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Arian M, Hajiabadi F, Amini Z, Oghazian MB, Valinejadi A, Sahebkar A. Introduction of Various Models of Palliative Oncology Care: A Systematic Review. Rev Recent Clin Trials 2024; 19:109-126. [PMID: 38155467 DOI: 10.2174/0115748871272511231215053624] [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: 08/21/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The aim of this study is to synthesize the existing evidence on various palliative care (PC) models for cancer patients. This effort seeks to discern which facets of PC models are suitable for various patient cohorts, elucidate their mechanisms, and clarify the circumstances in which these models operate. METHODS A comprehensive search was performed using MeSH terms related to PC and cancer across various databases. The Preferred Reporting Items for Systematic Reviews and a comprehensive evidence map were also applied. RESULTS Thirty-three reviews were published between 2009 and 2023. The conceptual PC models can be classified broadly into time-based, provider-based, disease-based, nurse-based, issue-based, system-based, team-based, non-hospice-based, hospital-based, community-based, telehealth-based, and setting-based models. The study argues that the outcomes of PC encompass timely symptom management, longitudinal psychosocial support, enhanced communication, and decision-making. Referral methods to specialized PC services include oncologist-initiated referral based on clinical judgment alone, via referral criteria, automatic referral at the diagnosis of advanced cancer, or referral based on symptoms or other triggers. CONCLUSION The gold standard for selecting a PC model in the context of oncology is a model that ensures broad availability of early PC for all patients and provides well-timed, scheduled, and specialized care for patients with the greatest requirement.
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Affiliation(s)
- Mahdieh Arian
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Hajiabadi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zakiyeh Amini
- Department of Nursing, Faculty of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mohammad Bagher Oghazian
- Department of Internal Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Ali Valinejadi
- Department of Health Information Technology, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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2
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Brugel M, Dupont M, Carlier C, Botsen D, Essi DE, Sanchez V, Slimano F, Perrier M, Bouché O. Association of palliative care management and survival after chemotherapy discontinuation in patients with advanced pancreatic adenocarcinoma: A retrospective single-centre observational study. Pancreatology 2023:S1424-3903(23)00069-8. [PMID: 37037682 DOI: 10.1016/j.pan.2023.03.005] [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: 10/15/2022] [Revised: 02/20/2023] [Accepted: 03/16/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Palliative care (PC) is integrated into standard oncology care. However, its clinical impact at the end of life remains unclear in pancreatic adenocarcinoma (PA). We aimed to describe the end-of-life care pathway and to assess whether PC referral influences survival after chemotherapy discontinuation (CD) among advanced PA patients. METHODS This retrospective single-centre observational study was conducted among deceased patients with advanced PA who had received chemotherapy between January 1, 2016, and December 31, 2021. Baseline characteristics, the timing of PC referral and events after CD were collected. The primary outcome was time from CD to death. RESULTS Among the 148 included patients, 53.4% (n = 79) received PC, mostly late after the CD (n = 133, 89.9%), 16.9% (n = 25) received chemotherapy in the last 14 days of life and 75.6% died at the hospital. None received PC in the 8 weeks following the diagnosis. PC referral significantly increased PC department admissions (p < 0.001) and decreased medical unit admissions (p < 0.001). The median survival after the CD was 35 days (IQR: 19-64.5). PC referral was associated with increased survival after CD (HR: 0.65 [0.47-0.90], p = 0.010, Cox) and after adjusting (HR: 0.65 [0.42-0.99], p = 0.045, Cox). CONCLUSION The study suggests that PC may be associated with longer survival after CD in advanced PA patients. However, PC is underused, and patients are referred late in their care pathway.
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Affiliation(s)
- M Brugel
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France.
| | - M Dupont
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - C Carlier
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France; Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - D Botsen
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France; Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - D Edoh Essi
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - V Sanchez
- Department of Palliative Care, CHU Reims, Reims, France
| | - F Slimano
- Université de Reims Champagne-Ardenne, Department of Pharmacy, CHU Reims, Reims, France
| | - M Perrier
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France
| | - O Bouché
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France
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3
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The Role of Palliative Care in COPD. Chest 2021; 161:1250-1262. [PMID: 34740592 PMCID: PMC9131048 DOI: 10.1016/j.chest.2021.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States and is a serious respiratory illness characterized by years of progressively debilitating breathlessness, high prevalence of associated depression and anxiety, frequent hospitalizations, and diminished wellbeing. Despite the potential to confer significant quality of life benefits for patients and their care partners and to improve end-of-life care, specialist palliative care is rarely implemented in COPD and when initiated it often occurs only at the very end of life. Primary palliative care delivered by frontline clinicians is a feasible model, but is not routinely integrated in COPD. In this review, we discuss the following: 1) the role of specialist and primary palliative care for patients with COPD and the case for earlier integration into routine practice; 2) the domains of the National Consensus Project Guidelines for Quality Palliative Care applied to people living with COPD and their care partners; and, 3) triggers for initiating palliative care and practical ways to implement palliative care using case-based examples. In the end, this review solidifies that palliative care is much more than hospice and end-of-life care and demonstrates that early palliative care is appropriate at any point during the COPD trajectory. We emphasize that palliative care should be integrated long before the end of life to provide comprehensive support for patients and their care partners and to better prepare them for the end of life.
