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Tranung M, Solheim TS, Løhre ET, Marsaa K, Faksvåg Haugen D, Laird B, Thronæs M, Due Larsen M. Midazolam Indications and Dosing in Palliative Medicine: Results from a Multinational Survey. Curr Oncol 2024; 31:4093-4104. [PMID: 39057177 PMCID: PMC11276578 DOI: 10.3390/curroncol31070305] [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: 05/28/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Despite sparse evidence and limited guidance on indications, use, and dosing, midazolam is widely used in palliative care. We aimed to describe and compare the use of midazolam in three different countries to improve clinical practice in palliative care. We performed an online survey among palliative care physicians in Norway, Denmark, and the United Kingdom (UK). The focus was indications, dosing, administration, and concomitant drugs. A web-based questionnaire was distributed to members of the respective national palliative medicine associations. The total response rate was 9.4%. Practices in the UK, Norway, and Denmark were overall similar regarding the indications of midazolam for anxiety, dyspnoea, and pain treatment in combination with opioids. However, physicians in the UK used a higher starting dose for anxiety, dyspnoea, and pain treatment compared to Norway and Denmark, as well as a higher maximum dose. Danish physicians preferred, to a higher degree, on-demand midazolam administration. Despite practice similarities in the UK, Norway, and Denmark, differences exist for midazolam dosing and administration in palliative medicine. We demonstrated a lack of consensus on how midazolam should be used in palliative care, setting the stage for future studies on the topic.
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Affiliation(s)
- Morten Tranung
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (T.S.S.); (E.T.L.); (M.T.); (M.D.L.)
- Department of Clinical Pharmacy, Trondheim Hospital Pharmacy, 7030 Trondheim, Norway
| | - Tora Skeidsvoll Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (T.S.S.); (E.T.L.); (M.T.); (M.D.L.)
- Cancer Clinic, Trondheim University Hospital, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Erik Torbjørn Løhre
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (T.S.S.); (E.T.L.); (M.T.); (M.D.L.)
- Cancer Clinic, Trondheim University Hospital, St. Olavs Hospital, 7030 Trondheim, Norway
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5006 Bergen, Norway
| | - Kristoffer Marsaa
- Department of Multidisease, Copenhagen University Hospital—North Zealand, 3400 Hilleroed, Denmark;
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, 5009 Bergen, Norway;
- Department of Clinical Medicine K1, University of Bergen, 5007 Bergen, Norway
| | - Barry Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH8 9YL, UK;
| | - Morten Thronæs
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (T.S.S.); (E.T.L.); (M.T.); (M.D.L.)
- Cancer Clinic, Trondheim University Hospital, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Michael Due Larsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (T.S.S.); (E.T.L.); (M.T.); (M.D.L.)
- Centre for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark
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Weng XR, Nakdali R, Almoosawi B, Al Saeed M, Maiser S, Al Banna M. Health Care Providers' Attitudes and Beliefs on Providing Palliative Care to Patients in Bahrain: Findings From a Qualitative Study. J Pain Symptom Manage 2021; 62:98-106.e1. [PMID: 33188863 DOI: 10.1016/j.jpainsymman.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/22/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022]
Abstract
CONTEXT Present studies suggested that cultural and religious factors, as well as law and policy, may have impeded the advancement of palliative care in the Middle East. Little is known about health care providers' perceptions of palliative care and the barriers to its development in the Gulf Cooperation Council. OBJECTIVES To understand health care professionals' attitudes and beliefs regarding palliative care and highlight current practice barriers in Bahrain. METHODS Semistructured interviews with 16 health care providers (physicians and nurses) were conducted. Thematic analysis was then performed after interviews were transcribed verbatim. RESULTS Health care professionals perceived palliative care as a service only delivered to patients at the end of life. Palliative care was only offered to patients who have been diagnosed with cancer and had exhausted all curative treatments. Do-not-resuscitate orders and code status discussions are not currently practiced. Palliative care decisions are usually decided by patients' families. Middle Eastern culture, health care law and policy, conservative interpretations of Islam, and a lack of professional expertise were identified as barriers. CONCLUSION This study unveiled the perceptions of palliative care among health care professionals in a Gulf Cooperation Council country. Six major barriers that hindered palliative care practice were identified. Future health care policy in the region needs to address these barriers within the current health care system while taking culture, religion, and social factors into consideration.
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Affiliation(s)
- Xingran R Weng
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rama Nakdali
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Barrak Almoosawi
- Department of Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | | | - Samuel Maiser
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mona Al Banna
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA.
