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Rossnan O, Hanson A, Spaulding A, Satashia P, Bhakta S, Robinson M, Helgeson SA, Moreno-Franco P, Sanghavi D. Palliative care needs in medical intensive care: improved identification-retrospective cohort study. BMJ Support Palliat Care 2024:spcare-2022-004128. [PMID: 38777373 DOI: 10.1136/spcare-2022-004128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 05/25/2024]
Affiliation(s)
- Olivia Rossnan
- Department of Critical Care Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Abby Hanson
- Department of Critical Care Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Aaron Spaulding
- Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Parthkumar Satashia
- Department of Critical Care Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Maisha Robinson
- Department of Palliative Care, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Scott A Helgeson
- Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Pablo Moreno-Franco
- Department of Critical Care Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
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Müller E, Müller MJ, Boehlke C, Schäfer H, Quante M, Becker G. Screening for Palliative Care Need in Oncology: Validation of Patient-Reported Outcome Measures. J Pain Symptom Manage 2024; 67:279-289.e6. [PMID: 38154625 DOI: 10.1016/j.jpainsymman.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
CONTEXT Leading oncology societies recommend monitoring symptoms and support needs through patient-reported outcome measures (PROMs), but their use for assessing specialist palliative care (SPC) need has not yet been explored. Research on SPC integration has focused on staff-assessed screening tools, which are time-consuming. OBJECTIVES This study aimed to assess the diagnostic validity of the Integrated Palliative Outcome Scale (IPOS) and NCCN Distress Thermometer (NCCN DT) in identifying need for SPC in patients with incurable cancer. METHODS In a cross-sectional study, patients with incurable cancer (prognosis <2 years) completed PROMs. In an independent process, the palliative care consultation service (PCCS) assessed the need for SPC in each patient through multiprofessional case review, and this was used as the reference standard. ROC analyses were employed to determine diagnostic validity. RESULTS Of the 208 participants, 71 (34.1 %) were classified as having SPC need by the PCCS. Aiming for a minimum sensitivity of 80%, a cut-off of ≥2 items with high/very high burden in the IPOS resulted in a 90.2% sensitivity (specificity = 50; AUC = 0.791; CI 95%= 0.724-0.858). A cut-off of ≥5 resulted in a sensitivity of 80 % for NCCN DT (specificity = 49.5 %; AUC = 0.687; CI 95% = 0.596-0.777). CONCLUSION PROMs are useful for identifying SPC need in cancer patients. Their implementation might facilitate timely integration of SPC. Future research should focus on an integrated assessment approach with PROMs that combines the requirements of the different specialties to save patient and staff resources.
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Affiliation(s)
- Evelyn Müller
- Department of Palliative Medicine (E.M., M.J.M., G.B.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Josef Müller
- Department of Palliative Medicine (E.M., M.J.M., G.B.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Christopher Boehlke
- Department of Palliative Care (C.B.), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Henning Schäfer
- Department of Radiation Oncology (H.S.), Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ) Heidelberg, Freiburg, Germany
| | - Michael Quante
- Clinic for Internal Medicine II (M.Q.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerhild Becker
- Department of Palliative Medicine (E.M., M.J.M., G.B.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Müller E, Müller MJ, Seibel K, Boehlke C, Schäfer H, Klein C, Heckel M, Simon ST, Becker G. Interrater agreement of multi-professional case review as reference standard for specialist palliative care need: a mixed-methods study. BMC Palliat Care 2023; 22:181. [PMID: 37974104 PMCID: PMC10652431 DOI: 10.1186/s12904-023-01281-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND A wide variety of screening tools for the need for specialist palliative care (SPC) have been proposed for the use in oncology. However, as there is no established reference standard for SPC need to compare their results with, their sensitivity and specificity have not yet been determined. The aim of the study was to explore whether SPC need assessment by means of multi-professional case review has sufficient interrater agreement to be employed as a reference standard. METHODS Comprehensive case descriptions were prepared for 20 inpatients with advanced oncologic disease at the University Hospital Freiburg (Germany). All cases were presented to the palliative care teams of three different hospitals in independent, multi-professional case review sessions. The teams assessed whether patients had support needs in nine categories and subsequently concluded SPC need (yes / no). Interrater agreement regarding SPC need was determined by calculating Fleiss' Kappa. RESULTS In 17 out of 20 cases the three teams agreed regarding their appraisal of SPC need (substantial interrater agreement: Fleiss' Kappa κ = 0.80 (95% CI: 0.55-1.0; p < 0.001)). The number of support needs was significantly lower for patients who all teams agreed had no SPC need than for those with agreed SPC need. CONCLUSIONS The proposed expert case review process shows sufficient reliability to be used as a reference standard. Key elements of the case review process (e.g. clear definition of SPC need, standardized review of the patients' support needs) and possible modifications to simplify the process are discussed. TRIAL REGISTRATION German Clinical Trials Register, DRKS00021686, registered 17.12.2020.
