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Hochrath S, Dhollander N, Deliens L, Schots R, Daenen F, Kerre T, Beernaert K, Pardon K. Palliative Care in Hematology: A Systematic Review of the Components, Effectiveness, and Implementation. J Pain Symptom Manage 2024:S0885-3924(24)00960-6. [PMID: 39173896 DOI: 10.1016/j.jpainsymman.2024.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
CONTEXT While the evidence supporting the benefits of integration of palliative care into cancer care for patients and informal caregivers is growing, it poses challenges for hematological cancer patients due to rapidly changing disease trajectories, uncertain prognosis, and diverse care needs. OBJECTIVES This systematic review aims to provide an overview of the intervention components, the targeted outcomes, the effectiveness in improving patient and informal caregiver outcomes, and the implementation into clinical practice. METHODS We systematically searched PubMed (MEDLINE), EMBASE, CENTRAL, PsycINFO, and CINAHL in March 2023. The studies included described interventions in palliative care, with multiple components, targeting patients with hematological cancer and/or their informal caregivers, and producing primary data on effectiveness or implementation. Quality was assessed using the QualSyst tool. RESULTS We identified 19 reports on 16 different palliative care interventions, including four quasi-randomized controlled trials. These interventions were provided by secondary and tertiary palliative care providers in a hospital setting. Tertiary interventions significantly improved the most common patient outcomes, including pain, quality of life, symptom burden, depression, and anxiety. Meanwhile, secondary interventions were feasible and well-accepted by healthcare professionals and patients. Despite limited inclusion of informal caregivers, the results indicated significant improvements in quality of life and depression. CONCLUSION While palliative care interventions are found to improve patient outcomes, future research is needed on the effectiveness of secondary palliative care interventions, integrating primary palliative care, and more reliable and frequent implementation measurements. More focus on informal caregivers and resource allocation based on patient needs is warranted.
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Affiliation(s)
- Sophie Hochrath
- End-of-Life Care Research Group (S.H., N.D., L.D., F.D., K.P.), Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Naomi Dhollander
- End-of-Life Care Research Group (S.H., N.D., L.D., F.D., K.P.), Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group (S.H., N.D., L.D., F.D., K.P.), Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Rik Schots
- Vrije Universiteit Brussel (R.S.), Brussels, Belgium; Department of Hematology (R.S. ), University Hospital Brussels, Brussels, Belgium
| | - Frederick Daenen
- End-of-Life Care Research Group (S.H., N.D., L.D., F.D., K.P.), Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Tessa Kerre
- Ghent University (T.K.), Ghent, Belgium; Department of Hematology (T.K.), University Hospital Ghent, Ghent, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group (K.B.), Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
| | - Koen Pardon
- End-of-Life Care Research Group (S.H., N.D., L.D., F.D., K.P.), Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
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Gebel C, Kruschel I, Bodinger S, Simon ST, Eichenauer DA, Pralong A, Wedding U. Palliative care for patients with hematologic malignancies in Germany: a nationwide survey on everyday practice and influencing factors from the perspective of treating physicians. Ann Hematol 2024; 103:1753-1763. [PMID: 38538976 PMCID: PMC11009764 DOI: 10.1007/s00277-024-05726-8] [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: 02/01/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
Integrating palliative care into the treatment of patients with advanced hematological malignancies (HM) remains challenging. To explore treating physicians' perspectives on current palliative care practice and to evaluate factors influencing integration, we conducted a nationwide online survey. Based on literature and expert review, the survey addressed the importance of palliative care, communication about life-threatening conditions, challenges in establishing goals of care, and factors influencing the integration of palliative care. 207 physicians treating patients with HM in Germany participated. We used standard descriptive statistics to analyze quantitative data and a content structuring approach. Most physicians considered palliative care in HM to be very important (60.6%) and discussed life-threatening conditions with more than half of their patients (52%), especially when goals of care were changed (87.0%) or when patients raised the topic (84.0%). Disease-related factors, different professional perspectives on prognosis, and patient hopes were the main barriers to changing goals of care, but collaboration with colleagues and multidisciplinary teams provided important support. Time constraints were identified as the main barrier to integrating palliative care. The majority worked well with palliative care teams. Referral processes and conditions were perceived as minor barriers. The study highlights the need to address barriers to integrating palliative care into the management of patients with advanced HM. Future research should aim at optimizing palliative care for patients with HM.