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Kenny C, Regan J, Balding L, Higgins S, O'Leary N, Kelleher F, McDermott R, Armstrong J, Mihai A, Tiernan E, Westrup J, Thirion P, Walsh D. Dysphagia Prevalence and Predictors in Cancers Outside the Head, Neck, and Upper Gastrointestinal Tract. J Pain Symptom Manage 2019; 58:949-958.e2. [PMID: 31445137 DOI: 10.1016/j.jpainsymman.2019.06.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 01/14/2023]
Abstract
CONTEXT Dysphagia is usually associated with malignancies of the head, neck, and upper gastrointestinal tract but also occurs in those with tumors outside anatomic swallow regions. It can lead to aspiration pneumonia, malnutrition, reduced quality of life, and psychosocial distress. No studies have yet reliably described dysphagia prevalence in those with malignancies outside anatomic swallow regions. OBJECTIVE The objective of this study was to establish the prevalence and predictors of dysphagia in adults with solid malignancies outside the head, neck, and upper gastrointestinal tract. METHODS A cross-sectional, observational study using consecutive sampling was conducted. There were 385 participants (mean age 66 ± 12 years) with 21 different primary cancer sites from two acute hospitals and one hospice. Locoregional disease was present in 33%, metastatic in 67%. Dysphagia was screened by empirical questionnaire and confirmed through swallow evaluation. Demographic and clinical predictors were determined by univariate and multivariate binary regression. RESULTS Dysphagia occurred in 19% of those with malignancies outside anatomic swallow regions. Prevalence was 30% in palliative care and 32% in hospice care. Dysphagia was most strongly associated with cough, nausea, and worse performance status. It was also associated with lower quality of life and nutritional difficulties. CONCLUSION Dysphagia was common and usually undiagnosed before study participation. It occurred at all disease stages but coincided with functional decline. It may therefore represent a cancer frailty marker. Oncology and palliative care services should routinely screen for this symptom. Timely dysphagia identification and management may improve patient well-being and prevent adverse effects like aspiration pneumonia and weight loss.
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Affiliation(s)
- Ciarán Kenny
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland; Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland.
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Lucy Balding
- Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Norma O'Leary
- Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | | | - Ray McDermott
- Tallaght University Hospital, Dublin, Ireland; Beacon Hospital, Dublin, Ireland
| | | | | | | | | | | | - Declan Walsh
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland; Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
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Sigurdardottir KR, Hjermstad MJ, Filbet M, Tricou C, McQuillan R, Costantini M, Autelitano C, Bennett MI, Haugen DF. Pilot testing of the first version of the European Association for Palliative Care basic dataset: A mixed methods study. Palliat Med 2019; 33:832-849. [PMID: 31023149 DOI: 10.1177/0269216319844439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inadequate description of palliative care cancer patients in research studies often leads to results having limited generalizability. To standardize the description of the sample, the European Association for Palliative Care basic data set was developed, with 31 core demographic and disease-related variables. AIM To pilot test the data set to check acceptability, comprehensibility and feasibility. DESIGN International, multi-centre pilot study at nine study sites in five European countries, using mixed methods. SETTING/PARTICIPANTS Adult cancer patients and staff in palliative care units, hospices and home care. RESULTS In all, 191 patients (544 screened) and 190 health care personnel were included. Median time to fill in the patient form was 5 min and the health care personnel form was 7 min. Ethnicity was the most challenging item for patients and requires decisions at a national level about whether or how to include. Health care personnel found weight loss, principal diagnosis, additional diagnoses and stage of non-cancer diseases most difficult to respond to. Registration of diagnoses will be changed from International Statistical Classification of Diseases and Related Health Problems, 10th version code to a predefined list, while weight loss and stage of non-cancer diseases will be removed. The pilot study has led to rewording of items, improvement in response options and shortening of the data set to 29 items. CONCLUSION Pilot testing of the first version of the European Association for Palliative Care basic data set confirmed that patients and health care personnel understand the questions in a consistent manner and can answer within an acceptable timeframe. The pilot testing has led to improvement, and the new version is now subject to further testing.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- 1 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,2 European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,3 Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Marianne J Hjermstad
- 2 European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marilene Filbet
- 4 Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Colombe Tricou
- 4 Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | | | - Massimo Costantini
- 6 Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Autelitano
- 7 Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michael I Bennett
- 8 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Dagny Faksvåg Haugen
- 1 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,9 Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Nicholson E, Murphy T, Larkin P, Normand C, Guerin S. Findings From a Thematic Synthesis of Key Messages From a Palliative Care Research Network: The KINDLE Project. Am J Hosp Palliat Care 2018; 36:241-248. [PMID: 30360632 DOI: 10.1177/1049909118806461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Effective palliative care requires a strong evidence base to advance clinical practice and policy-making. Calls for more collaborative and strategic approaches to research have resulted in the development of research networks at national and wider regional levels. AIM The aim was to synthesize the learning arising from the activities of the Palliative Care Research Network from the island of Ireland, in order to identify the overarching messages from these activities. The ultimate aim is to promote the communication of these messages to practice. DESIGN The study developed a systematic search process influenced by Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, with analysis of data adopting a qualitative critical interpretative synthesis approach using thematic synthesis. PARTICIPANTS In total, 142 dissemination products were sourced from 22 associated projects, including peer-reviewed publications, conference presentations, reports, and web/social media posts. RESULTS The synthesis of dissemination products identified 4 key themes relating to palliative care research and practice: (1) addressing the needs of patients while recognizing the caregiver role, (2) equal access to connected services, (3) general and specific needs in palliative care research, and (4) challenges in palliative care research. CONCLUSIONS The key themes identified relate to challenges in both practice and research, highlighting the complexity of palliative care provision that aims to support both patients and carers, and research in this area. However, an important implication is the need for a broader approach to dissemination (beyond traditional academic activities) to ensure that research in palliative care is well placed to inform both practice and policy.
