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Cerullo G, Figueiredo T, Coelho C, Campos CS, Videira-Silva A, Carrilho J, Midão L, Costa E. Palliative Care in the Ageing European Population: A Cross-Country Comparison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:113. [PMID: 38276807 PMCID: PMC10815293 DOI: 10.3390/ijerph21010113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
With Europe's ageing population and rising demand for palliative care, it is crucial to examine the use of palliative care among older adults during their last years of life and understand the factors influencing their access and end-of-life circumstances. This study employed a cohort of SHARE participants aged 65 years or older who had passed away between Wave 6 (2015) and Wave 7 (2017). Information on death circumstances, palliative care utilization, and associated variables were analysed. The study revealed that nearly 13.0% of individuals across these countries died under palliative care, with Slovenia having the lowest rate (0.3%) and France the highest (30.4%). Palliative care utilization in the last 30 days before death was observed in over 24.0% of participants, with the Czech Republic having the lowest rate (5.0%) and Greece the highest (48.8%). A higher risk of using or dying in palliative care was significantly associated with cognitive impairment (low verbal fluency), physical inactivity, and good to excellent self-perceived health. This work highlights the urgent need for enhanced global access to palliative care and advocates for the cross-country comparison of effective practices within Europe, tailored to the unique healthcare needs of older adults.
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Affiliation(s)
- Giovanni Cerullo
- Palliative Care, Centro Hospitalar Universitário do Algarve, 8000-386 Algarve, Portugal;
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Teodora Figueiredo
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Constantino Coelho
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Cláudia Silva Campos
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - António Videira-Silva
- Pediatric University Clinic, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal;
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Universidade Lusófona, 1749-024 Lisbon, Portugal
| | - Joana Carrilho
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Luís Midão
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Elísio Costa
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
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Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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Sedhom R, Gupta A, Smith TJ. Short Hospice Length of Service in a Comprehensive Cancer Center. J Palliat Med 2020; 24:257-260. [PMID: 32302497 DOI: 10.1089/jpm.2019.0634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The benefits of hospice for patients with advanced cancer are well established. Short hospice length of service (LOS) is a marker of poor quality care and patient and family dissatisfaction. Interventions based on behavioral science might reduce suboptimal hospice use. Objective: To assess effects of peer comparisons on rates of short hospice LOS for cancer patients at a tertiary comprehensive cancer center. Design: Pre-post design utilizing a peer-comparison feedback intervention comparing individual oncologist hospice data. Setting: Urban, academic, comprehensive cancer center in Maryland. Measurements: Hospice enrollment rate. Median hospice LOS and percentage short hospice LOS (defined as ≤7 days). Results: Sixty oncologists received the intervention. Before the intervention, 394 patients enrolled in hospice for a period of 21 months (18.76 enrollments per month). Median hospice LOS was 14.5 days. After the intervention, 418 patients enrolled in hospice for 14 months (29.85 enrollments per month). Median hospice LOS was nine days. The percentage of patients experiencing a short hospice LOS increased from 33.3% to 43.5%. Conclusions: The methods are not sufficient to conclude that the intervention does not improve hospice use. A substantial number of patients with cancer who used hospice had LOS ≤7 days, a marker of poor quality. Using peer comparison in combination with additional behavioral interventions should be considered to improve end-of-life care.
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Affiliation(s)
- Ramy Sedhom
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Arjun Gupta
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Thomas J Smith
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
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Heins M, Hofstede J, Rijken M, Korevaar J, Donker G, Francke A. Palliative care for patients with cancer: do patients receive the care they consider important? A survey study. BMC Palliat Care 2018; 17:61. [PMID: 29665807 PMCID: PMC5905150 DOI: 10.1186/s12904-018-0315-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In many countries, GPs and home care nurses are involved in care for patients with advanced cancer. Given the varied and complex needs of these patients, providing satisfactory care is a major challenge for them. We therefore aimed to study which aspects of care patients, GPs and home care nurses consider important and whether patients receive these aspects. METHODS Seventy-two Dutch patients with advanced cancer, 87 GPs and 26 home care nurses rated the importance of support when experiencing symptoms, respect for patients' autonomy and information provision. Patients also rated whether they received these aspects. Questionnaires were based on the CQ index palliative care. RESULTS Almost all patients rated information provision and respect for their autonomy as important. The majority also rated support when suffering from specific symptoms as important, especially support when in pain. In general, patients received the care they considered important. However, 49% of those who considered it important to receive support when suffering from fatigue and 23% of those who wanted to receive information on the expected course of their illness did not receive this or only did so sometimes. CONCLUSION For most patients with advanced cancer, the palliative care that they receive matches what they consider important. Support for patients experiencing fatigue may need more attention. When symptoms are difficult to control, GPs and nurses may still provide emotional support and practical advice. Furthermore, we recommend that GPs discuss patients' need for information about the expected course of their illness.