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Agne JL, Bertino EM, Grogan M, Benedict J, Janse S, Naughton M, Eastep C, Callahan M, Presley CJ. Too Many Appointments: Assessing Provider and Nursing Perception of Barriers to Referral for Outpatient Palliative Care. Palliat Med Rep 2021; 2:137-145. [PMID: 34223513 PMCID: PMC8241388 DOI: 10.1089/pmr.2020.0114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Integration of early outpatient palliative care for patients with advanced cancer requires overcoming logistical constraints as well as attitudinal barriers of referring providers. This pilot study assessed provider perception of logistical and attitudinal barriers to outpatient palliative care referral as well as provider acceptability of an embedded onco-palliative clinic model. Methods: This was a cross-sectional survey-based study of medical oncologists, palliative care physicians, advanced practice providers (APP), and oncology nurses at a large U.S. academic center. Participants were invited to participate through anonymous online survey. Participants rank ordered logistical barriers influencing referral to an outpatient palliative clinic. Respondents indicated level of agreement with attitudinal perception of palliative care and acceptability of an embedded palliative clinic model through five-item Likert-like scales. Results: There were a total of 54 study participants (28 oncology physicians/APPs, 15 palliative physicians/APPs, and 11 oncology nurses). Across the three cohorts, most survey respondents ranked "time burden to patients" as the primary logistical barrier to outpatient palliative care referral. Both oncology and palliative providers indicated comfort with primary palliative care skills although palliative providers were more comfortable with symptom management compared with oncology providers (93.3% vs. 32.2%). A majority of participants (94.9%) were willing to refer to a palliative care provider embedded within an oncology clinic. Conclusion: Additional health care time cost to patients is a major barrier to outpatient palliative care referral. Embedding a palliative care provider in an oncology clinic may be an acceptable model to increase patient access to outpatient palliative care while supporting the oncology team.
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Affiliation(s)
- Julia L Agne
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Erin M Bertino
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Madison Grogan
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jason Benedict
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sarah Janse
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michelle Naughton
- Cancer Control and Prevention, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Christine Eastep
- Department of Oncology Nursing, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Michael Callahan
- Department of Oncology Nursing, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Carolyn J Presley
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
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5
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Blum D, Seiler A, Schmidt E, Pavic M, Strasser F. Patterns of integrating palliative care into standard oncology in an early ESMO designated center: a 10-year experience. ESMO Open 2021; 6:100147. [PMID: 33984671 PMCID: PMC8134655 DOI: 10.1016/j.esmoop.2021.100147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Integration of specialist palliative care (PC) into standard oncology care is recommended. This study investigated how integration at the Cantonal Hospital St. Gallen (KSSG) was manifested 10 years after initial accreditation as a European Society for Medical Oncology (ESMO) Designated Center (ESMO-DC) of Integrated Oncology and Palliative Care. METHODS A chart review covering the years 2006-2009 and 2016 was carried out in patients with an incurable malignancy receiving PC. Visual graphic analysis was utilized to identify patterns of integration of PC into oncology based on the number and nature of medical consultations recorded for both specialties. A follow-up cohort collected 10 years later was analyzed and changes in patterns of integrating specialist PC into oncology were compared. RESULTS Three hundred and forty-five patients from 2006 to 2009 and 64 patients from 2016 were included into analyses. Four distinct patterns were identified using visual graphic analysis. The 'specialist PC-led pattern' (44.9%) and the 'oncology-led pattern' (20.3%) represent disciplines that took primary responsibility for managing patients, with occasional and limited involvement from other disciplines. Patients in the 'concurrent integrated care pattern' (18.3%) had medical consultations that frequently bounced between specialist PC and oncology. In the 'segmented integrated care pattern' (16.5%), patients had sequences of continuous consultations provided by one discipline before alternating to a stretch of consultations provided by the other specialty. In the 2016 follow-up, while the 'oncology-led pattern' occurred significantly less frequently relative to the 'specialist PC-led pattern' and the 'segmented integrated care pattern', the 'concurrent integrated care pattern' emerged more frequently when compared with the 2006-2009 follow-up. CONCLUSION The 'specialist PC-led pattern' was the most prominent pattern in this data. The 2016 follow-up showed that a growing number of patients received a collaborative pattern of care, indicating that integration of specialist PC into standard oncology can manifest as either segmented or concurrent care pathways. Our data suggest a closer, more dynamic and flexible collaboration between oncology and specialist PC early in the disease course of patients with advanced cancer and concurrent with active treatment.