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Affiliation(s)
- Emma Nicholson
- All Ireland Institute of Hospice and Palliative Care, Education and Research Centre, Our Lady's Hospice and Care Services, Harold's Cross, DUB, Ireland
| | - Tara Murphy
- All Ireland Institute of Hospice and Palliative Care, Education and Research Centre, Our Lady's Hospice and Care Services, Harold's Cross, DUB, Ireland
| | - Philip Larkin
- UCD School of Nursing, Midwifery and Health Systems, UCD College of Health Sciences, Belfield, DUB, Ireland.,Palliative Care Research Network, All Ireland Institute for Hospice and Palliative Care, Harold's Cross, DUB, Ireland
| | - Charles Normand
- Palliative Care Research Network, All Ireland Institute for Hospice and Palliative Care, Harold's Cross, DUB, Ireland.,Trinity College Dublin, School of Medicine, DUB, Ireland
| | - Suzanne Guerin
- Palliative Care Research Network, All Ireland Institute for Hospice and Palliative Care, Harold's Cross, DUB, Ireland.,UCD School of Psychology, Newman Building, University College Dublin, Belfield, DUB, Ireland
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Fox S, FitzGerald C, Harrison Dening K, Irving K, Kernohan WG, Treloar A, Oliver D, Guerin S, Timmons S. Better palliative care for people with a dementia: summary of interdisciplinary workshop highlighting current gaps and recommendations for future research. BMC Palliat Care 2017; 17:9. [PMID: 28705196 PMCID: PMC5512895 DOI: 10.1186/s12904-017-0221-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/29/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Dementia is the most common neurological disorder worldwide and is a life-limiting condition, but very often is not recognised as such. People with dementia, and their carers, have been shown to have palliative care needs equal in extent to those of cancer patients. However, many people with advanced dementia are not routinely being assessed to determine their palliative care needs, and it is not clear why this is so. MAIN BODY An interdisciplinary workshop on "Palliative Care in Neurodegeneration, with a focus on Dementia", was held in Cork, Ireland, in May 2016. The key aim of this workshop was to discuss the evidence base for palliative care for people with dementia, to identify 'gaps' for clinical research, and to make recommendations for interdisciplinary research practice. To lead the discussion throughout the day a multidisciplinary panel of expert speakers were brought together, including both researchers and clinicians from across Ireland and the UK. Targeted invitations were sent to attendees ensuring all key stakeholders were present to contribute to discussions. In total, 49 experts representing 17 different academic and practice settings, attended. Key topics for discussion were pre-selected based on previously identified research priorities (e.g. James Lind Alliance) and stakeholder input. Key discussion topics included: i. Advance Care Planning for people with Dementia; ii. Personhood in End-of-life Dementia care; iii. Topics in the care of advanced dementia at home. These topics were used as a starting point, and the ethos of the workshop was that the attendees could stimulate discussion and debate in any relevant area, not just the key topics, summarised under iv. Other priorities. CONCLUSIONS The care experienced by people with dementia and their families has the potential to be improved; palliative care frameworks may have much to offer in this endeavour. However, a solid evidence base is required to translate palliative care into practice in the context of dementia. This paper presents suggested research priorities as a starting point to build this evidence base. An interdisciplinary approach to research and priority setting is essential to develop actionable knowledge in this area.
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Affiliation(s)
- Siobhán Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St Finbarr's Hospital, Douglas road, Cork, T21XH60, Republic of Ireland.
| | - Carol FitzGerald
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St Finbarr's Hospital, Douglas road, Cork, T21XH60, Republic of Ireland
| | | | - Kate Irving
- Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - W George Kernohan
- Institute of Nursing and Health Research, Ulster University, Co., Antrim, UK
| | | | - David Oliver
- Tizard Centre, University of Kent, Canterbury, UK.,EAPC Board Member, European Association of Palliative Care, Vilvoorde, Belgium
| | - Suzanne Guerin
- Research Design & Analysis, School of Psychology, University College Dublin, Dublin, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St Finbarr's Hospital, Douglas road, Cork, T21XH60, Republic of Ireland
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Kühne F, Meinders C, Mohr H, Hafenbrack K, Kieseritzky K, Rosenberger C, Härter M, Schulz-Kindermann F, Klinger R, Nestoriuc AY. Schmerzpsychologische Interventionen bei onkologischen Patienten. Schmerz 2016; 30:496-509. [DOI: 10.1007/s00482-016-0169-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Brenne E, Loge JH, Lie H, Hjermstad MJ, Fayers PM, Kaasa S. The Edmonton Symptom Assessment System: Poor performance as screener for major depression in patients with incurable cancer. Palliat Med 2016; 30:587-98. [PMID: 26763008 DOI: 10.1177/0269216315620082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with advanced cancer, sometimes of a severity that fulfil the criteria for a major depressive episode. AIM The aim of this study was to investigate how the item on depression in the Edmonton Symptom Assessment System with a 0-10 Numerical Rating Scale performed as a screener for major depressive episode. A possible improved performance by adding the Edmonton Symptom Assessment System-Anxiety item was also examined. DESIGN An international cross-sectional study including patients with incurable cancer was conducted. The Edmonton Symptom Assessment System score was compared against major depressive episode as assessed by the Patient Health Questionnaire-9. Screening performance was examined by sensitivity, specificity and the kappa coefficient. SETTING Patients with incurable cancer (n = 969), median age 63 years and from eight nationalities provided report. Median Karnofsky Performance Status was 70. Median survival was 229 days (205-255 days). RESULTS Patient Health Questionnaire-9 major depressive episode was present in 133 of 969 patients (13.7%). Edmonton Symptom Assessment System-Depression screening ability for Patient Health Questionnaire-9 major depressive episode was limited. Area under the receiver operating characteristic curve was 0.71 (0.66-0.76). Valid detection or exclusion of Patient Health Questionnaire-9 major depressive episode could not be concluded at any Edmonton Symptom Assessment System-Depression cut-off; by the cut-off Numerical Rating Scale ⩾ 2, sensitivity was 0.69 and specificity was 0.60. By the cut-off Numerical Rating Scale ⩾ 4, sensitivity was 0.51 and specificity was 0.82. Combined mean ratings by Edmonton Symptom Assessment System-Depression and Edmonton Symptom Assessment System-Anxiety revealed similar limited screening ability. CONCLUSION The depression and anxiety items of the Edmonton Symptom Assessment System, a frequently used assessment tool in palliative care settings, seem to measure a construct other than major depressive episode as assessed by the Patient Health Questionnaire-9 instrument.