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Affiliation(s)
- Cordula Gebel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University, Jena, Germany.
- Comprehensive Cancer Center Central Germany (CCCG), Cologne, Germany.
| | - Isabel Kruschel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Cologne, Germany
| | - Steffi Bodinger
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Cologne, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, Faculty of Medicine and Cologne University Hospital, Center for Integrated Oncology Aachen Bonn Dusseldorf Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Dusseldorf Cologne, University of Cologne, Cologne, Germany
| | - Anne Pralong
- Department of Palliative Medicine, Faculty of Medicine and Cologne University Hospital, Center for Integrated Oncology Aachen Bonn Dusseldorf Cologne, Cologne, Germany
| | - Ulrich Wedding
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Cologne, Germany
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Gebel C, Ditscheid B, Meissner F, Slotina E, Kruschel I, Marschall U, Wedding U, Freytag A. Utilization and quality of palliative care in patients with hematological and solid cancers: a population-based study. J Cancer Res Clin Oncol 2024; 150:191. [PMID: 38607376 PMCID: PMC11014814 DOI: 10.1007/s00432-024-05721-6] [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: 02/19/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Palliative care (PC) contributes to improved end-of-life care for patients with hematologic malignancies (HM) and solid tumors (ST) by addressing physical and psychological symptoms and spiritual needs. Research on PC in HM vs. ST patients is fragmented and suggests less use. METHODS We analyzed claims data of all deceased members of a large German health insurance provider for the year before death. First, we analyzed the frequency and the beginning of different types of PC and compared patients with HM vs. ST. Second, we analyzed the adjusted impact of PC use on several end-of-life quality outcomes in patients with HM vs. ST. We performed simple and multiple (logistic) regression analysis, adjusted for relevant covariates, and standardized for age and sex. RESULTS Of the 222,493 deceased cancer patients from 2016 to 2020, we included 209,321 in the first analysis and 165,020 in the second analysis. Patients with HM vs. ST received PC less often (40.4 vs. 55.6%) and later (34 vs. 50 days before death). PC use significantly improved all six quality indicators for good end-of-life care. HM patients had worse rates in five of the six indicators compared with ST patients. Interaction terms revealed that patients with ST derived greater benefit from PC in five of six quality indicators than those with HM. CONCLUSION The data highlight the need to integrate PC more often, earlier, and more effectively into the care of patients with HM.
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Affiliation(s)
- Cordula Gebel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany.
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland.
| | - Bianka Ditscheid
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Franziska Meissner
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Ekaterina Slotina
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Isabel Kruschel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland
| | | | - Ullrich Wedding
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland
| | - Antje Freytag
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
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Paim Miranda DL, Orathes Ponte Silva AM, Pereira Ferreira D, Teixeira da Silva L, Lins-Kusterer L, de Queiroz Crusoé E, Vieira Lima MB, Aurélio Salvino M. Variability in the perception of palliative care and end-of-life care among hematology professionals from the same reference center in Bahia, Brazil: A descriptive cross-sectional study. SAO PAULO MED J 2024; 142:e2023225. [PMID: 38422243 PMCID: PMC10885630 DOI: 10.1590/1516-3180.2023.0255.r1.29112023] [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: 08/15/2023] [Revised: 10/31/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND There are several illness-specific cultural and system-based barriers to palliative care (PC) integration and end-of-life (EOL) care in the field of oncohematology. OBJECTIVES This study aimed to investigate the variability in the perceptions of PC and EOL care. DESIGN AND SETTING A cross-sectional study was conducted in the Hematology Division of our University Hospital in Salvador, Bahia, Brazil. METHODS Twenty physicians responded to a sociodemographic questionnaire and an adaptation of clinical questionnaires used in previous studies from October to December 2022. RESULTS The median age of the participants was 44 years, 80% of the participants identified as female, and 75% were hematologists. Participants faced a hypothetical scenario involving the treatment of a 65-year-old female with a poor prognosis acute myeloid leukemia refractory to first-line treatment. Sixty percent of the participants chose to follow other chemotherapy regimens, whereas 40% opted for PC. Next, participants considered case salvage for the patient who developed septic shock following chemotherapy and were prompted to choose their most probable conduct, and the conduct they thought would be better for the patient. Even though participants were from the same center, we found a divergence from the most probable conduct among 40% of the participants, which was due to personal convictions, legal aspects, and other physicians' reactions. CONCLUSIONS We found considerable differences in the perception of PC and EOL care among professionals, despite following the same protocols. The study also demonstrated variations between healthcare professionals' beliefs and practices and persistent historical tendencies to prioritize aggressive interventions.
