1
|
Shalev D, Brenner K, Carlson RL, Chammas D, Levitt S, Noufi PE, Robbins-Welty G, Webb JA. Palliative Care Psychiatry: Building Synergy Across the Spectrum. Curr Psychiatry Rep 2024; 26:60-72. [PMID: 38329570 DOI: 10.1007/s11920-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE OF REVIEW Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. RECENT FINDINGS PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.
Collapse
Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA.
| | - Keri Brenner
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Rose L Carlson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA
| | - Danielle Chammas
- Department of Medicine, University of California: San Francisco, San Francisco, CA, USA
| | - Sarah Levitt
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul E Noufi
- Department of Medicine, Georgetown University, Baltimore, MD, USA
| | | | - Jason A Webb
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
| |
Collapse
|
2
|
Shalev D, Robbins-Welty G, Ekwebelem M, Moxley J, Riffin C, Reid MC, Kozlov E. Mental Health Integration and Delivery in the Hospice and Palliative Medicine Setting: A National Survey of Clinicians. J Pain Symptom Manage 2024; 67:77-87. [PMID: 37788757 PMCID: PMC10841817 DOI: 10.1016/j.jpainsymman.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
CONTEXT Mental health comorbidities among individuals with serious illness are prevalent and negatively impact outcomes. Mental healthcare is a core domain of palliative care, but little is known about the experiences of palliative care clinicians delivering such care. OBJECTIVES This national survey aimed to characterize the frequency with which palliative care providers encounter and manage common psychiatric comorbidities, evaluate the degree of mental health integration in their practice settings, and prioritize strategies to meet the mental health needs of palliative care patients. METHODS A e-survey distributed to the American Academy of Hospice and Palliative Medicine membership. RESULTS Seven hundred eight palliative care clinicians (predominantly physicians) were included in the analysis. Mood, anxiety, and neurocognitive disorders were frequently encountered comorbidities that many respondents felt comfortable managing. Respondents felt less comfortable with other psychiatric comorbidities. Eighty percent of respondents noted that patients' mental health status impacted their comfort delivering general palliative care at least some of the time. Mental health screening tool use varied and access to specialist referral or to integrated psychiatrists/psychologists was low. Respondents were unsatisfied with mental health training opportunities. CONCLUSION Palliative care clinicians play a crucial role in addressing mental health comorbidities, but gaps exist in care. Integrated mental health care models, streamlined referral systems, and increased training opportunities can improve mental healthcare for patients with serious illness.
Collapse
Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY; Department of Psychiatry (D.S.), Weill Cornell Medicine, New York, NY.
| | - Gregg Robbins-Welty
- Department of Medicine (G.R.W.), Duke University School of Medicine, Durham, NC; Department of Psychiatry and Behavioral Sciences (G.R.W.), Duke University School of Medicine, Durham, NC
| | - Maureen Ekwebelem
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - Jerad Moxley
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - Catherine Riffin
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - Elissa Kozlov
- Department of Health Behavior, Society, and Policy (E.K.), Rutgers School of Public Health, West Piscataway, NJ
| |
Collapse
|
3
|
Hurwitz O, Chammas D, Shalev D. Psychiatry and Palliative Care: Growing the Interface Through Education. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:540-545. [PMID: 36447070 PMCID: PMC10228389 DOI: 10.1007/s40596-022-01733-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/15/2022] [Indexed: 05/14/2023]
Affiliation(s)
- Olivia Hurwitz
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | | |
Collapse
|
4
|
Shalev D, Ekwebelem MI, Brody LA, Callahan ME, Singh N, Reid MC. Hospice and Palliative Medicine Fellowship Training in Mental Health: A Survey of Program Directors. J Pain Symptom Manage 2023; 66:310-319. [PMID: 37442531 PMCID: PMC10528591 DOI: 10.1016/j.jpainsymman.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023]
Abstract
CONTEXT Psychological and psychiatric care is a core domain of palliative care. Despite a high burden of mental health comorbidity among individuals with serious illness, the Accreditation Council of Graduate Medical Education gives little guidance about training hospice and palliative medicine (HPM) fellows in this domain of care. Currently, there is a lack of empiric data on HPM physician fellowship training in mental health topics. OBJECTIVES To characterize HPM physician fellowship training practices in the psychological and psychiatric aspects of palliative care. METHODS A cross-sectional survey study querying HPM fellowship training directors nationally. RESULTS A total of 95 programs participated (51% response rate). A total of 98% programs offered didactics on mental health topics. Topics universally deemed as important by program directors were commonly taught, but there was variability in both the perceived importance and the didactic coverage of several topics. Only 15% of programs offered core rotations in psychiatry. Most programs offered psychiatry electives, but such electives were only rarely utilized by fellows. Interdisciplinary team (IDT) rounds infrequently included doctoral mental health clinicians. CONCLUSIONS Beyond a few commonly identified and taught key topics, there is variability in clinical and didactic exposure to mental health training among HPM fellowships. Standardizing key learning objectives and guiding educators in how to achieve these objectives could improve the preparedness of the physician workforce in HPM to meet the mental health needs of patients with serious illness.