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Affiliation(s)
- Elisabeth Brenne
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jon H Loge
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Hanne Lie
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Marianne J Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Peter M Fayers
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Public Health, Aberdeen University Medical School, Aberdeen City, UK
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Abstract
There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by ‘gold standard’ randomised controlled trials (RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves considerations of the patient’s physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This review uses examples of the management of cancer-related fatigue and death rattle (noisy breathing) to demonstrate the current state of EBM in palliative care. The future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a ‘mixed methods approach’ are likely to pose the correct clinical questions and derive evidence-based yet clinically relevant outcomes.
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Affiliation(s)
- Claire Visser
- 1 Harris Manchester College, University of Oxford, Oxford OX3 9DU, UK ; 2 Sir Michael Sobell House, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK
| | - Gina Hadley
- 1 Harris Manchester College, University of Oxford, Oxford OX3 9DU, UK ; 2 Sir Michael Sobell House, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK
| | - Bee Wee
- 1 Harris Manchester College, University of Oxford, Oxford OX3 9DU, UK ; 2 Sir Michael Sobell House, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK
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Abstract
ABSTRACTObjective:The difficulties in conducting palliative care research have been widely acknowledged. In order to generate the evidence needed to underpin palliative care provision, collaborative research is considered essential. Prior to formalizing the development of a research network for the state of Victoria, Australia, a preliminary study was undertaken to ascertain interest and recommendations for the design of such a collaboration.Method:Three data-collection strategies were used: a cross-sectional questionnaire, interviews, and workshops. The questionnaire was completed by multidisciplinary palliative care specialists from across the state (n = 61); interviews were conducted with senior clinicians and academics (n = 21) followed by two stakeholder workshops (n = 29). The questionnaire was constructed specifically for this study, measuring involvement of and perceptions of palliative care research.Results:Both the interview and the questionnaire data demonstrated strong support for a palliative care research network and aided in establishing a research agenda. The stakeholder workshops assisted with strategies for the formation of the Palliative Care Research Network Victoria (PCRNV) and guided the development of the mission and strategic plan.Significance of results:The research and efforts to date to establish the PCRNV are encouraging and provide optimism for the evolution of palliative care research in Australia. The international implications are highlighted.
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An examination of the research priorities for a hospice service in New Zealand: A Delphi study. Palliat Support Care 2015; 14:232-40. [DOI: 10.1017/s1478951515000838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectives:Palliative care research is relatively diverse and prioritizing research in this field is dependent on multiple factors such as complex ethical decisions in designing and conducting the research; access to participants who may be deemed “vulnerable” and an increasingly medically focused approach to care. The aim of this study was to inform organizational decision-making and policy development regarding future research priorities for a hospice service in New Zealand.Methods:A modified three-round Delphi technique was employed. Participants were drawn from one dedicated specialist palliative care service that delivers care in the community, day-care, hospice inpatient, aged residential care, and acute hospital palliative care service. A purposive sample included palliative care staff (n = 10, 18, 9, for rounds 1–3, respectively) volunteers (n = 10, 12, 11); and patients and family carers (n = 6, 8, for rounds 1 and 2). Patients and family carers were not involved in the third round.Results:At final ranking of six research themes encompassing 23 research topics were identified by staff and volunteers. These were: symptom management; aged care; education; community; patient and family; and bereavement support and young people. Patients and family carers agreed on four themes, made up of 10 research topics. These were: decision-making, bereavement and loss, symptom management; and recognition of need and response of service.Significance of results:The study generated a rich set of research themes and specific research topics. The perspectives of staff and volunteers are significantly different from those of patients and family members, in spite of the recognition by all concerned that palliative care services work within a philosophy of patient-centered care. Open discussion of ideas has the potential to engage both staff and patients and carers in quality improvement initiatives, and to reinforce the value of research for patient care.
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Aoun SM, Nekolaichuk C. Improving the evidence base in palliative care to inform practice and policy: thinking outside the box. J Pain Symptom Manage 2014; 48:1222-35. [PMID: 24727305 DOI: 10.1016/j.jpainsymman.2014.01.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/23/2014] [Accepted: 02/07/2014] [Indexed: 02/01/2023]
Abstract
The adoption of evidence-based hierarchies and research methods from other disciplines may not completely translate to complex palliative care settings. The heterogeneity of the palliative care population, complexity of clinical presentations, and fluctuating health states present significant research challenges. The aim of this narrative review was to explore the debate about the use of current evidence-based approaches for conducting research, such as randomized controlled trials and other study designs, in palliative care, and more specifically to (1) describe key myths about palliative care research; (2) highlight substantive challenges of conducting palliative care research, using case illustrations; and (3) propose specific strategies to address some of these challenges. Myths about research in palliative care revolve around evidence hierarchies, sample heterogeneity, random assignment, participant burden, and measurement issues. Challenges arise because of the complex physical, psychological, existential, and spiritual problems faced by patients, families, and service providers. These challenges can be organized according to six general domains: patient, system/organization, context/setting, study design, research team, and ethics. A number of approaches for dealing with challenges in conducting research fall into five separate domains: study design, sampling, conceptual, statistical, and measures and outcomes. Although randomized controlled trials have their place whenever possible, alternative designs may offer more feasible research protocols that can be successfully implemented in palliative care. Therefore, this article highlights "outside the box" approaches that would benefit both clinicians and researchers in the palliative care field. Ultimately, the selection of research designs is dependent on a clearly articulated research question, which drives the research process.