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Affiliation(s)
- Marianne Heins
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Jolien Hofstede
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Joke Korevaar
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Gé Donker
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Anneke Francke
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands.,Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands.,Expertise center palliative care, VU University Medical Center, Amsterdam, the Netherlands
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Duff JM, Thomas RM. Impact of Palliative Chemotherapy and Travel Distance on Hospice Referral in Patients With Stage IV Pancreatic Cancer: A Retrospective Analysis Within a Veterans Administration Medical Center. Am J Hosp Palliat Care 2017; 35:875-881. [PMID: 29216749 DOI: 10.1177/1049909117746390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Metastatic pancreatic ductal adenocarcinoma (mPDAC) has a poor prognosis despite chemotherapy advancements. Although hospice utilization has increased, timing of referral is not always optimal. AIM To investigate whether palliative chemotherapy and travel distance to the treatment center impact hospice referral patterns in veterans of the US military in order to identify potential areas for improving referral timing. DESIGN Demographic and clinical data were collected retrospectively according to the timing of hospice referral. Settings/Participants: Patients with mPDAC within a Veterans Administration Medical Center from 2005 to 2014. RESULTS Of 58 patients identified, 52 were referred to hospice. The median time from diagnosis to referral and referral to death was 2.4 and 3.1 weeks, respectively. Palliative chemotherapy was administered to 22 (42.3%) patients, with 30 (57.7%) patients not treated due to poor functional status (n = 16, 53.3%) or patient refusal (n = 14, 46.7%). Subset analysis for those travelling >60 miles versus <60 miles to the treatment center showed the median time to hospice referral was 1.7 versus 4.7 weeks. With no significant differences between groups, univariate analysis demonstrated that those referred to hospice >2.4 weeks from diagnosis more often received chemotherapy ( P < .001) and lived <60 miles from the treatment center ( P = .05). CONCLUSION Receipt of palliative chemotherapy and proximity to the treatment center appear to delay referral to hospice in patients with mPDAC. Increasing physician awareness of such factors that may impact the decision to involve hospice is necessary for delivering optimal oncology care.
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Affiliation(s)
- Jennifer M Duff
- 1 Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.,2 Department of Medicine, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Ryan M Thomas
- 3 Department of Surgery, University of Florida, Gainesville, FL, USA.,4 Department of Surgery, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
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Abstract
Introduction A main goals of palliative care is to improve the health-related quality of life (QOL) of patients with advanced illnesses. The objective of this narrative review is to provide an updated synopsis on the use of QOL questionnaires in the palliative care setting. Areas covers Focusing on the palliative cares setting, we will define QOL, discuss how QOL instruments can be used clinically and in research, review approaches to validate these questionnaires, and how they can be used in utility analyses. Expert opinion/commentary Several QOL questionnaires, such as EORTC-QLQ-C30, McGill QOL questionnaire and EQ-5D have been validated in the palliative care setting. However, significant gaps impede their application, including lack of determination of their responsiveness to change and minimal clinically important differences, the need to conduct more psychometric validation on QOL questionnaires among patients at various stages of disease trajectory, and the paucity of studies examining utility and cost-effectiveness. Further research is needed to address these knowledge gaps so QOL questionnaires can be better used to inform clinical practice and research.
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Affiliation(s)
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD D Anderson Cancer Center, Houston, TX, USA, 77030
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Kassianos AP, Ioannou M, Koutsantoni M, Charalambous H. The impact of specialized palliative care on cancer patients' health-related quality of life: a systematic review and meta-analysis. Support Care Cancer 2017; 26:61-79. [PMID: 28932908 DOI: 10.1007/s00520-017-3895-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Specialized palliative care (SPC) is currently underutilized or provided late in cancer care. The aim of this systematic review and meta-analysis is to critically evaluate the impact of SPC on patients' health-related quality of life (HRQoL). METHODS Five databases were searched through June 2016. Randomized controlled trials (RCTs) and prospective studies using a pre- and post- assessment of HRQoL were included. The PRISMA reporting statement was followed. Criteria from available checklists were used to evaluate the studies' quality. A meta-analysis followed using random-effect models separately for RCTs and non-RCTs. RESULTS Eleven studies including five RCTs and 2939 cancer patients published between 2001 and 2014 were identified. There was improved HRQoL in patients with cancer following SPC especially in symptoms like pain, nausea, and fatigue as well as improvement of physical and psychological functioning. Less or no improvements were observed in social and spiritual domains. In general, studies of inpatients showed a larger benefit from SPC than studies of outpatients whereas patients' age and treatment duration did not moderate the impact of SPC. Methodological shortcomings of included studies include high attrition rates, low precision, and power and poor reporting of control procedures. CONCLUSIONS The methodological problems and publication bias call for higher-quality studies to be designed, funded, and published. However, there is a clear message that SPC is multi-disciplinary and aims at palliation of symptoms and burden in line with current recommendations.