Collapse
Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA; Department of Psychiatry (D.S), Weill Cornell Medicine, New York, New York, USA.
| | - Maureen I Ekwebelem
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
| | - Lilla A Brody
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
| | - Mary E Callahan
- Department of Medicine (M.E.C), Columbia University Irving Medical Center, New York, New York, USA
| | - Navendra Singh
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
5
|
Shalev D, Patterson M, Aytaman Y, Moya-Tapia MA, Blinderman CD, Silva MD, Reid MC. Operationalizing Depression Screening in Ambulatory Palliative Care: A Quality Improvement Project. J Pain Symptom Manage 2023; 65:e7-e13. [PMID: 36103939 PMCID: PMC9790031 DOI: 10.1016/j.jpainsymman.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/27/2022] [Accepted: 09/01/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Depression is common in the palliative care setting and impacts outcomes. Operationalized screening is unusual in palliative care. LOCAL PROBLEM Lack of operationalized depression screening at two ambulatory palliative care sites. METHODS A fellow-driven quality improvement initiative to implement operationalized depression screening using the patient health questionnaire-2 (PHQ-2). The primary measure was rate of EMR-documented depression screening. Secondary measures were clinician perspectives on the feasibility and acceptability of implementing the PHQ-2. INTERVENTION The intervention is a clinic-wide implementation of PHQ-2 screening supported by note templates, brief clinician training, referral resources for clinicians, and opportunities for indirect psychiatric consultation. RESULTS Operationalized depression screening rates increased from 2% to 38%. All clinicians felt incorporation of depression screening was useful and feasible. CONCLUSIONS Operationalized depression screening is feasible in ambulatory palliative care workflow, though optimization through having screening be completed prior to clinician visit might improve uptake.
Collapse
Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine (D.S., M.D.S., M.C.R.), New York, New York, USA.
| | - Melissa Patterson
- Department of Medicine (M.P., M.A.M.T., C.D.B.), Columbia University Irving Medical Center, New York, New York, USA
| | - Yasemin Aytaman
- Department of Medicine (Y.A.), Brooklyn Campus of the VA NY Harbor Healthcare System, Brooklyn, New York, USA
| | - Manuel A Moya-Tapia
- Department of Medicine (M.P., M.A.M.T., C.D.B.), Columbia University Irving Medical Center, New York, New York, USA
| | - Craig D Blinderman
- Department of Medicine (M.P., M.A.M.T., C.D.B.), Columbia University Irving Medical Center, New York, New York, USA
| | - Milagros D Silva
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine (D.S., M.D.S., M.C.R.), New York, New York, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine (D.S., M.D.S., M.C.R.), New York, New York, USA
| |
Collapse
|
6
|
Jang H, Lee K, Kim S, Kim S. Unmet needs in palliative care for patients with common non-cancer diseases: a cross-sectional study. Palliat Care 2022; 21:151. [PMID: 36038840 PMCID: PMC9426270 DOI: 10.1186/s12904-022-01040-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Non-cancer patients experience the chronic process of disease that increases the patients’ suffering as well as families’ care burden. Although two-thirds of deaths are caused by non-cancer diseases, there is a lack of studies on palliative care for non-cancer patients. This study identified the palliative care needs and satisfaction, anxiety and depression, and health-related quality of life (HRQOL) of non-cancer patients and identified the factors influencing their HRQOL. Methods A cross-sectional survey design was employed. Participants were 114 non-cancer patients with chronic heart failure, stroke, end-stage renal disease, or end-stage liver disease who were admitted to the general ward of a tertiary hospital in South Korea. Measures included the Palliative Care Needs and Satisfaction Scale, the Hospital Anxiety and Depression Scale, and the Medical Outcome Study 36-items Short Form Health Survey version 2. Data were analysed with descriptive statistics, independent t-tests, analyses of variance, Pearson’s correlations, and multiple linear regression analyses. Results The average score of palliative care needs was 3.66 ± 0.62, which falls between ‘moderate’ and ‘necessary’. Among the four domains, the average score of palliative care needs in the psychosocial domain was the highest: 3.83 ± 0.67. Anxiety was nearly in the normal range (7.48 ± 3.60; normal range = 0–7) but depression was higher than normal (9.17 ± 3.71; normal range = 0–7). Similar to patients with cancer, physical HRQOL (38.89 ± 8.69) and mental HRQOL (40.43 ± 11.19) were about 80% of the general population’s score (50 points). Duration of disease and physical performance were significant factors associated with physical HRQOL, whereas physical performance, anxiety, and depression were significant factors associated with mental HRQOL. Conclusion It is necessary to maintain non-cancer patients’ physical performance and assess and manage their mental health in advance for effective palliative care. This study provides relevant information that can be used to develop a tailored palliative care model for non-cancer patients.