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Affiliation(s)
- D. Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland,Correspondence to: Dr David Blum, Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, CH-8091 Zürich, Switzerland. Tel: +044-255-37-42; Mob: +079-154-87-47
| | - A. Seiler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - E. Schmidt
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland,Oncological Palliative Medicine, Clinic Oncology/Hematology, Cantonal Hospital St. Gallen, Switzerland
| | - M. Pavic
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - F. Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Cantonal Hospital St. Gallen, Switzerland
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6
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Umaretiya PJ, Rubin JP, Snaman JM, Ullrich C, Feraco AM, Dussel V, Wolfe J, Waldman E. Are we undermining the value of palliative care through advanced cancer clinical trial consent language? Cancer 2021; 127:1954-1956. [PMID: 33689176 DOI: 10.1002/cncr.33482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jennifer P Rubin
- Department of Pediatric Neurology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer M Snaman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christina Ullrich
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Angela M Feraco
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Veronica Dussel
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Centro de Investigación e Implementación en Cuidados Paliativos, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Joanne Wolfe
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elisha Waldman
- Division of Palliative Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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7
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Saouma Nehmé M, Desbiens JF, Gagnon J. [Nursing practice in palliative care with terminally ill cancer patients in an interdisciplinary team: A case study in Lebanon]. Rech Soins Infirm 2020; 141:60-69. [PMID: 32988191 DOI: 10.3917/rsi.141.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Nurses in Lebanon are poorly prepared to provide palliative care (PC), and practice in this area is poorly documented. This qualitative descriptive study aimed to understand the reality of nursing practice in PC, with terminally ill cancer patients, within an interdisciplinary team. A simple case study was conducted with eleven nurses, three families, an interdisciplinary team, and national experts in PC. Data analysis, carried out with triangulation of both methods and sources, highlighted a humanist relationship characterized by caring, transcending the five central emerging themes : the perception of PC as a means of offering a better quality of life, comprehensive patient care, interdisciplinarity, spirituality, and family support during PC. The results could provide empirical foundations to guide the development of PC nursing practice in the country.
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8
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Ndiok A, Ncama B. Barriers and benefits of model development for integration of palliative care for cancer patients in a developing country: A qualitative study. Int J Nurs Pract 2020; 27:e12884. [PMID: 32815240 DOI: 10.1111/ijn.12884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 11/27/2022]
Abstract
AIM The aim of the study was to identify barriers and benefits in establishing a model for integration of palliative care of cancer patients in daily clinical practice in tertiary health institutions. METHODS This was a qualitative design study using in-depth interviews with four stakeholders and focus group discussions with 19 nurse managers using purposive sampling to select the participants, utilizing interpretive paradigm method. Need was ascertained for a model that would guide nursing care for cancer patients. RESULTS Barriers identified in relation to integrating palliative care in daily clinical practice included lack of hospital policies about palliative care activities, cultural influences, denial or rejection of diagnosis by patients, inappropriate attitude of health care workers, patients failing to keep check-up appointments and financial implications of setting up a dedicated palliative care team. Benefits of the model were twofold: hospital outcomes and patients/family outcomes. CONCLUSIONS Quality care for cancer patients/families calls for the adoption of clearly set out principles of palliative care as an integral component of daily practice. Challenges to implementation of palliative care services in hospitals can be overcome by establishing workable policies and allocating adequate funds for palliative care activities.
