E, Tuveri M, Bonamini D, Rimondini M, Salvia R, Bassi C, Del Piccolo L. PREPARE: PreoPerative Anxiety REduction. One-Year Feasibility RCT on a Brief Psychological Intervention for Pancreatic Cancer Patients Prior to Major Surgery. Front Psychol 2020; 11:362. [PMID: 32194490 PMCID: PMC7066303 DOI: 10.3389/fpsyg.2020.00362] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/17/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction The aim of the present paper is to establish feasibility and required power of a one-session psychological intervention devoted to increasing patient's self-efficacy and awareness in dealing with anxiety symptoms before major pancreatic cancer surgery. Methods Parallel assignment RCT. All consenting patients listed for pancreatic major surgery during day-hospital visits (T0) between June 2017-June 2018 were assigned randomly in blocks of ten to a psychological intervention vs usual care group to be held the day before surgery (T1). The psychological intervention provided the patient the opportunity to increase self-efficacy in dealing with anxiety by talking with a psychologist about personal concerns and learning mindfulness based techniques to cope with anxiety. Results 400 patients were randomized into the experimental vs. usual care group. 49 and 65, respectively, completed baseline and post-intervention measures. The dropout rate between day-hospital (T0) and pre-surgery intervention (T1) was high (74.5%) due to several management and organization pitfalls. The main outcome, perceived self-efficacy in managing anxiety, showed a significant increase in the intervention group compared to the control group (p < 0.001), and was related to a reduction in state anxiety (p < 0.001). The intervention group perceived also lower emotional pain (p = 0.03). A power analysis was performed to define the appropriate sample size in a definitive RCT. Conclusion Beneath the complexity in retaining patients along their trajectory in pancreatic surgery department, when they had the opportunity to follow a brief psychological intervention, most of them adhered, showing a significant reduction in preoperative emotional distress and less emotional pain perception after surgery. Even if results need caution because of the high attrition rate, we can infer that our psychological intervention has the potential to be proposed in surgical setting, being short, easy to learn and applicable to a wide range of patients. Clinical Trial Registration The trial was registered on ClinicalTrials.gov (identifier: NCT03408002). The full protocol is available from the last author.
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Affiliation(s)
- Veronica Marinelli
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Olivia Purnima Danzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Erica Secchettin
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | | | - Deborah Bonamini
- Pancreas Institute, University Hospital of Verona (AOUI), Verona, Italy
| | - Michela Rimondini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Salvia
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Claudio Bassi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Watson EK, Brett J, Hay H, Witwicki C, Perris A, Poots AJ, Sizmur S, Soonawalla Z, Tallett A. Experiences and supportive care needs of UK patients with pancreatic cancer: a cross-sectional questionnaire survey. BMJ Open 2019; 9:e032681. [PMID: 31690609 PMCID: PMC6858107 DOI: 10.1136/bmjopen-2019-032681] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Patients diagnosed with pancreatic cancer have the poorest survival prognosis of any cancer. This survey aimed to describe their experiences of care and supportive care needs to inform future service provision. DESIGN Cross-sectional questionnaire survey of patients with pancreatic cancer in the UK. SETTING Individuals at any stage along the care pathway were recruited via five National Health Service sites in the UK, and online, from January to June 2018. PARTICIPANTS 274 individuals completed the questionnaire (78% (215) were completed online). Approximately half of participants were diagnosed within the last year (133/274). Of 212 providing gender details, 82 were male and 130 were female. Ninety per cent (192/213) described themselves as White British. PRIMARY OUTCOME MEASURES Experiences of communication and information; involvement in treatment decisions; supportive care needs. RESULTS Communication with, and care received from, clinical staff were generally reported positively. However, 29% (75/260) of respondents did not receive enough information at diagnosis, and 10% (25/253) felt they were not involved in decisions about their treatment, but would have liked to be. Supportive care needs were greatest in psychological and physical/daily living domains. 49% (108/221) of respondents reported one or more moderate/high unmet needs within the last month, of which the most commonly reported were: dealing with uncertainty about the future; fears about the cancer spreading; not being able to do things they used to; concerns about those close to them; lack of energy; anxiety; feelings of sadness and feeling down/depressed. Experiences were poorer, and unmet supportive care needs greater, in patients with unresectable disease. CONCLUSIONS Patients with pancreatic cancer have unmet information and support needs across the cancer trajectory. Psychological and physical support appears to be the biggest gap in care. Needs should be assessed and supportive care interventions implemented from the point of diagnosis, and monitored regularly to help patients live as good a quality of life as possible.