Collapse
Affiliation(s)
- Hyoeun Jang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Kyunghwa Lee
- College of Nursing, Konyang University, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, Republic of Korea
| | - Sookyung Kim
- School of Nursing, Soonchunhyang University, 50, Suncheonhyang 4-gil, Dongnam-gu, Chungcheongnam-do, 31151, Cheonan-si, Republic of Korea
| | - Sanghee Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
| |
Collapse
|
7
|
Whitehead K, Ala-Leppilampi K, Lee B, Menagh J, Spaner D. Factors That Determine the Experience of Transition to an Inpatient Palliative Care Unit for Patients and Caregivers: A Qualitative Study. J Palliat Care 2022; 37:579-585. [PMID: 35837725 PMCID: PMC9465532 DOI: 10.1177/08258597221105001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: Transitions in care settings near the end of life can
present challenges to patients and families, especially when there are also
adjustments in level of care and illness trajectory. In this study, we explored
what factors influenced how patients and family caregivers experienced a
transition to an inpatient Palliative Care Unit (PCU). Methods:
This qualitative study was conducted at a PCU in Toronto, Canada.
Semi-structured interviews were held with 29 participants (14 patients and 15
family caregivers) during their time on the PCU. Data was analyzed through an
iterative process of constant comparison to generate themes. The recruitment
process continued to the point of thematic saturation. Results:
Five themes were identified that represented the participants’ experiences in
transitioning to the PCU: Being prepared, Feeling supported, Coming to terms
with end of life issues, Dealing with uncertainty, and Continuity of care.
Conclusions: Our findings highlight the need for clear and
iterative communication with patients and family caregivers during the
transition to a PCU. Identification and consideration of the common themes
involved in the experience of transfer to PCU can help guide future practice and
improve the experience of patients and families during transitions at the end of
life.
Collapse
Affiliation(s)
- Katherine Whitehead
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Salvation Army Toronto Grace Health Centre, Palliative Care Unit, Toronto, ON, Canada
| | | | - Betty Lee
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Salvation Army Toronto Grace Health Centre, Palliative Care Unit, Toronto, ON, Canada
| | - Jacqueline Menagh
- Salvation Army Toronto Grace Health Centre, Palliative Care Unit, Toronto, ON, Canada
| | - Donna Spaner
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Salvation Army Toronto Grace Health Centre, Palliative Care Unit, Toronto, ON, Canada
| |
Collapse
|
8
|
Hamatani Y, Iguchi M, Ikeyama Y, Kunugida A, Ogawa M, Yasuda N, Fujimoto K, Ichihara H, Sakai M, Kinoshita T, Nakashima Y, Akao M. Comprehensive symptom assessment using Integrated Palliative care Outcome Scale in hospitalized heart failure patients. ESC Heart Fail 2022; 9:1963-1975. [PMID: 35307988 PMCID: PMC9065822 DOI: 10.1002/ehf2.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/06/2022] Open
Abstract
Aims Patients with heart failure (HF) may have variable unrecognized symptom burdens. We sought to investigate the details, determinants, and prognostic significance of symptom burden in hospitalized patients with HF. Methods and results We prospectively evaluated consecutive hospitalized patients with HF as primary diagnosis at our institution using the Integrated Palliative care Outcome Scale (IPOS) both on admission and at discharge. The IPOS, which is a well‐validated multi‐dimensional symptom assessment scale among advanced illness, consists of 17 questions for enquiring about physical symptoms (10 items), emotional symptoms (4 items) and communication and practical issues (3 items) using a 5‐point Likert scale (0 [best]–4 [worst] points). Clinically relevant symptoms were defined as ≥2 points for each IPOS item. Worsening symptom burden was defined as the total IPOS score at discharge being poorer than that on admission. Of 294 patients (mean age: 77.5 ± 12.0 years, male: 168 patients, New York Heart Association class IV: 96 patients, mean left ventricular ejection fraction [LVEF]: 44%, and median N‐terminal pro B‐type natriuretic peptide [NT‐proBNP] level: 4418 ng/L), the median (IQR) total IPOS score on admission was 19 (12, 27) and they were widely distributed (minimum: 0 – maximum: 52). The total IPOS score on admission was not correlated with the HF severity, including LVEF (Spearman's ρ = −0.05, P = 0.43), NT‐proBNP levels (Spearman's ρ = 0.08, P = 0.20) or in‐hospital mortality prediction model (GWTG‐HF risk score) (Spearman's ρ = 0.01, P = 0.90). Total IPOS scores significantly decreased during hospitalization as a whole (median [IQR]: 13 [6, 21] at discharge; P < 0.001 vs. those on admission). All of the four emotional symptoms (patient anxiety, depression, family anxiety and feeling at peace) remained in the top 5 of clinically relevant symptoms at discharge, whereas none of 10 physical symptoms were nominated. Worsening symptom burden was noted in 28% of the patients during hospitalization, and was independently associated with higher all‐cause mortality after discharge (hazard ratio: 2.28, 95% confidence interval: 1.02–5.09; P = 0.044) even after adjustment by age and HF mortality prediction model (MAGGIC risk score). Conclusions We revealed that hospitalized patients with HF had multi‐dimensional symptom burdens which varied among individuals and were not correlated with the disease severity. Emotional symptoms, such as anxiety and depression, were the main clinically relevant symptoms at discharge. A worsening IPOS score was noted in a quarter of patients with HF and was associated with a poor prognosis, suggesting the importance of holistic symptom assessment during the course of hospitalization for HF.