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Affiliation(s)
- Akon Ndiok
- Department of Nursing Science, University of Calabar, Calabar, Nigeria.,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Busisiwe Ncama
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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9
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Borraccino A, Campagna S, Politano G, Dalmasso M, Dimonte V, Gianino MM. Predictors and trajectories of ED visits among patients receiving palliative home care services: findings from a time series analysis (2013-2017). BMC Palliat Care 2020; 19:126. [PMID: 32799860 PMCID: PMC7429889 DOI: 10.1186/s12904-020-00626-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current policies recommend integrating home care and palliative care to enable patients to remain at home and avoid unnecessary hospital admission and emergency department (ED) visits. The Italian health care system had implemented integrated palliative home care (IHPC) services to guarantee a comprehensive, coordinated approach across different actors and to reduce potentially avoidable ED visits. This study aimed to analyze the trajectories of ED visit rates among patients receiving IHPC in the Italian healthcare system, as well as the association between socio-demographic, health supply, and clinical factors. METHODS A pooled, cross-sectional, time series analysis was performed in a large Italian region in the period 2013-2017. Data were taken from two databases of the official Italian National Information System: Home Care Services and ED use. A clinical record is opened at the time a patient is enrolled in IHPC and closed after the last service is provided. Every such clinical record was considered as an IHPC event, and only ED visits that occurred during IHPC events were considered. RESULTS The 20,611 patients enrolled in IHPC during the study period contributed 23,085 IHPC events; ≥1 ED visit occurred during 6046 of these events. Neoplasms accounted for 89% of IHPC events and for 91% of ED visits. Although there were different variations in ED visit rates during the study period, a slight decline was observed for all diseases, and this decline accelerated over time (b = - 0.18, p = 0.796, 95% confidence interval [CI] = - 1.59;1.22, b-squared = - 1.25, p < 0.001, 95% CI = -1.63;-0.86). There were no significant predictors among the socio-demographic factors (sex, age, presence of a non-family caregiver, cohabitant family members, distance from ED), health supply factors (proponent of IHPC) and clinical factors (prevalent disorder at IHPC entry, clinical symptoms). CONCLUSION Our results show that use of ED continues after enrollment in IHPC, but the trend of this use declines over time. As no significant predictive factors were identified, no specific interventions can be recommended on which the avoidable ED visits depend.
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Affiliation(s)
- Alberto Borraccino
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126, Torino, Italy
| | - Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126, Torino, Italy.
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico of Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Marco Dalmasso
- Regional Public Health Observatory (SEPI), Local Health Unit TO3, Via Sabaudia 164, 10095, Grugliasco (To), Italy
| | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126, Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126, Torino, Italy
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10
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Ferrell BR, Chung V, Koczywas M, Smith TJ. Dissemination and Implementation of Palliative Care in Oncology. J Clin Oncol 2020; 38:995-1001. [PMID: 32023151 PMCID: PMC7082157 DOI: 10.1200/jco.18.01766] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 12/24/2022] Open
Abstract
Palliative care began in academic centers with specialty consultation services, and its value to patients, families, and health systems has been evident. The demand for palliative care to be integrated throughout the cancer trajectory, combined with a limited palliative care workforce, means that new models of care are needed. This review discusses evidence regarding the need for integration of palliative care into routine oncology care and describes best practices recognized for dissemination of palliative care. The available evidence suggests that palliative care be widely adopted by clinicians in all oncology settings to benefit patients with cancer and their families. Efforts are needed to adapt and integrate palliative care into community practice. Limitations of these models are discussed, as are future directions to continue implementation efforts. The benefits of palliative care can only be realized through effective dissemination of these principles of care, with more primary palliative care delivered by oncology clinicians.
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Affiliation(s)
| | | | | | - Thomas J. Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, MD
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11
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Hagan TL, Xu J, Lopez RP, Bressler T. Nursing's role in leading palliative care: A call to action. NURSE EDUCATION TODAY 2018; 61:216-219. [PMID: 29245101 PMCID: PMC5859921 DOI: 10.1016/j.nedt.2017.11.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/07/2017] [Accepted: 11/28/2017] [Indexed: 05/31/2023]
Abstract
Palliative care aims to alleviate the suffering of patients with life-limiting illness while promoting their quality of life. In this call to action commentary, we review the ways in which nursing care and palliative care align, describe barriers to nurses engaging in palliative care, and provide specific recommendations for nurses involved in education, training, and administration to assist nurses at all levels of practice to engage in palliative care for their patients.