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Affiliation(s)
- Diego Lopes Paim Miranda
- MD. MSc student, Postgraduate Program in Medicine and Health, Professor Edgard Santos University Hospital, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Alini Maria Orathes Ponte Silva
- MD. MSc student, Postgraduate Program in Medicine and Health, Professor Edgard Santos University Hospital, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - David Pereira Ferreira
- Medicine Student, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Laís Teixeira da Silva
- MD. MSc student, Postgraduate Program in Medicine and Health, Professor Edgard Santos University Hospital, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Liliane Lins-Kusterer
- PhD. Dental Surgeon, Professor, Postgraduate Program in Medicine and Health, Department of Preventive and Social Medicine Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Edvan de Queiroz Crusoé
- MD, PhD. Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Marianna Batista Vieira Lima
- MD. Physician, Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Marco Aurélio Salvino
- MD, PhD. Associate Professor, Postgraduate Program in Medicine and Health, Professor Edgard Santos University Hospital, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
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Tsang M, Bischoff K, Schoenbeck KL, Berry K, O’Riordan D, Fakhri B, Wong SW, Shah N, Olin R, Andreadis C, Vieaux J, Cohen E, Lopez NS, Mannis GN, Rabow M. Value of embedded palliative care: outpatient palliative care and health care utilization for patients with hematologic malignancies. Blood Adv 2023; 7:3146-3149. [PMID: 36809787 PMCID: PMC10362539 DOI: 10.1182/bloodadvances.2022009039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/23/2023] Open
Affiliation(s)
- Mazie Tsang
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Kara Bischoff
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Kelly L. Schoenbeck
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
- Division of Hematology and Oncology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Kim Berry
- Executive Finance Consultant, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - David O’Riordan
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Bita Fakhri
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Sandy W. Wong
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Nina Shah
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Rebecca Olin
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Charalambos Andreadis
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Jules Vieaux
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Eve Cohen
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Nancy Shepard Lopez
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Gabriel N. Mannis
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Michael Rabow
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
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Gebel C, Basten J, Kruschel I, Ernst T, Wedding U. Knowledge, feelings, and willingness to use palliative care in cancer patients with hematologic malignancies and solid tumors: a prospective, cross-sectional study in a comprehensive cancer center in Germany. Support Care Cancer 2023; 31:445. [PMID: 37410174 DOI: 10.1007/s00520-023-07914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Patients with hematologic malignancies (HM) receive palliative care (PC) less often and later than patients with solid tumors (ST). Patients' lack of knowledge about PC and negative feelings about PC are barriers to their willingness to use PC. Is there a difference between patients with HM and ST in their knowledge and willingness to use PC? METHODS Two hundred ten patients (85 HM, 125 ST) from an oncology day clinic at a university hospital participated in this cross-sectional, questionnaire-based survey. RESULTS Patients with HM and ST had high knowledge and mainly positive feelings about PC. More than half of the patients answered that they would feel reassured by the use of PC, and one-third would feel anxious or hopeless. The majority of patients (58.3%) were willing to use PC. There are no significant differences between patients with HM and ST. In multiple regression analysis, perceived chance of cure and feelings of reassurance and anxiety are associated with willingness to use PC, but not with the HM/ST disease group. More than half (53.9%) of the participants would like the treating physician to choose the timing of a discussion about PC. CONCLUSION Our study shows a high level of knowledge and relatively positive feelings of patients about PC, with no differences between patients with HM or ST. They expect their treating physician to initiate communication about PC. Communication should include the patient's feelings about PC and their chances of a cure.
