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Heipon CS, Brom L, van der Linden YM, Tange D, Reyners AKL, Raijmakers NJH. Characteristics of timely integration of palliative care into oncology hospital care for patients with incurable cancer: results of a Delphi Study. Support Care Cancer 2024; 32:324. [PMID: 38700723 DOI: 10.1007/s00520-024-08508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To identify elements of timely integration of palliative care (PC) into hospital oncology care from best practices. Thereafter, to assess the level of consensus among oncology and PC specialists and patient and relative representatives on the characteristics of timely integration of PC. METHODS A three-round modified Delphi study was conducted. The expert panel consisted of 83 healthcare professionals (HCPs) from 21 Dutch hospitals (43 physicians, 40 nurses), 6 patient and 2 relative representatives. In the first round, four elements of integrated PC were considered: (1) identification of potential PC needs, (2) advance care planning (ACP), (3) routine symptom monitoring and (4) involvement of the specialist palliative care team (SPCT). In subsequent rounds, the panellists assessed which characteristics were triggers for initiating an element. A priori consensus was set at ≥ 70%. RESULTS A total of 71 (78%) panellists completed the first questionnaire, 65 (71%) the second and 49 (54%) the third. Panellists agreed that all patients with incurable cancer should have their PC needs assessed (97%), symptoms monitored (91%) and ACP initiated (86%). The SPCT should be involved at the patient's request (86%) or when patients suffer from increased symptom burden on multiple dimensions (76%). Patients with a life expectancy of less than 3 months should be offered a consultation (71%). CONCLUSION The expert panel agreed that timely integration of PC into oncology is important for all patients with incurable cancer, using early identification, ACP and routine symptom monitoring. Involvement of the SPCT is particularly needed in patients with multidimensional symptom burden and in those nearing death.
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Affiliation(s)
- Carly S Heipon
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Linda Brom
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Yvette M van der Linden
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | - Dorien Tange
- Dutch Federation of Cancer Patients Organisations, Utrecht, the Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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2
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van der Padt-Pruijsten A, Leys MB, Oomen-de Hoop E, van der Rijt CCD, van der Heide A. Quality of cancer treatment care before and after a palliative care pathway: bereaved relatives' perspectives. BMJ Support Palliat Care 2023:spcare-2023-004495. [PMID: 37973203 DOI: 10.1136/spcare-2023-004495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Appropriate communication between healthcare providers and patients and their families is an essential part of good (palliative) care. We investigated whether implementation of a standardised palliative care pathway (PCP) facilitated communication, that is, aspects of shared decision-making (SDM), including advance care planning (ACP) conversations and satisfaction with care as experienced by bereaved relatives of patients with advanced cancer. METHODS We conducted a prospective preintervention and postintervention study in a hospital. Questionnaires were sent to relatives of patients who died between February 2014 and February 2015 (pre-PCP period) or between November 2015 and November 2016 (post-PCP period). Relatives' perceptions on communication and satisfaction with care were assessed using parts of the Views of Informal Carers-Evaluation of Services and IN-PATSAT32 Questionnaires. RESULTS 195 (46%) and 180 (42%) bereaved relatives completed the questionnaire in the pre-PCP and post-PCP period, respectively. The majority of all patients in both the pre-PCP period and the post-PCP period had been told they had an incurable illness (92% and 89%, respectively, p=0.544), mostly in the presence of a relative (88% and 85%, respectively, p=0.865) and had discussed their preferences for end-of-life (EOL) treatment (82% and 76%, respectively, p=0.426). Bereaved relatives were reasonably satisfied with the received hospital care in both groups. CONCLUSIONS We found no overall effect of the PCP on the communication process and satisfaction with EOL care of bereaved relatives. Before the use of the PCP bereaved relatives already reported favourably about the EOL care provided.