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Affiliation(s)
- Teresa L Hagan
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Jiayun Xu
- University of Utah College of Nursing, Salt Lake City, UT, United States
| | - Ruth P Lopez
- MGH Institute of Health Professions School of Nursing, Boston, MA, United States
| | - Toby Bressler
- Oncology Nursing Services at Mount Sinai Health System, New York City, NY, United States
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12
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Validity and reliability of the Palliative Care Transition Measure for Caregivers (PCTM-C). Palliat Support Care 2018; 17:202-207. [PMID: 29352818 DOI: 10.1017/s1478951517001225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Patients suffering from advanced disease face different care transitions. The transition from acute to palliative care is challenging and may lead to the discontinuity of care. Family caregivers become important sources of information, as patients begin to experience difficulties in coping with emotional transition events. The Care Transition Measure was developed to evaluate care transitions as experienced by the elderly. It has never been used in palliative care. The aim of this study was to test the validity and reliability of a modified version of the Palliative Care Transition Measure, specifically the Palliative Care Transition Measure for Caregivers (PCTM-C). METHOD The study included two main phases. Phase I focused on the construction of a modified version of the Palliative Care Transition Measure through two focus groups and by computing the content validity index. Phase II focused on testing the psychometric properties of the PCTM-C on 272 family caregivers through confirmatory factor analysis. RESULT The content validity index for each of the items was higher than 0.80, whereas that for the scale was 0.95. The model tested with confirmatory factor analysis fitted the data well and confirmed that the transition measures referred to communication, integrated care and a trusting-relationship, and therefore the core dimensions of continuity according to existing conceptual models. The internal consistency was high (Cronbach's alpha = 0.94). SIGNIFICANCE OF RESULTS The PCTM-C proved to be a suitable measure of the quality of such transitions. It may be used in clinical practice as a continuity quality indicator and has the potential to guide interventions to enhance family caregivers' experience of care continuity.
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13
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Bakitas MA. On the Road Less Traveled: Journey of an Oncology Palliative Care Researcher. Oncol Nurs Forum 2017; 44:87-95. [PMID: 27991601 DOI: 10.1188/17.onf.87-95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2001, as the Trish Greene Quality of Life lecturer, I described coming to a career crossroads and cited a metaphor from Robert Frost's poem "The Road Not Taken," realizing that, as I chose to leave the path of bone marrow transplantation clinician and go to that of palliative care nurse, there was no turning back. In this article based on my 2016 Oncology Nursing Society Congress Distinguished Nurse Researcher Award lecture, I would like to continue the Frost metaphor as I describe what has transpired since taking "the one less traveled by"-that of palliative care nurse scientist.
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14
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Porta-Sales J, Guerrero-Torrelles M, Moreno-Alonso D, Sarrà-Escarré J, Clapés-Puig V, Trelis-Navarro J, Sureda-Balarí A, Fernández De Sevilla-Ribosa A. Is Early Palliative Care Feasible in Patients With Multiple Myeloma? J Pain Symptom Manage 2017; 54:692-700. [PMID: 28807703 DOI: 10.1016/j.jpainsymman.2017.04.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/11/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022]
Abstract
CONTEXT Evidence for the benefits of early palliative care (EPC) in patients with solid tumors is strong, but EPC has received scant attention in hematologic malignancies. OBJECTIVE To assess the benefits of outpatient-based EPC for symptom control in patients with multiple myeloma. METHODS Retrospective study of patients attending the Multiple Myeloma Palliative Care Clinic at our hospital in the year 2013 (February 1-December 31). The following symptoms were assessed at baseline and at three follow-up consultations using a Numerical Visual Scale (0 = no symptoms; 10 = worst possible): pain, anorexia, constipation, insomnia, nausea/vomiting, dyspnea, anxiety, and sadness. Physical and emotional symptom burden scores were calculated. Pain interference with general activity, sleep, and mood was also evaluated. RESULTS About 67 patients were included. The proportion of patients reporting moderate-to-severe pain (Numerical Visual Scale ≥5) decreased significantly from baseline to the final follow-up: worst pain decreased from 57% to 18% (P < 0.0001), whereas average pain fell from 24% to 2% (P < 0.0001). The percentage of patients reporting no pain interference increased significantly from baseline: general activity (52% vs. 82%; P = 0.0001), sleep (73% vs. 91%; P = 0.01), and mood (52% vs. 87.5%; P = 0.0001). Physical and emotional symptom burden also improved, with significantly fewer patients reporting depression (13% vs. 5%; P = 0.001). Most patients (86.6%) were alive and still attending the Multiple Myeloma Palliative Care Clinic at study end. CONCLUSIONS These findings indicate that EPC is feasible in patients with multiple myeloma. Pain and other symptoms were well controlled.