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Affiliation(s)
- Angelos P Kassianos
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Myria Ioannou
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
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Wang X, Knight LS, Evans A, Wang J, Smith TJ. Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer. J Oncol Pract 2017; 13:e496-e504. [PMID: 28221897 DOI: 10.1200/jop.2016.018093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. METHODS We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. RESULTS Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P < .01). In addition, there was dramatic variation in median LOS by individual physician (range, 4 to 88 days for physicians with five or more patients), indicating differences in hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. CONCLUSION Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.
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Affiliation(s)
- Xiao Wang
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Louise S Knight
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Anne Evans
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Jiangxia Wang
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Thomas J Smith
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
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Maeda I, Miyashita M, Yamagishi A, Kinoshita H, Shirahige Y, Izumi N, Yamaguchi T, Igarashi M, Kato M, Morita T. Changes in Relatives' Perspectives on Quality of Death, Quality of Care, Pain Relief, and Caregiving Burden Before and After a Region-Based Palliative Care Intervention. J Pain Symptom Manage 2016; 52:637-645. [PMID: 27664834 DOI: 10.1016/j.jpainsymman.2016.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 03/09/2016] [Accepted: 05/20/2016] [Indexed: 11/17/2022]
Abstract
CONTEXT A region-based palliative care intervention (Outreach Palliative Care Trial of Integrated Regional Model Study) increased home death, access to specialist palliative care, quality of care, and quality of death and dying. OBJECTIVES The objective of this study was to examine changes in palliative care outcomes in different care settings (hospitals, palliative care units, and home) and obtain insights into how to improve region-level palliative care. METHODS The intervention program was implemented from April 2008 to March 2011. Two bereavement surveys were conducted before and after intervention involving 4228 family caregivers of deceased cancer patients. Family-perceived quality of care (range 1-6), quality of death and dying (1-7), pain relief (1-7), and caregiver burden (1-7) were measured. RESULTS Response rates were 69% (preintervention) and 66% (postintervention), respectively. Family-perceived quality of care (adjusted mean 4.89, 95% CI 4.54-5.23) and quality of death and dying (4.96, 4.72-5.20) at home were the highest and sustained throughout the study. Palliative care units were at the intermediate level between home and hospitals. In hospitals, both quality of care and quality of death and dying were low at baseline but significantly improved after intervention (quality of care: 4.24, 4.13-4.34 to 4.43, 4.31-4.54, P = 0.002; quality of death and dying: 4.22, 4.09-4.36 to 4.36, 4.22-4.50, P = 0.012). Caregiver burden did not significantly increase after intervention, regardless of place of death. CONCLUSIONS The dual strategies of transition of place of death to home and improving quality of care in hospitals should be recognized as important targets for improving region-level palliative care.
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Affiliation(s)
- Isseki Maeda
- Department of Palliative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Mitsunori Miyashita
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Akemi Yamagishi
- Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Hiroya Kinoshita
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwashi, Chiba, Japan
| | | | - Noriko Izumi
- Department of Internal Medicine and Palliative Care Team, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Miyuki Igarashi
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masashi Kato
- Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
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Schnakenberg R, Goeldlin A, Boehm-Stiel C, Bleckwenn M, Weckbecker K, Radbruch L. Written survey on recently deceased patients in germany and switzerland: how do general practitioners see their role? BMC Health Serv Res 2016; 16:22. [PMID: 26787308 PMCID: PMC4719660 DOI: 10.1186/s12913-016-1257-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background General practitioners (GPs) play an important role in end-of-life care due to their proximity to the patient’s dwelling-place and their contact to relatives and other care providers. Methods In order to get a better understanding of the role which the GP sees him- or herself as playing in end-of-life care and which care their dying patients get, we conducted this written survey. It asked questions about the most recently deceased patient of each physician. The questionnaire was sent to 1,201 GPs in southern North Rhine-Westphalia (Germany) and the Canton of Bern (Switzerland). Results Response rate was 27.5 % (n = 330). The average age of responding physicians was 54.5 years (range: 34–76; standard derivation: 7.4), 68 % of them were male and 45 % worked alone in their practice. Primary outcome measures of this observational study are the characteristics of recently deceased patients as well as their care and the involvement of other professional caregivers. Almost half of the most recently deceased patients had cancer. Only 3 to 16 % of all deceased suffered from severe levels of pain, nausea, dyspnea or emesis. More than 80 % of the doctors considered themselves to be an indispensable part of their patient’s end-of-life care. Almost 90 % of the doctors were in contact with the patient’s family and 50 % with the responsible nursing service. The majority of the GPs had taken over the coordination of care and cooperation with other attending physicians. Conclusion The study confirms the relevance of caring for dying patients in GPs work and provides an important insight into their perception of their own role.
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Affiliation(s)
- Rieke Schnakenberg
- Department of General Practice and Family Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Adrian Goeldlin
- Institute of General Practice, University of Bern, Gesellschaftsstrasse 49, CH-3012, Bern, Switzerland.
| | - Christina Boehm-Stiel
- Department of Palliative Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Markus Bleckwenn
- Department of General Practice and Family Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Klaus Weckbecker
- Department of General Practice and Family Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Lukas Radbruch
- Department of Palliative Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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