1
|
Di Lorenzo S, Mozzi L, Salmaso F, Silvagni C, Soffientini S, Valenti V, Zagonel V. A multicentre survey on the perception of palliative care among health professionals working in haematology. Support Care Cancer 2024; 32:253. [PMID: 38536470 PMCID: PMC10973048 DOI: 10.1007/s00520-024-08452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/20/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Patients with haematologic malignancies have less access to palliative care and are referred later than patients with solid tumours. We developed a survey to investigate this phenomenon, with the intention of analysing palliative care perceptions among health professionals who treat haematology patients and identifying barriers and facilitators to referrals to palliative care services. METHODS This was a multicentre exploratory descriptive web-based survey. A questionnaire was administered to 320 medical and nursing staff members from five Italian haematological units and San Marino's hospital to investigate their perception of palliative care. Quantitative and qualitative analyses were performed. RESULTS A total of 142/320 healthcare professionals completed the survey, achieving a 44% response rate. Most of the respondents supported the integration of haematology and palliative care and were aware of the role of palliative care. Despite this, only half had an in-hospital palliative care team, and only a few had previously attended a specific training course. The majority agreed with palliative care referral when the prognosis was less than 3 months or when the symptoms were incoercible and with blood transfusions even in the last stages of the disease. Many considered the presence of an in-hospital palliative care team or a case manager, as well as structured palliative care training, as fundamental facilitators of palliative care referrals. CONCLUSION These results showed that healthcare professionals in haematology generally hold a favourable attitude and a high interest in integrating palliative care into their patients' care. The low referral rate could depend on clinical, cultural, and organisational issues.
Collapse
Affiliation(s)
- Sara Di Lorenzo
- Clinical Hematology and Bone Marrow Transplant and Cellular Therapies Center, Carlo Melzi", Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Lisa Mozzi
- Clinical Hematology, Azienda Ospedaliera Ulss 8 Berica, "St. Bortolo" Hospital, Vicenza, Italy
| | - Flavia Salmaso
- Palliative Care Unit, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
| | - Claudia Silvagni
- Continuity of Care Center, Istituto Per La Sicurezza Sociale, Cailungo, Republic of San Marino
| | - Silvia Soffientini
- Integrated Home Care Unit, AULLS 6 Euganea - Terme Colli District, Padua, Italy
| | - Vanessa Valenti
- Palliative Care Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), "Dino Amadori", Via P. Maroncelli 40, Meldola, FC, 47014, Italy.
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
| |
Collapse
|
2
|
Mercadante S, Villari P, David F. Palliative sedation outside a palliative care unit. BMJ Support Palliat Care 2023; 13:e297-e299. [PMID: 33597167 DOI: 10.1136/bmjspcare-2020-002494] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/08/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The need of acute transition from an intensive care setting to an end-of-life setting requires collaboration and experience. Variable information exists on palliative sedation in traditional palliative care settings, including home care, hospices or palliative care units. MATERIALS Four cases which required a rapid decision-making to alleviate suffering in patients close to death are described. RESULTS Despite having different clinical pathways leading to intensive but medically non-beneficial treatments, patients were converted to a rapid transition of care in the unit where they had been admitted, due to different logistic reasons. An appropriate discussion with relatives about the short prognosis and the need to sedate for controlling suffering in the last hours of life was fundamental in preventing further suffering with intensive treatments. CONCLUSIONS These clinical notes suggest that palliative care and end-of-life measures should be also expanded in other settings, where palliative care issues are traditionally not properly assessed, implementing the collaboration with other colleagues with different clinical extractions.