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Affiliation(s)
- Josep Porta-Sales
- Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat. Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Maria Guerrero-Torrelles
- Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | | | - Victòria Clapés-Puig
- Hematology Service, Institut Català d'Oncologia-L'Hospitalet L.-Barcelona, Barcelona, Spain
| | - Jordi Trelis-Navarro
- Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat. Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna Sureda-Balarí
- Hematology Service, Institut Català d'Oncologia-L'Hospitalet L.-Barcelona, Barcelona, Spain
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Walling AM, D'Ambruoso SF, Malin JL, Hurvitz S, Zisser A, Coscarelli A, Clarke R, Hackbarth A, Pietras C, Watts F, Ferrell B, Skootsky S, Wenger NS. Effect and Efficiency of an Embedded Palliative Care Nurse Practitioner in an Oncology Clinic. J Oncol Pract 2017; 13:e792-e799. [PMID: 28813191 DOI: 10.1200/jop.2017.020990] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To test a simultaneous care model for palliative care for patients with advanced cancer by embedding a palliative care nurse practitioner (NP) in an oncology clinic. METHODS We evaluated the effect of the intervention in two oncologists' clinics beginning March 2014 by using implementation strategies, including use of a structured referral mechanism, routine symptom screening, integration of a psychology-based cancer supportive care center, implementation team meetings, team training, and a metrics dashboard for continuous quality improvement. After 1 year of implementation, we evaluated key process and outcome measures for supportive oncology and efficiency of the model by documenting tasks completed by the NP during a subset of patient visits and time-motion studies. RESULTS Of approximately 10,000 patients with active cancer treated in the health system, 2,829 patients had advanced cancer and were treated by 42 oncologists. Documentation of advance care planning increased for patients of the two intervention oncologists compared with patients of the other oncologists. Hospice referral before death was not different at baseline, but was significantly higher for patients of intervention oncologists compared with patients of control oncologists (53% v 23%; P = .02) over the intervention period. Efficiency evaluation revealed that approximately half the time spent by the embedded NP potentially could have been completed by other staff (eg, a nurse, a social worker, or administrative staff). CONCLUSION An embedded palliative care NP model using scalable implementation strategies can improve advance care planning and hospice use among patients with advanced cancer.
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Affiliation(s)
- Anne M Walling
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Sarah F D'Ambruoso
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Jennifer L Malin
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Sara Hurvitz
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Ann Zisser
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Anne Coscarelli
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Robin Clarke
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Andrew Hackbarth
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Christopher Pietras
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Frances Watts
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Bruce Ferrell
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Samuel Skootsky
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
| | - Neil S Wenger
- Greater Los Angeles Veterans Affairs Healthcare System; University of California at Los Angeles (UCLA); UCLA Center for Integrative Oncology; UCLA Health, Los Angeles, CA; and Anthem, Indianapolis, IN
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Sparla A, Flach-Vorgang S, Villalobos M, Krug K, Kamradt M, Coulibaly K, Szecsenyi J, Thomas M, Gusset-Bährer S, Ose D. Reflection of illness and strategies for handling advanced lung cancer - a qualitative analysis in patients and their relatives. BMC Health Serv Res 2017; 17:173. [PMID: 28253884 PMCID: PMC5333386 DOI: 10.1186/s12913-017-2110-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/23/2017] [Indexed: 11/16/2022] Open
Abstract
Background Lung cancer patients are often diagnosed in an advanced stage of disease. In a situation of palliative treatment, both patients and their relatives experience existential burden. Evidence suggests that multi-professional teams should deal with them as dyads. However, little is known about differences in their individual situation. The purpose of this study is to explore and compare reflections that arise out of the context of diagnosis and to compare how patients and their relatives try to handle advanced lung cancer. Methods Data was collected by qualitative interviews. A total of 18 participants, 9 patients diagnosed with advanced lung cancer (ICD- 10 C-34, stage IV) starting or receiving palliative treatment and 9 relatives were interviewed. Data was interpreted using qualitative content analysis. Results Reflection aspects were “thoughts about the cause”, “meaning of belief” and “experience of inequity”. Patients often experienced the diagnosis as inequity and were more receptive for believing in treatment success. The main strategies found were “repression”, “positive attitude”, “strong focus on the present” and “adjustment of life terms”. Patient and relative dyads used the same strategies, but with different emphasis. That life time is limited was more frequently realized by relatives than by patients. Conclusion While strategies used by relatives are similar to those of patients’, they are less reflective and more pragmatic in terms of handling daily life and organizing care. The interviewed patients were mostly not able to takeover these tasks. To strong was their belief in treatment success, their repression of the future and the focus on the present. This implicates, that in terms of end-of-life care, relatives are important to reach patients who are often not receptive to this topic. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2110-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anika Sparla
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany.