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Affiliation(s)
- Samar M Aoun
- School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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Sigurdardottir KR, Kaasa S, Rosland JH, Bausewein C, Radbruch L, Haugen DF. The European Association for Palliative Care basic dataset to describe a palliative care cancer population: Results from an international Delphi process. Palliat Med 2014; 28:463-473. [PMID: 24503559 DOI: 10.1177/0269216314521264] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND One of the barriers identified in palliative care research is the lack of common criteria to describe the population. AIM The aim of this Delphi process was to obtain consensus on a basic set of core variables to describe or classify a palliative care cancer population. DESIGN AND SETTING This was a five-step international Delphi exercise. A total of 117 experts were invited to participate. Based on a literature review and analyses of existing minimum datasets for national databases, a list of 18 proposed variables was presented in the first Delphi round. The two first rounds focused on which variables to include, and several new variables were proposed. The three last Delphi rounds focused on how the agreed variables should be recorded. Consensus was defined as at least 70% agreement. RESULTS A total of 64 experts from 30 countries participated. High consensus was reached on 31 variables, divided between a 'patient form' - date of birth, gender, living situation, education, ethnicity and 12 symptoms - and a 'health-care personnel form' - patient's date of birth, principal diagnosis, date of the principal diagnosis, stage of the cancer disease, site of metastases, present anticancer treatment, main additional diagnoses, stage of the additional diagnoses, medication, weight loss, performance status, cognitive impairment, place of care and provision of care. It was more difficult to agree upon how to record the variables, but consensus was reached on all except ethnicity, vomiting and weight loss. CONCLUSION Consensus was reached on a set of core variables and how they should be recorded.
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Affiliation(s)
- Katrin R Sigurdardottir
- 1 European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- 2 Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
- 3 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Stein Kaasa
- 1 European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- 4 Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jan H Rosland
- 2 Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
- 5 Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Claudia Bausewein
- 6 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
- 7 Department for Palliative Medicine, University Hospital Munich, Munich, Germany
| | - Lukas Radbruch
- 8 Department of Palliative Medicine, University of Bonn, Bonn, Germany
- 9 European Association for Palliative Care (EAPC), Milan, Italy
| | - Dagny F Haugen
- 1 European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- 3 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Sigurdardottir KR, Oldervoll L, Hjermstad MJ, Kaasa S, Knudsen AK, Løhre ET, Loge JH, Haugen DF. How are palliative care cancer populations characterized in randomized controlled trials? A literature review. J Pain Symptom Manage 2014; 47:906-914.e17. [PMID: 24018205 DOI: 10.1016/j.jpainsymman.2013.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/05/2013] [Accepted: 06/14/2013] [Indexed: 02/08/2023]
Abstract
CONTEXT The difficulties in defining a palliative care patient accentuate the need to provide stringent descriptions of the patient population in palliative care research. OBJECTIVES To conduct a systematic literature review with the aim of identifying which key variables have been used to describe adult palliative care cancer populations in randomized controlled trials (RCTs). METHODS The data sources used were MEDLINE (1950 to January 25, 2010) and Embase (1980 to January 25, 2010), limited to RCTs in adult cancer patients with incurable disease. Forty-three variables were systematically extracted from the eligible articles. RESULTS The review includes 336 articles reporting RCTs in palliative care cancer patients. Age (98%), gender (90%), cancer diagnosis (89%), performance status (45%), and survival (45%) were the most frequently reported variables. A large number of other variables were much less frequently reported. CONCLUSION A substantial variation exists in how palliative care cancer populations are described in RCTs. Few variables are consistently registered and reported. There is a clear need to standardize the reporting. The results from this work will serve as the basis for an international Delphi process with the aim of reaching consensus on a minimum set of descriptors to characterize a palliative care cancer population.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.
| | - Line Oldervoll
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Røros Rehabilitation Centre, Røros, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Erik Torbjørn Løhre
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jon Håvard Loge
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; National Resource Centre for Late Effects After Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Powell RA, Harding R, Namisango E, Katabira E, Gwyther L, Radbruch L, Murray SA, El-Ansary M, Leng M, Ajayi IO, Blanchard C, Kariuki H, Kasirye I, Namukwaya E, Gafer N, Casarett D, Atieno M, Mwangi-Powell FN. Palliative care research in Africa: consensus building for a prioritized agenda. J Pain Symptom Manage 2014; 47:315-24. [PMID: 23870840 DOI: 10.1016/j.jpainsymman.2013.03.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/20/2013] [Accepted: 03/29/2013] [Indexed: 11/20/2022]
Abstract
CONTEXT Palliative care research in Africa is in its relative infancy, with dedicated financial support extremely limited. Therefore, setting research priorities to optimize use of limited resources is imperative. OBJECTIVES To develop a prioritized research agenda for palliative care in Africa. METHODS We used a two-stage process involving palliative care professionals and researchers: 1) generation of an initial topic list at a consultative workshop of experts and 2) prioritization of that list using a consensus development process, the nominal group technique. RESULTS Phase 1: 41 topics were generated across five groups, with several topics nominated in more than one group. Phase 2: 16 topics and three broad thematic areas were identified. The two most prioritized topics within each of the three themes were the following: Theme 1: patient, family, and volunteers-1) care outcomes and the impact of palliative care as perceived by patients and caregivers and 2) palliative care needs of children; Theme 2: health providers-1) impact of palliative care training on care and practice and 2) integration of palliative care and antiretroviral therapy services; and Theme 3: health systems-1) palliative care needs assessments at the micro-, meso-, and macro-levels and 2) integration of palliative care into health systems and educational curricula. CONCLUSION Consensus-based palliative care topics determined by the study can assist researchers in optimizing limited research capacities by focusing on these prioritized areas. Subsequent to the identification and publication of the research agenda, concrete steps will be undertaken by the African Palliative Care Research Network and other partners to help implement it.