Collapse
Affiliation(s)
- Sebastiano Mercadante
- Pain Relief and Supportive Care, Private Hospital La Maddalena, Palermo, Sicilia, Italy
| | - Patrizia Villari
- Anesthesia, Private Hospital La Maddalena, Palermo, Sicilia, Italy
| | - Fabrizio David
- Anesthesia, Private Hospital La Maddalena, Palermo, Sicilia, Italy
| |
Collapse
|
3
|
Noh H, Bui C, Mack JW. Factors Affecting Hospice Use Among Adolescents and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2023; 12:151-158. [PMID: 35639128 PMCID: PMC10124177 DOI: 10.1089/jayao.2021.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background/Objective: Compared to existing studies on end-of-life care of mid- to older-aged patients diagnosed with cancer, there is a paucity of research on adolescents and young adult (AYA) patients. Guided by the Anderson's Behavioral Model for Healthcare Utilization, this study examined predisposing/enabling/need factors associated with hospice referral/enrollment among AYA patients diagnosed with cancer. Methods: Data were drawn from medical records of AYA patients who died of cancer between January 2013 and December 2016 at three academic sites in the United States and were 15-39 years old at the time of death. Logistic regression was conducted (N = 224). Results: Findings showed that hospice referral was strongly associated with hospice enrollment (odds ratio [OR] = 69.68, p < 0.0001). White patients were more likely to be referred to hospice care than non-White patients; the effect was, however, significant only among patients with private insurance (OR = 3.44, p = 0.040). Patients with public insurance were more likely to be referred to hospice than those with private insurance; the effect was, however, significant only among non-White patients (OR = 5.66, p = 0.005). Among those not receiving cancer treatment in the last month of life (LML), patients with hematologic malignancies were less likely to be referred to hospice than those with solid tumors (OR = 0.19). Among patients with solid tumors, receiving cancer treatment in the LML lowered the odds of hospice referral (OR = 0.50, p = 0.043). Conclusion: Further research efforts are needed to investigate the role of race, insurance, cancer types, and treatments in hospice use among bigger samples of AYA patients diagnosed with cancer.
Collapse
Affiliation(s)
- Hyunjin Noh
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Chuong Bui
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Jennifer W. Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Pallotti MC, Rossi R, Scarpi E, Dall'Agata M, Ricci M, Ceccolini M, Ronconi S, Valenti V, Maltoni M, Martinelli G, Cerchione C. Patients with multiple myeloma referred for palliative care consultation: from retrospective analysis to future directions to improve clinical outcomes. Support Care Cancer 2021; 30:2293-2298. [PMID: 34718886 PMCID: PMC8795014 DOI: 10.1007/s00520-021-06560-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022]
Abstract
Introduction New treatments have improved the overall survival of patients with multiple myeloma (MM). At diagnosis and during the course of the disease, patients often report pain and other symptoms. Given the long disease trajectory, psychological and social issues are also frequent. Recently, the potential usefulness of early palliative care (EPC) was hypothesized in the area of hematology. We conducted a retrospective analysis of patients with MM referred to our institute for a palliative care (PC) consultation between January 2017 and June 2020. Our aim was to evaluate the main reasons (pain or other clinical symptoms) for the referral for a first PC consultation. Methods We examined the main reasons for the first PC consultation, the number of PC consultations carried out, and the period of time between diagnosis, first and subsequent PC visits, and death. We also recorded information on the type of pain experienced and the treatments administered. Results Of the 325 patients with MM followed at our hematology unit during the study period, 43 were referred for a PC consultation (39 for pain management and 4 to determine the most appropriate care setting (hospice or palliative homecare service)). Nineteen (44.2%) of the 43 patients reported other symptoms in addition to pain. The median time between MM diagnosis and the first PC consultation was 473 days. Fifteen patients died, with a median 332 days between the first PC visit and death. Conclusion Randomized studies on MM involving larger patient populations with access to EPC are needed to identify an effective clinical model to improve the management of patients with MM.
Collapse
Affiliation(s)
- Maria Caterina Pallotti
- Palliative Care Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, FC, Italy.