Collapse
Affiliation(s)
- Yasuhiro Hamatani
- Department of Cardiology National Hospital Organization Kyoto Medical Center 1‐1, Mukaihata‐cho, Fukakusa, Fushimi‐ku Kyoto 612‐8555 Japan
| | - Moritake Iguchi
- Department of Cardiology National Hospital Organization Kyoto Medical Center 1‐1, Mukaihata‐cho, Fukakusa, Fushimi‐ku Kyoto 612‐8555 Japan
| | - Yurika Ikeyama
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Atsuko Kunugida
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Megumi Ogawa
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Natsushige Yasuda
- Department of Rehabilitation National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kana Fujimoto
- Department of Pharmacy National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Hidenori Ichihara
- Department of Pharmacy National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Misaki Sakai
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
- Department of Palliative Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Tae Kinoshita
- Department of Palliative Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Yasuyo Nakashima
- Department of Rehabilitation National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Masaharu Akao
- Department of Cardiology National Hospital Organization Kyoto Medical Center 1‐1, Mukaihata‐cho, Fukakusa, Fushimi‐ku Kyoto 612‐8555 Japan
| |
Collapse
|
9
|
Roch C, Heckel M, van Oorschot B, Alt-Epping B, Tewes M. Screening for Palliative Care Needs: Pilot Data From German Comprehensive Cancer Centers. JCO Oncol Pract 2021; 17:e1584-e1591. [PMID: 33571007 DOI: 10.1200/op.20.00698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Guidelines recommend several screening tools to identify patients with complex palliative needs. This diversity and lack of structural recommendations offer a wide scope for implementing screening. Against this background, the current status of implementation at German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid has not yet been investigated. METHODS e-mail survey of the 17 hospital sites of the 13 CCCs. The questionnaire asked for structural characteristics of the centers as well as preconditions of the screening process. Structurally established screening procedures (one item) and standardized workflows, modes of performance, screening tools (four items), modes of training how to screen, and responsibilities (two items) were assessed. RESULTS In a 2-month period, 15 hospital sites responded; seven hospital sites conducted a palliative care needs (PCN) screening. Only one hospital site carried out PCN screening in almost all oncology departments, but only with the distress thermometer. Other hospital sites determined palliative needs by assessing physical symptoms using the Integrated Palliative Care Outcome Scale or the Minimal Documentation System, and two hospital sites combined tools to determine both physical and psychological stress. The type of screening varied from paper-pencil-based to tablet computer-based documentation. The main barriers to implementation were identified as a lack of human resources and a lack of structural conditions. CONCLUSION There is a lack of consensus among palliative care specialists and oncologists in the CCCs supported by the German Cancer Aid in PCN screening as well as of structured guidelines and the professional association. Structural requirements should be adapted to these needs, which include both technical and human resources. A combined psycho-oncologic and palliative care screening might help to formulate best practice recommendations.
Collapse
Affiliation(s)
- Carmen Roch
- Interdisciplinary Center for Palliative Medicine, CCC Mainfranken, University Hospital Wuerzburg, Julius-Maximilians-Universität Würzburg, Wuerzburg, Germany
| | - Maria Heckel
- Department of Palliative Medicine, CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Center for Palliative Medicine, CCC Mainfranken, University Hospital Wuerzburg, Julius-Maximilians-Universität Würzburg, Wuerzburg, Germany
| | - Bernd Alt-Epping
- Heidelberg University Hospital, Department of Palliative Medicine, Heidelberg, Germany
| | - Mitra Tewes
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Essen, Germany
| |
Collapse
|