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Affiliation(s)
- Evelyn Müller
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany.
| | - Michael Josef Müller
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
| | - Katharina Seibel
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
| | - Christopher Boehlke
- Department of Palliative Care, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Henning Schäfer
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
| | - Carsten Klein
- Department of Palliative Medicine, University Hospital Erlangen-EMN, Comprehensive Cancer Center CCC Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine, University Hospital Erlangen-EMN, Comprehensive Cancer Center CCC Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Steffen T Simon
- Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), University Hospital of Cologne, Faculty of Medicine and University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - Gerhild Becker
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
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Rossnan O, Hanson A, Spaulding A, Satashia P, Bhakta S, Robinson M, Helgeson SA, Moreno-Franco P, Sanghavi D. Improved needs identification in medical intensive care and palliative medicine: retrospective cohort study. BMJ Support Palliat Care 2023:spcare-2023-004205. [PMID: 36797044 DOI: 10.1136/spcare-2023-004205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Olivia Rossnan
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Abby Hanson
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Aaron Spaulding
- Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Maisha Robinson
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Scott A Helgeson
- Department of Internal Medicine, Mayo Clinic's Campus in Florida, Jacksonville, Florida, USA
| | - Pablo Moreno-Franco
- Transplant Medicine, Critical Care Services, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
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Lüthi FT, Bernard M, Gamondi C, Ramelet AS, Borasio GD. ID-PALL: An Instrument to Help You Identify Patients in Need of Palliative Care. PRAXIS 2021; 110:839-844. [PMID: 34814722 DOI: 10.1024/1661-8157/a003788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Palliative care is frequently associated with the end of life and cancer. However, other patients may need palliative care, and this need may be present earlier in the disease trajectory. It is therefore essential to identify at the right time patients who need palliative care and to distinguish between those in need of general palliative care and those for whom a referral to specialists is required. ID-PALL has been developed as an instrument to support professionals in this identification and to discuss a suitable palliative care project, in order to maintain the best quality of life for patients and their relatives. Recommendations for clinical practice are also proposed to guide professionals after the identification phase.
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Affiliation(s)
- Fabienne Teike Lüthi
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - Mathieu Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - Claudia Gamondi
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne
- Palliative and Supportive Care Service, Istituto Oncologico della Svizzera Italiana, Bellinzona
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Lausanne
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne
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Abstract
Patients with advanced COPD have a high symptom burden that is often multidimensional. Identification of patients who might benefit from palliative care through validated identification tools, multidimensional symptom management, and timely discussion of advance planning are elements of a palliative care approach for these patients and their families. Coordination among stakeholders providing care and support to these patients is central to ensuring high-quality care and meeting all of their needs.
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Affiliation(s)
- Tanja Fusi-Schmidhauser
- Palliative and Supportive Care Clinic, IOSI-EOC and Department of Internal Medicine, Ospedale Regionale di Lugano, Lugano
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