| | - Romina Rossi
- Palliative Care Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, FC, Italy
| | - Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Monia Dall'Agata
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Marianna Ricci
- Palliative Care Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, FC, Italy
| | - Michela Ceccolini
- Hematology Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Sonia Ronconi
- Hematology Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Vanessa Valenti
- Palliative Care Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, FC, Italy
| | - Marco Maltoni
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria Bologna, Bologna, Italy.,Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - Giovanni Martinelli
- Scientific Directorate, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Claudio Cerchione
- Hematology Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| |
Collapse
|
5
|
Kassam A, Gupta A, Rapoport A, Srikanthan A, Sutradhar R, Luo J, Widger K, Wolfe J, Earle C, Gupta S. Impact of Palliative Care Involvement on End-of-Life Care Patterns Among Adolescents and Young Adults With Cancer: A Population-Based Cohort Study. J Clin Oncol 2021; 39:2506-2515. [PMID: 34097441 DOI: 10.1200/jco.20.03698] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Evidence suggests that adolescents and young adults (AYAs) with cancer (defined as age 15-39 years) receive high-intensity (HI) medical care at the end-of-life (EOL). Previous population-level studies are limited and lack information on the impact of palliative care (PC) provision. We evaluated prevalence and predictors of HI-EOL care in AYAs with cancer in Ontario, Canada. A secondary aim was to evaluate the impact of PC physicians on the intensity of EOL care in AYAs. METHODS A retrospective decedent cohort of AYAs with cancer who died between 2000 and 2017 in Ontario, Canada, was assembled using a provincial registry and linked to population-based health care data. On the basis of previous studies, the primary composite measure HI-EOL care included any of the following: intravenous chemotherapy < 14 days from death, more than one emergency department visit, and more than one hospitalization or intensive care unit admission < 30 days from death. Secondary measures included the most invasive (MI) EOL care (eg, mechanical ventilation < 14 days from death) and PC physician involvement. We determined predictors of outcomes using appropriate regression models. RESULTS Of 7,122 AYAs, 43.8% experienced HI-EOL care. PC physician involvement (odds ratio [OR], 0.57; 95% CI, 0.51 to 0.63) and older age at death (OR, 0.60; 95% CI, 0.48 to 0.74) were associated with a lower risk of HI-EOL care. AYAs with hematologic malignancies were at highest risk for HI and MI-EOL care. PC physician involvement substantially reduced the odds of mechanical ventilation at EOL (OR, 0.36; 95% CI, 0.30 to 0.43). CONCLUSION A large proportion of AYAs with cancer experience HI-EOL care. Our study provides strong evidence that PC physician involvement can help mitigate the risk of HI and MI-EOL care in AYAs with cancer.
Collapse
Affiliation(s)
- Alisha Kassam
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics and Division of Palliative Care, Southlake Regional Health Centre, Newmarket, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abha Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Adam Rapoport
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, ON, Canada.,Emily's House Children's Hospice, Toronto, ON, Canada
| | - Amirrtha Srikanthan
- Department of Medical Oncology, The Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Toronto, ON, Canada
| | - Rinku Sutradhar
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Jin Luo
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Kimberley Widger
- Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Craig Earle
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Bramati P, Hui D, Bruera E. Integrated Palliative and Oncology Care for Patients With Acute Myeloid Leukemia-Moving From Evidence to Practice. JAMA Oncol 2021; 7:943. [PMID: 33885730 DOI: 10.1001/jamaoncol.2021.0706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Patricia Bramati
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
7
|
Franjul Sánchez A, Fuentes Armesto AM, Briones Chávez C, Ruiz M. Revisiting Early Palliative Care for Patients With Hematologic Malignancies and Bone Marrow Transplant: Why the Delay? Cureus 2020; 12:e10504. [PMID: 32963924 PMCID: PMC7500707 DOI: 10.7759/cureus.10504] [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: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/12/2022] Open
Abstract
Palliative care has been defined as specialized care for patients facing serious illnesses. Despite advancements in the field and studies documenting the effectiveness of early palliative care (PC) interventions in seriously ill patients, the fields of hematologic malignancies and bone marrow transplant still lag behind of a comprehensive framework for early and effective interventions. The aim of this literature review is to analyze and discuss the possible barriers to care and delayed referrals for hematologic malignancies and bone marrow transplant patients. Using the EBSCO and PubMed databases, articles regarding PC among patients with hematologic malignancies and bone marrow transplant were analyzed. There are three main domains with its respective barriers in PC: physicians, patients and caregivers, and the healthcare system. Issues that were identified included the lack of knowledge and misconceptions about PC among physicians, patients, and caregivers, delayed referral of patients with hematologic malignancies, unrealistic treatment expectations, lack of communication between specialties, difficulties with appointment availability, geographical distance between clinics, and lack of insurance coverage for PC services. We suggest possible alternatives including obligatory continuing medical education (CME) credits, loan forgiveness, rotations during residency and fellowship training, use of informational videos and pamphlets to educate patients and caregivers, obligatory early consults despite prognosis, an algorithm to evaluate patient's needs, creating a platform within electronic medical records (EMR) systems shared by specialties, and having PC service in every cancer center. Findings suggest a need for further studies aimed towards implementing solutions to increase the early referral of patients with hematologic malignancies and bone marrow transplantation (BMT) to palliative care.
Collapse
Affiliation(s)
| | | | | | - Marco Ruiz
- Hematology and Oncology, Miami Cancer Institute, Miami, USA
| |
Collapse
|
8
|
Affiliation(s)
- Josep Porta-Sales
- 1 Support and Palliative Care Service, Institut Català d'Oncologia, Girona, Spain
| | - Simon Noble
- 2 Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| |
Collapse
|