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Affiliation(s)
- Cordula Gebel
- Department of Palliative Care, Jena University Hospital, Jena, Germany.
| | - Judith Basten
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - Isabel Kruschel
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Jena, Germany
| | - Ulrich Wedding
- Department of Palliative Care, Jena University Hospital, Jena, Germany
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McPherson S, Mitchell AK, Sletten I, Kvande ME, Steindal SA. Haematological nurses' experiences about palliative care trajectories of patients with life-threatening haematological malignancies: A qualitative study. Nurs Open 2022; 10:3094-3103. [PMID: 36539384 PMCID: PMC10077405 DOI: 10.1002/nop2.1558] [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: 09/02/2022] [Revised: 11/12/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS To explore haematological nurses' experiences about the palliative care trajectories of patients with life-threatening haematological malignancies. DESIGN A qualitative study with a descriptive and explorative design. METHODS Data were collected through 12 individual semi-structured interviews of nurses who work with patients with haematological malignancies from four hospitals in Norway. The data were analysed using systematic text condensation. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. RESULTS Three categories emerged from the data analysis: focus on a cure delays integration of palliative care, dialogue with patients facilitates palliative care and the need for enhanced interdisciplinary understanding. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution since nurses' experiences were explored.
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Affiliation(s)
- Siobhan McPherson
- Lovisenberg Diaconal University College, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Ann-Kristin Mitchell
- Lovisenberg Diaconal University College, Oslo, Norway.,Oslo Myeloma Center, Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Ida Sletten
- Lovisenberg Diaconal University College, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Monica Evelyn Kvande
- Lovisenberg Diaconal University College, Oslo, Norway.,Department of Anaesthesiology and Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Simen Alexander Steindal
- Lovisenberg Diaconal University College, Oslo, Norway.,Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Abstract
Patients diagnosed with acute myeloid leukemia (AML) face sudden-onset life-threatening disease that requires intensive treatments. Although their early disease trajectory is characterized by significant, toxic side effects, there is limited data describing coping strategies among patients with AML and how these inform patient-reported outcomes. We used cross-sectional secondary data analyses to describe coping in 160 patients with newly diagnosed high-risk AML. We used the Brief COPE, Hospital Anxiety and Depression Scale, PTSD Checklist-Civilian Version, and Functional Assessment of Cancer Therapy-Leukemia at time of AML diagnosis to measure coping strategies, psychological distress and quality of life (QOL), respectively. We used the median split method for distribution of coping domains, and multivariate regression models to assess the relationship between coping and patient-reported outcomes. Participants (median age=64.4 years) were mostly non-Hispanic White (86.3%), male (60.0%), and married (73.8%). Most (51.9%) had high utilization of approach-oriented coping strategies whereas 38.8% had high utilization of avoidant coping strategies. At time of diagnosis, use of approach-oriented coping was associated with less psychological distress (anxiety: β=-0.262, p=0.002; depression symptoms β=-0.311, p<0.001; PTSD symptoms: β=-0.596, p=0.006) and better QOL (β=1.491, p=0.003). Use of avoidant coping was associated with more psychological distress (anxiety: β=0.884, p<0.001; depression symptoms: β=0.697, p<0.001; PTSD symptoms: β=3.048, p<0.001) and worse QOL (β=-5.696, p<0.001). Patients with high-risk AML utilize various approach-oriented and avoidant coping strategies at time of diagnosis. Use of approach-oriented coping strategies was associated with less psychological distress and better QOL, suggesting a possible target for supportive oncology interventions.
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