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Affiliation(s)
- Annemieke van der Padt-Pruijsten
- Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
- Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maria Bl Leys
- Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Toffart AC, Gonzalez F, Hamidfar-Roy R, Darrason M. [ICU admission for cancer patients with respiratory failure: An ethical dilemma]. Rev Mal Respir 2023; 40:692-699. [PMID: 37659881 DOI: 10.1016/j.rmr.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/06/2023] [Indexed: 09/04/2023]
Abstract
In medicine, each decision is the result of a trade-off between medical scientific data, the rights of individuals (protection of persons, information, consent), individual desires, collective values and norms, and the economic constraints that guide our society. Whether or not to admit a cancer patient to an intensive care unit is very often an ethical dilemma. It is necessary to distinguish patients who would benefit from admission to an intensive care unit (ICU) from those for whom it would be futile. In this review, we will discuss the appropriateness of ICU admission and the concept of unreasonable admission, along with the different levels of intensity of ICU care and the alternatives to intensive care. We will then consider how and when to initiate reflection leading to a reasonable decision for the patient.
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Affiliation(s)
- A-C Toffart
- Service hospitalo-universitaire de pneumologie et physiologie, pôle thorax et vaisseaux, centre hospitalier universitaire Grenoble Alpes, 38043 Grenoble cedex 9, France; Université Grenoble 1 U 823, institut pour l'avancée des biosciences, université Grenoble Alpes, Grenoble, France.
| | - F Gonzalez
- Unité de réanimation, département anesthésie-réanimation, institut Paoli-Calmettes, Marseille, France
| | - R Hamidfar-Roy
- Service hospitalo-universitaire de pneumologie et physiologie, pôle thorax et vaisseaux, centre hospitalier universitaire Grenoble Alpes, 38043 Grenoble cedex 9, France
| | - M Darrason
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon Sud, Lyon, France; Institut de recherches philosophiques de Lyon, université Lyon 3, Lyon, France
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Rizvi F, Wilding HE, Rankin NM, Le Gautier R, Gurren L, Sundararajan V, Bellingham K, Chua J, Crawford GB, Nowak AK, Le B, Mitchell G, McLachlan SA, Sousa TV, Hudson R, IJzerman M, Collins A, Philip J. An evidence-base for the implementation of hospital-based palliative care programs in routine cancer practice: A systematic review. Palliat Med 2023; 37:1326-1344. [PMID: 37421156 PMCID: PMC10548767 DOI: 10.1177/02692163231186177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND Despite global support, there remain gaps in the integration of early palliative care into cancer care. The methods of implementation whereby evidence of benefits of palliative care is translated into practice deserve attention. AIM To identify implementation frameworks utilised in integrated palliative care in hospital-based oncology services and to describe the associated enablers and barriers to service integration. DESIGN Systematic review with a narrative synthesis including qualitative, mixed methods, pre-post and quasi experimental designs following the guidance by the Centre for Reviews and Dissemination (PROSPERO registration CRD42021252092). DATA SOURCES Six databases searched in 2021: EMBASE, EMCARE, APA PsycINFO, CINAHL, Cochrane Library and Ovid MEDLINE searched in 2023. Included were qualitative or quantitative studies, in English language, involving adults >18 years, and implementing hospital-based palliative care into cancer care. Critical appraisal tools were used to assess the quality and rigour. RESULTS Seven of the 16 studies explicitly cited the use of frameworks including those based on RE-AIM, Medical Research Council evaluation of complex interventions and WHO constructs of health service evaluation. Enablers included an existing supportive culture, clear introduction to the programme across services, adequate funding, human resources and identification of advocates. Barriers included a lack of communication with the patients, caregivers, physicians and palliative care team about programme goals, stigma around the term 'palliative', a lack of robust training, or awareness of guidelines and undefined staff roles. CONCLUSIONS Implementation science frameworks provide a method to underpin programme development and evaluation as palliative care is integrated within the oncology setting.