| | - Sebastian Flach-Vorgang
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany
| | - Matthias Villalobos
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany
| | - Martina Kamradt
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany
| | - Kadiatou Coulibaly
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany
| | - Michael Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Sinikka Gusset-Bährer
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Dominik Ose
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany.,Department of Population Health Sciences, Health System Innovation and Research, University of Utah, Salt Lake City, UT, USA
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Levels of Care Burden and Self-efficacy for Informal Caregiver of Patients With Cancer. Holist Nurs Pract 2017; 31:7-15. [DOI: 10.1097/hnp.0000000000000185] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Seven M, Sahin E, Yilmaz S, Akyuz A. Palliative care needs of patients with gynaecologic cancer. J Clin Nurs 2016; 25:3152-3159. [PMID: 27312398 DOI: 10.1111/jocn.13280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To identify gynaecologic cancer patients' palliative care needs using the three levels of needs questionnaire. BACKGROUND Measuring both the burden of symptoms and patient-reported palliative care needs is valuable to improve cancer care. Data representing the palliative care needs of cancer patients in Turkey remain limited. DESIGN A cross-sectional descriptive study. METHODS A total of 134 cancer patients were included in the study at an oncology hospital in Turkey. A data collection form, a short-form medical outcomes health survey, and the three levels of needs questionnaire were used to collect data. RESULTS The mean age of participants was 59 ± 8·76, of 69·4% were diagnosed with ovarian cancer and 52·2% had stage-3-4 cancer. Of patients, 69·3% had no desire for sexual intimacy, 33·5% expressed feeling as though they burden their families and 28·4% feel lonely at some level. The most prevalent problems were tiredness, to feel depressed and problems performing physical activities. The most frequent unmet needs were tiredness (60·5%), feel depressed (47·4%) and lack of appetite (38·5%). CONCLUSIONS Gynaecologic cancer patients have relatively high prevalence of symptoms and unmet palliative care needs. Health professions mostly were unable to recognise and properly manage tiredness, depression as well as lack of appetite as an integral part of quality cancer care. RELEVANCE TO CLINICAL PRACTICE Nurses trained in palliative care are needed to evaluate and meet cancer patients' needs regularly to improve quality of palliative care. Nurses should examine the underlying reasons for most prevalent problems and give nursing care accordingly.
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Affiliation(s)
- Memnun Seven
- College of Nursing, Koç University, İstanbul, Turkey.
| | - Eda Sahin
- Gülhane Military Medical Academy, School of Nursing, Ankara, Turkey
| | - Sakine Yilmaz
- Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Aygul Akyuz
- College of Nursing, Koç University, İstanbul, Turkey
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Abstract
OBJECTIVES To provide an overview of the four major palliative care delivery models: ambulatory clinics, home-based programs, inpatient palliative care units, and inpatient consultation services. The advantages and disadvantages of each model and the generalist and specialist roles in palliative care will be discussed. DATA SOURCES Literature review. CONCLUSION The discipline of palliative care continues to experience growth in the number of programs and in types of delivery models. Ambulatory- and home-based models are the newest on the scene. IMPLICATIONS FOR NURSING PRACTICE Nurses caring for oncology patients with life-limiting disease should be informed about these models for optimal impact on patient care outcomes. Oncology nurses should demonstrate generalist skills in the care of the seriously ill and access specialist palliative care providers as warranted by the patient's condition.
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20
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Bakitas MA, Tosteson TD, Li Z, Lyons KD, Hull JG, Li Z, Dionne-Odom JN, Frost J, Dragnev KH, Hegel MT, Azuero A, Ahles TA. Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. J Clin Oncol 2015; 33:1438-45. [PMID: 25800768 PMCID: PMC4404422 DOI: 10.1200/jco.2014.58.6362] [Citation(s) in RCA: 771] [Impact Index Per Article: 85.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Randomized controlled trials have supported integrated oncology and palliative care (PC); however, optimal timing has not been evaluated. We investigated the effect of early versus delayed PC on quality of life (QOL), symptom impact, mood, 1-year survival, and resource use. PATIENTS AND METHODS Between October 2010 and March 2013, 207 patients with advanced cancer at a National Cancer Institute cancer center, a Veterans Affairs Medical Center, and community outreach clinics were randomly assigned to receive an in-person PC consultation, structured PC telehealth nurse coaching sessions (once per week for six sessions), and monthly follow-up either early after enrollment or 3 months later. Outcomes were QOL, symptom impact, mood, 1-year survival, and resource use (hospital/intensive care unit days, emergency room visits, chemotherapy in last 14 days, and death location). RESULTS Overall patient-reported outcomes were not statistically significant after enrollment (QOL, P = .34; symptom impact, P = .09; mood, P = .33) or before death (QOL, P = .73; symptom impact, P = .30; mood, P = .82). Kaplan-Meier 1-year survival rates were 63% in the early group and 48% in the delayed group (difference, 15%; P = .038). Relative rates of early to delayed decedents' resource use were similar for hospital days (0.73; 95% CI, 0.41 to 1.27; P = .26), intensive care unit days (0.68; 95% CI, 0.23 to 2.02; P = .49), emergency room visits (0.73; 95% CI, 0.45 to 1.19; P = .21), chemotherapy in last 14 days (1.57; 95% CI, 0.37 to 6.7; P = .27), and home death (27 [54%] v 28 [47%]; P = .60). CONCLUSION Early-entry participants' patient-reported outcomes and resource use were not statistically different; however, their survival 1-year after enrollment was improved compared with those who began 3 months later. Understanding the complex mechanisms whereby PC may improve survival remains an important research priority.