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Affiliation(s)
- Eila K Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Jo Brett
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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11
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Scott E, Jewell A. Supportive care needs of people with pancreatic cancer: a literature review. ACTA ACUST UNITED AC 2019. [DOI: 10.7748/cnp.2019.e1566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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12
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Ibrahim F, Sandström P, Björnsson B, Larsson AL, Drott J. 'I want to know why and need to be involved in my own care…': a qualitative interview study with liver, bile duct or pancreatic cancer patients about their experiences with involvement in care. Support Care Cancer 2018; 27:2561-2567. [PMID: 30430301 PMCID: PMC6541569 DOI: 10.1007/s00520-018-4548-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/08/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Patients' involvement in their own care is important for those with upper abdominal tumours. Care is often conducted according to standardized fast-track care programs (FTCP), and a shorter hospital stay is one of the goals. However, there is no research providing an in-depth perspective on patients' experiences of involvement in care. In this qualitative study, we explored experiences of involvement among patients who had surgery for upper abdominal tumours and were cared for according to an FTCP. METHODS Qualitative in-depth face-to-face interviews about patient involvement in care were conducted with 20 patients who had surgery for the liver, bile duct, or pancreatic cancer using an open-interview guide. RESULTS The most important findings are that customized information and active dialogue about care decisions stimulate patient involvement. We identified three themes from the analysed data: involvement depended on the quality of information, communication and involvement during the care period, and safety at discharge. CONCLUSIONS Individualized care and continuous information about treatment and care goals in the FTCP during the care process create trust between patients and healthcare professionals and increase patient experiences of involvement.
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Affiliation(s)
- Farzana Ibrahim
- Department of Clinical and Experimental Medicine, Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden.,Department of Medicine and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
| | - Per Sandström
- Department of Clinical and Experimental Medicine, Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Bergthor Björnsson
- Department of Clinical and Experimental Medicine, Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Anna Lindhoff Larsson
- Department of Clinical and Experimental Medicine, Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Jenny Drott
- Department of Clinical and Experimental Medicine, Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden. .,Department of Medicine and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden. .,Faculty of Medicine and Health Sciences, Linköping University, 581 83, Linköping, Sweden.
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Burrell SA, Yeo TP, Smeltzer SC, Leiby BE, Lavu H, Kennedy EP, Yeo CJ. Symptom Clusters in Patients With Pancreatic Cancer Undergoing Surgical Resection: Part I. Oncol Nurs Forum 2018; 45:E36-E52. [PMID: 29947349 DOI: 10.1188/18.onf.e36-e52] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe patient-reported symptoms and symptom clusters in patients with pancreatic cancer (PC) undergoing surgical resection. SAMPLE & SETTING 143 patients with stage II PC undergoing surgical resection alone or with subsequent adjuvant chemoradiation or chemotherapy were recruited to participate in a nested, longitudinal, exploratory study through convenience sampling techniques from Thomas Jefferson University Hospital, a National Cancer Institute-designated cancer center. METHODS & VARIABLES The Functional Assessment in Cancer Therapy-Hepatobiliary questionnaire was used to assess 17 PC symptoms preoperatively and at three, six, and nine months postoperatively. Exploratory and confirmatory factor analyses were used to identify symptom clusters. RESULTS Fatigue, trouble sleeping, poor appetite, trouble digesting food, and weight loss were consistently reported as the most prevalent and severe symptoms. Sixteen distinct symptom clusters were identified within nine months of surgery. Four core symptom clusters persisted over time. IMPLICATIONS FOR NURSING Findings may be used to provide anticipatory patient and family guidance and to inform clinical assessments of symptoms and symptom clusters in this population.
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Pain in pancreatic ductal adenocarcinoma: A multidisciplinary, International guideline for optimized management. Pancreatology 2018; 18:446-457. [PMID: 29706482 DOI: 10.1016/j.pan.2018.04.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023]
Abstract
Abdominal pain is an important symptom in most patients with pancreatic ductal adenocarcinoma (PDAC). Adequate control of pain is often unsatisfactory due to limited treatment options and significant variation in local practice, emphasizing the need for a multidisciplinary approach. This review contends that improvement in the management of PDAC pain will result from a synthesis of best practice and evidence around the world in a multidisciplinary way. To improve clinical utility and evaluation, the evidence was rated according to the GRADE guidelines by a group of international experts. An algorithm is presented, which brings together all currently available treatment options. Pain is best treated early on with analgesics with most patients requiring opioids, but neurolytic procedures are often required later in the disease course. Celiac plexus neurolysis offers medium term relief in a substantial number of patients, but other procedures such as splanchnicectomy are also available. Palliative chemotherapy also provides pain relief as a collateral benefit. It is stressed that the assessment of pain must take into account the broader context of other physical and psychological symptoms. Adjunctive treatments for pain, depression and anxiety as well as radiotherapy, endoscopic therapy and neuromodulation may be required in selected patients. There are few comparative studies to help define which combination and order of these treatment options should be applied. New pain therapies are emerging and could for example target neural transmitters. However, until better methods are available, management of pain should be individualized in a multidisciplinary setting to ensure optimal care.
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