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Affiliation(s)
- Farwa Rizvi
- Palliative Medicine, University of Melbourne, Parkville, Victoria, Australia
| | | | - Nicole M Rankin
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Vijaya Sundararajan
- La Trobe University, Melbourne, Victoria, Australia
- Department of Medicine, St Vincent’s Hospital, Melbourne Medical School, Fitzroy, Victoria, Australia
| | - Kylee Bellingham
- Palliative Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Joyce Chua
- Research Nurse Palliative Medicine, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gregory B Crawford
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Brian Le
- Deparment of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Deparment of Palliative Care, Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Geoff Mitchell
- General Practice Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Sue-Anne McLachlan
- Oncology and Cancer Services, St Vincent’s Hospital, University of Melbourne, Parkville, Victoria, Australia
| | | | - Robyn Hudson
- Safer Care Victoria, Melbourne, Victoria, Australia
| | - Maarten IJzerman
- Cancer Health Services Research, University of Melbourne, Parkville, Victoria, Australia
| | - Anna Collins
- Department of Medicine, St Vincent’s Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Philip
- Palliative Medicine, University of Melbourne, Parkville, Victoria, Australia
- Deparment of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Deparment of Palliative Care, Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Palliative Medicine, Department of Medicine, St Vincent’s Hospital Melbourne, Victoria, Australia
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van der Padt‐Pruijsten A, Oostergo T, Leys MBL, van der Rijt CCD, van der Heide A. Hospitalisations of patients with cancer in the last stage of life. Reason to improve advance care planning? Eur J Cancer Care (Engl) 2022; 31:e13720. [PMID: 36172990 PMCID: PMC9788226 DOI: 10.1111/ecc.13720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study is to examine why patients are hospitalised in the last stage of life. METHODS Our study was conducted in a large Dutch teaching hospital. We conducted a retrospective chart review of patients aged ≥18 years who died of cancer either during hospitalisation or after discharge to receive terminal care outside the hospital. We collected data about the characteristics of these hospitalisations and indicators of advance care planning. RESULTS Of the 264 deceased patients, 56% had died in the hospital and 44% after hospital discharge. Of all patients, 80% had been admitted to the hospital because of symptom distress. Dyspnoea (39%) and pain (33%) were the most common symptoms. Most patients underwent diagnostic procedures (laboratory tests [97%] and radiology tests [91%]) and received medical treatment (analgesics [71%] and antibiotics [55%]) during their hospitalisation. A 'Do-Not-Resuscitate' code had been recorded before admission in 42% of the patients and in an additional 52% during admission. CONCLUSION Our study shows that patients with cancer in the last stage of life were mainly admitted to the hospital because of symptom distress. Some hospitalisations and in-hospitals deaths may be avoided by more timely recognition of patients' impending death and start of advance care planning.
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Affiliation(s)
| | - Tanja Oostergo
- Department of Internal MedicineMaasstad HospitalRotterdamThe Netherlands
| | - Maria B. L. Leys
- Department of Internal MedicineMaasstad HospitalRotterdamThe Netherlands
| | - Carin C. D. van der Rijt
- Department Medical OncologyErasmus MC Cancer InstituteRotterdamThe Netherlands,Netherlands Comprehensive Cancer OrganisationThe Netherlands
| | - Agnes van der Heide
- Department of Public HealthErasmus MC, University Medical Centre RotterdamRotterdamThe Netherlands
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Burghout C, Nahar-van Venrooij LMW, Bolt SR, Smilde TJ, Wouters EJM. Benefits of Structured Advance Care Plan in end-of-Life Care Planning among Older Oncology Patients: A Retrospective Pilot Study. J Palliat Care 2022; 38:30-40. [PMID: 36039518 DOI: 10.1177/08258597221119660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives: Studies suggest that advance care planning (ACP) results in improved quality of life and reduced healthcare consumption. We assessed how the use of a structured advance care planning tool (ACPT) in oncology patients relates to their healthcare consumption before death, and to the match between preferred and actual place of death. Methods: We performed a pilot study at a teaching hospital in the Netherlands. Endpoints were 1) healthcare consumption at three and one month(s) before death, and 2) the match between preferred and actual place of death. Results: The study included 75 patients without an ACPT (group 1) and 59 patients with an ACPT (group 2) of whom the preferred place of care or death were documented at least three months before death in 15 patients (subgroup 2b). Compared to group 1, patients in group 2 had significantly more healthcare consumption. However, compared to group 1, patients in subgroup 2b underwent significantly less diagnostic (33.3% (n = 5) versus 69.3% (n = 52), p < 0.05) and laboratory tests (33.3% (n = 5) versus 62.7% (n = 47), p < 0.05) one month before death. Patients in subgroup 2b died at their preferred place more often (76.9%, n = 10) compared to patients in group 1 (58.3%, n = 7) (NS), which meant more deaths at home and less in-hospital-deaths. Conclusions: The results suggest that timely documentation of the preferred place of care or death in a structured ACPT may result in less healthcare consumption and a better match between the preferred and actual place of death.