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Affiliation(s)
| | - Richard Harding
- King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, United Kingdom; Palliative Medicine Programme, Department of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Elly Katabira
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Liz Gwyther
- Division of Family Medicine, School of Public Health University of Cape Town, Cape Town, South Africa
| | - Lukas Radbruch
- Department of Palliative Medicine, University of Bonn, Bonn, Germany; Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Scott A Murray
- Primary Palliative Care Research Group, General Practice Section, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Maged El-Ansary
- Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mhoira Leng
- Makerere Palliative Care Unit, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ike O Ajayi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Centre for Palliative Care, Ibadan, Nigeria
| | - Charmaine Blanchard
- Gauteng Centre of Excellence for Palliative Care, Chris Hani Baragwanath Academic Hospital and University of Witwatersrand, Johannesburg, South Africa
| | - Helen Kariuki
- Department of Medical Physiology, University of Nairobi, Kenya
| | | | - Elizabeth Namukwaya
- Makerere Palliative Care Unit, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nahla Gafer
- Palliative Care Unit, Radiation and Isotope Centre, Khartoum, Sudan
| | - David Casarett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Aziz NM, Grady PA, Curtis JR. Training and career development in palliative care and end-of-life research: opportunities for development in the U.S. J Pain Symptom Manage 2013; 46:938-46. [PMID: 23631858 PMCID: PMC3735668 DOI: 10.1016/j.jpainsymman.2013.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/26/2013] [Accepted: 02/12/2013] [Indexed: 11/25/2022]
Abstract
There has been a dramatic increase in attention to the field of palliative care and end-of-life (PCEOL) research over the past 20 years. This increase is particularly notable in the development of palliative care clinical and educational programs. However, there remain important shortcomings in the evidence base to ensure access to and delivery of effective palliative care for patients with life-limiting illness and their families. Development of this evidence base will require that we train the next generation of researchers to focus on issues in PCEOL. The purpose of this article was to explore the current status of the recruitment, training, and retention of future investigators in PCEOL research in the U.S. and propose recommendations to move us forward. Some key contextual issues for developing and supporting this research workforce are articulated, along with timely and important research areas that will need to be addressed during research training and career development. We provide targeted key recommendations to facilitate the nurturing and support of the future research workforce that is needed to ensure the development and implementation of the science necessary for providing high-quality, evidence-based palliative care to all who need and desire it.
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Affiliation(s)
- Noreen M Aziz
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
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McIlfatrick SJ, Murphy T. Palliative care research on the island of Ireland over the last decade: a systematic review and thematic analysis of peer reviewed publications. BMC Palliat Care 2013; 12:33. [PMID: 24006932 PMCID: PMC3848123 DOI: 10.1186/1472-684x-12-33] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
Background As palliative care research continues to expand across Europe, and the world, questions exist about the nature and type of research undertaken in addition to the research priorities for the future. This systematic review, which is the first stage of a larger scale study to identify the research priorities for palliative care on the island of Ireland, examined palliative care research conducted on the island over the last decade. Methods A comprehensive search strategy was implemented and strict eligibility criteria were applied in order to identify relevant peer-reviewed journal articles. Inclusion criteria were all of the palliative care studies undertaken on the island of Ireland and published between January 2002 and May 2012. These were assessed in relation to year, setting, sample size, research methodology, and relevant findings. Results 412 publications were identified for screening and their abstracts obtained. After eliminating articles that did not meet the inclusion criteria, 151 remained for further analysis. A thematic analysis of 128 studies published between 2006 and 2012 revealed eight core themes: (1) specific groups/populations; (2) services and settings; (3) management of symptoms (physical, psychological, social); (4) bereavement; (5) communication and education; (6) death and dying; (7) spirituality; and (8) complementary and alternative medicine/intervention (CAM). There was an upward trend in the number of publications in palliative care research over the last ten years with over 72% of studies being published within the previous four years. A slightly higher number of studies were quantitative in nature (surveys, questionnaires, standardised assessments) followed by qualitative (individual and focus group interviews, case studies, documentary analysis and retrospective case note reviews), mixed methods, and systematic reviews. Conclusions Whilst there has been a welcome growth in palliative care research across Ireland, this has largely been needs-based and small scale studies. In contrast, international researchers and decision makers recommend the need for more outcomes focused multidisciplinary research. An examination of palliative care research is an essential first step in seeking to develop future priority areas for further research, highlighting opportunities for future collaboration both nationally and internationally.
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Affiliation(s)
- Sonja J McIlfatrick
- All Ireland Institute of Hospice and Palliative Care c/o Education and Research Centre, Our, Lady's Hospice and Care Services, Harold's Cross, Dublin 6w, Ireland.
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Rhondali W, Berthiller J, Hui D, Yennu S, Lafumas V, Ledoux M, Strasser F, Filbet M. Barriers to research in palliative care in France. BMJ Support Palliat Care 2013; 4:182-189. [PMID: 24644171 DOI: 10.1136/bmjspcare-2012-000360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 02/20/2013] [Accepted: 03/13/2013] [Indexed: 11/04/2022]
Abstract
PURPOSE Palliative care (PC) needs expansion of its research capacity to improve the quality of care. This is particularly true for France that contributed less than 2% of all European PC research publications. We conducted a survey to assess the barriers French healthcare professionals (HCPs) involved in PC research had to face. METHODS We surveyed all 420 PC departments registered in the French National Association for Palliative Care (SFAP) database using a previously used questionnaire. We documented the ethical limitations, time constraints, financial resources, patient issues and methodological issues related to PC research. RESULTS We obtained 382 responses. Ninety-two (24.1%) HCPs were involved in a research project during the last 5 years. In univariate results, predictors of being involved in PC research were men (p=0.004), physician (p=0.022), working at a university hospital (p<0.001). There was a trend towards working in a PC unit (p=0.052). The main barriers to participating in PC research were lack of time (80.1%) and patient issues (47.4%). Lack of methodological support (33.0%) and financial limitations (30.4%) were also reported as major barriers. CONCLUSIONS There is a consensus that PC research and publication in the English language for peer-reviewed journals must be expanded in France but at this stage, clinical teams still lack specific funding and appropriate support. More research is needed to confirm our results and to determine the best ways to develop PC research capacity in France.
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Affiliation(s)
- Wadih Rhondali
- Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France.,Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julien Berthiller
- Pole Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sriram Yennu
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Veronique Lafumas
- Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Mathilde Ledoux
- Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Florian Strasser
- Oncological Palliative Medicine, Department of Internal Medicine and Palliative Care Center, Cantonal Hospital, St Gallen, Switzerland
| | - Marilène Filbet
- Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
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Methodik und Entwicklung von Therapieempfehlungen zur Symptomkontrolle in der Palliativmedizin. Schmerz 2013; 26:475-80. [DOI: 10.1007/s00482-012-1219-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nwosu AC. Integrated clinical academic training: an exciting new dawn for academic palliative medicine. J Palliat Med 2012; 15:507-8. [PMID: 22577782 DOI: 10.1089/jpm.2011.0524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sigurdardottir KR, Haugen DF, Bausewein C, Higginson IJ, Harding R, Rosland JH, Kaasa S. A pan-European survey of research in end-of-life cancer care. Support Care Cancer 2010; 20:39-48. [PMID: 21116654 PMCID: PMC3223572 DOI: 10.1007/s00520-010-1048-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 11/11/2010] [Indexed: 12/04/2022]
Abstract
Background To date, there is no coordinated strategy for end-of-life (EOL) cancer care research in Europe. The PRISMA (Reflecting the Positive Diversities of European Priorities for Research and Measurement in End-of-life Care) project is aiming to develop a programme integrating research and measurement in EOL care. This survey aimed to map and describe present EOL cancer care research in Europe and to identify priorities and barriers. Material and methods A questionnaire of 62 questions was developed and 201 researchers in 41 European countries were invited to complete it online in May 2009. An open invitation to participate was posted on the internet. Results Invited contacts in 36 countries sent 127 replies; eight additional responses came through websites. A total of 127 responses were eligible for analysis. Respondents were 69 male and 58 female, mean age 49 (28–74) years; 85% of the scientific team leaders were physicians. Seventy-one of 127 research groups were located in a teaching hospital or cancer centre. Forty-five percent of the groups had only one to five members and 28% six to ten members. Sixty-three of 92 groups reported specific funding for EOL care research. Seventy-five percent of the groups had published papers in journals with impact factor ≤5 in the last 3 years; 8% had published in journals with impact factor >10. Forty-four out of 90 groups reported at least one completed Ph.D. in the last 3 years. The most frequently reported active research areas were pain, assessment and measurement tools, and last days of life and quality of death. Very similar areas—last days of life and quality of death, pain, fatigue and cachexia, and assessment and measurement tools—were ranked as the most important research priorities. The most important research barriers were lack of funding, lack of time, and insufficient knowledge/expertise. Conclusions Most research groups in EOL care are small. The few large groups (14%) had almost half of the reported publications, and more than half of the current Ph.D. students. There is a lack of a common strategy and coordination in EOL cancer care research and a great need for international collaboration. Electronic supplementary material The online version of this article (doi:10.1007/s00520-010-1048-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, 7006, Trondheim, Norway.