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Affiliation(s)
- Carolien Burghout
- Department of hemato-oncology, 10233Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands.,Jeroen Bosch Academy Research, 10233Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands.,Department of Tranzo, 120694Tilburg University, School of Social and Behavioral Sciences, Tilburg, Netherlands
| | | | - Sascha R Bolt
- Department of Tranzo, 120694Tilburg University, School of Social and Behavioral Sciences, Tilburg, Netherlands
| | - Tineke J Smilde
- Department of hemato-oncology, 10233Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands
| | - Eveline J M Wouters
- Department of Tranzo, 120694Tilburg University, School of Social and Behavioral Sciences, Tilburg, Netherlands.,3170Fontys University of Applied Science, School For Allied Health Professionals, Eindhoven, Noord-Brabant, Netherlands
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7
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van der Padt-Pruijsten A, Leys MBL, Hoop EOD, van der Heide A, van der Rijt CCD. The effect of a palliative care pathway on medical interventions at the end of life: a pre-post-implementation study. Support Care Cancer 2022; 30:9299-9306. [PMID: 36071303 PMCID: PMC9633459 DOI: 10.1007/s00520-022-07352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/25/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Adequate integration of palliative care in oncological care can improve the quality of life in patients with advanced cancer. Whether such integration affects the use of diagnostic procedures and medical interventions has not been studied extensively. We investigated the effect of the implementation of a standardized palliative care pathway in a hospital on the use of diagnostic procedures, anticancer treatment, and other medical interventions in patients with incurable cancer at the end of their life. METHODS In a pre- and post-intervention study, data were collected concerning adult patients with cancer who died between February 2014 and February 2015 (pre-PCP period) or between November 2015 and November 2016 (post-PCP period). We collected information on diagnostic procedures, anticancer treatments, and other medical interventions during the last 3 months of life. RESULTS We included 424 patients in the pre-PCP period and 426 in the post-PCP period. No differences in percentage of laboratory tests (85% vs 85%, p = 0.795) and radiological procedures (85% vs 82%, p = 0.246) were found between both groups. The percentage of patients who received anticancer treatment or other medical interventions was lower in the post-PCP period (40% vs 22%, p < 0.001; and 42% vs 29%, p < 0.001, respectively). CONCLUSIONS Implementation of a PCP resulted in fewer medical interventions, including anticancer treatments, in the last 3 months of life. Implementation of the PCP may have created awareness among physicians of patients' impending death, thereby supporting caregivers and patients to make appropriate decisions about medical treatment at the end of life. TRIAL REGISTRATION NUMBER Netherlands Trial Register; clinical trial number: NL 4400 (NTR4597); date registrated: 2014-04-27.
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Affiliation(s)
- Annemieke van der Padt-Pruijsten
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands ,Department Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Maria B. L. Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Esther Oomen-de Hoop
- Department Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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