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Sigurdardottir KR, Haugen DF, van der Rijt CCD, Sjøgren P, Harding R, Higginson IJ, Kaasa S. Clinical priorities, barriers and solutions in end-of-life cancer care research across Europe. Report from a workshop. Eur J Cancer 2010; 46:1815-22. [PMID: 20456947 DOI: 10.1016/j.ejca.2010.03.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/16/2010] [Indexed: 11/18/2022]
Abstract
AIM The PRISMA project is aiming to co-ordinate research priorities, measurement and practice in end-of-life (EOL) care in Europe. As part of PRISMA we undertook a questionnaire survey and a subsequent workshop to (1) identify clinical priorities for EOL care research in Europe and propose a future research agenda and (2) identify barriers to EOL care research, and possibilities and solutions to improve the research. METHODS Thirty participants selected among the principally medical survey responders from 25 European countries attended. Twenty-six answered a preparatory pre-workshop questionnaire based on the survey results. Group work was a main part of the workshop. RESULTS Consensus was reached on the following priorities for EOL cancer care research in Europe: symptomatology, issues related to care of the dying, and policy and organisation of services. Methodology was regarded important in all areas, including assessment/measurement and classification. Symptom research should particularly emphasise pain, fatigue, cachexia, delirium and breathlessness. Research should move from descriptive to interventional studies. The lack of consensus on definitions and outcomes was identified as a substantial research barrier. Other barriers were related to capacity and funding, environment and culture and knowledge transfer and dissemination. These areas are interrelated and should not be addressed in isolation. CONCLUSION Consensus was obtained on priority areas and research nature for EOL care research in the next years, and a model for addressing barriers was developed.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- Dept. of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, St Olavs Hospital, N-7006 Trondheim, Norway.
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[General practitioners' guideline for palliative care. A survey of guideline acceptance in quality circles of primary medical care]. ACTA ACUST UNITED AC 2010; 105:135-41. [PMID: 20349290 DOI: 10.1007/s00063-010-1021-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 02/17/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The implementation of the general practitioners' (GPs) guideline for palliative care released in 2007 with consent of the developing group was accompanied by an anonymous and voluntary survey designed to assess acceptance and feasibility of the recommendations. 60 quality circles of the GP-based care program in Hesse which are run by the PMV research group were used for guideline implementation. MATERIAL AND METHODS The quality of the palliative care quality circle meeting itself was checked with a standardized questionnaire (feedback, n = 473 of 515 participating GPs). After several weeks, the follow-up questioning on acceptance of the corresponding guideline was performed (n = 391 of 440 attendees) using twelve items to evaluate the guideline recommendations. The closed questions were appraised employing a Likert scale and the open questions after classifying the free text in categories. RESULTS 96% of the respondents considered palliative medicine to be important in daily routine. The majority agreed with form and content of this CME meeting (feedback, response rate 91%). The complexity, handling, and practical relevance of the guideline were evaluated positively (response rate 88%). 82% of GPs reported that they would recommend the guideline to colleagues. Specific, practical guideline recommendations on (non)pharmacological strategies in treating dyspnea, on reducing xerostomia and on comedication in the case of opioid treatment were confirmed by 80-94% of the participants, and 75-92% rated these recommendations as practical. CONCLUSION The relevance of palliative care in daily routine was shown by the responses evaluating the quality circle session. The grade of acceptance of the guideline is comparable to the other GPs' guidelines with focus on pharmacotherapy. 10-13% of the respondents were not able to judge the relevance nor the practicability of selected recommendations. Future implementation should therefore consider attitude and experience with palliative care. To date, the questionnaires have not been designed to evaluate individual adherence to palliative care guideline.
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Cherny N, Catane R, Schrijvers D, Kloke M, Strasser F. European Society for Medical Oncology (ESMO) Program for the Integration of Oncology and Palliative Care: a 5-year review of the Designated Centers’ incentive program. Ann Oncol 2010; 21:362-369. [DOI: 10.1093/annonc/mdp318] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pastrana T, Vallath N, Mastrojohn J, Namukwaya E, Kumar S, Radbruch L, Clark D. Disparities in the contribution of low- and middle-income countries to palliative care research. J Pain Symptom Manage 2010; 39:54-68. [PMID: 19892510 DOI: 10.1016/j.jpainsymman.2009.05.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/19/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
CONTEXT Important aspects of the palliative care needs of patients from low- and middle-income countries (LMIC) are largely unexplored. About 44 million of the 56 million annual deaths worldwide occur in developing countries, and it is estimated that more than 33 million of those concerned would benefit from palliative care. In this context, the understanding of specific social and cultural needs is fundamental to the development of appropriate health policy and clinical practice concerning palliative and end-of-life care. OBJECTIVES This study aims to answer the question: what are the contributions, in terms of generation of knowledge, of LMIC to the published palliative care literature? METHODS A bibliometric analysis was conducted in Medline and EMBASE (to June 2008). Articles were included when either the first author (institutional affiliation or contact address) or the data collection was derived from LMIC, as defined by criteria of the World Bank. Excluded were articles done in migrant and non-palliative care populations. RESULTS The literature search resulted in 845 references. In total, 245 articles coming from LMIC were identified, being published by 34 LMIC (27.3% of LMIC). The first publications appeared in 1982. The study shows a rather modest contribution of publications from LMIC. However, the volume of publications within LMIC is distributed unequally: upper-middle-income countries published almost half of the articles (46.9%), whereas only 11% of the publications came from low-income countries. In contrast, 104 LMIC (72.7% of LMIC) do not have any registered publications. Surprisingly, 25% of the articles with data from LMIC have been done and published by high-income countries. Reasons for the underrepresentation, as well a possible correction of this imbalance, are discussed. CONCLUSION Palliative care research should be a priority in LMIC, where many patients could benefit tremendously from it, and publication of findings in these countries should be encouraged.
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Affiliation(s)
- Tania Pastrana
- Department of Palliative Medicine, RWTH Aachen University, 52074 Aachen, Germany.
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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