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Affiliation(s)
- Marie A Bakitas
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY.
| | - Tor D Tosteson
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Zhigang Li
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kathleen D Lyons
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jay G Hull
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Zhongze Li
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Nicholas Dionne-Odom
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jennifer Frost
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Konstantin H Dragnev
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mark T Hegel
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Andres Azuero
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Tim A Ahles
- Marie A. Bakitas, J. Nicholas Dionne-Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Bakitas, Jennifer Frost, and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center, Lebanon; Tor D. Tosteson, Kathleen D. Lyons, and Mark T. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan-Kettering Cancer Center, New York, NY
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Dhiliwal SR, Muckaden M. Impact of specialist home-based palliative care services in a tertiary oncology set up: a prospective non-randomized observational study. Indian J Palliat Care 2015; 21:28-34. [PMID: 25709182 PMCID: PMC4332123 DOI: 10.4103/0973-1075.150170] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Home-based specialist palliative care services are developed to meet the needs of the patients in advanced stage of cancer at home with physical symptoms and distress. Specialist home care services are intended to improve symptom control and quality of life, enable patients to stay at home, and avoid unnecessary hospital admission. MATERIALS AND METHODS Total 690 new cases registered under home-based palliative care service in the year 2012 were prospectively studied to assess the impact of specialist home-based services using Edmonton symptom assessment scale (ESAS) and other parameters. RESULTS Out of the 690 registered cases, 506 patients received home-based palliative care. 50.98% patients were cared for at home, 28.85% patients needed hospice referral and 20.15% patients needed brief period of hospitalization. All patients receiving specialist home care had good relief of physical symptoms (P < 0.005). 83.2% patients received out of hours care (OOH) through liaising with local general practitioners; 42.68% received home based bereavement care and 91.66% had good bereavement outcomes. CONCLUSION Specialist home-based palliative care improved symptom control, health-related communication and psychosocial support. It promoted increased number of home-based death, appropriate and early hospice referral, and averted needless hospitalization. It improved bereavement outcomes, and caregiver satisfaction.
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Affiliation(s)
- Sunil R Dhiliwal
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Maryann Muckaden
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
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D'Angelo D, Mastroianni C, Hammer JM, Piredda M, Vellone E, Alvaro R, De Marinis MG. Continuity of Care During End of Life: An Evolutionary Concept Analysis. Int J Nurs Knowl 2014; 26:80-9. [DOI: 10.1111/2047-3095.12041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The Feasibility of Using Technology to Enhance the Transition of Palliative Care for Rural Patients. Comput Inform Nurs 2014; 32:257-66. [DOI: 10.1097/cin.0000000000000066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maloney C, Lyons KD, Li Z, Hegel M, Ahles TA, Bakitas M. Patient perspectives on participation in the ENABLE II randomized controlled trial of a concurrent oncology palliative care intervention: benefits and burdens. Palliat Med 2013; 27:375-83. [PMID: 22573470 PMCID: PMC3657725 DOI: 10.1177/0269216312445188] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND ENABLE (Educate, Nurture, Advise Before Life Ends) II was one of the first randomized controlled trials (RCTs) examining the effects of a concurrent oncology palliative care intervention on quality of life, mood, and symptom control for advanced cancer patients and their caregivers. However, little is known about how participants experience early palliative care and the benefits and burdens of participating in a palliative care clinical trial. AIM To gain a deeper understanding of participants' perspectives of the intervention and palliative care trial participation. DESIGN A qualitative descriptive study using thematic analysis to determine benefits and burdens of a new palliative care intervention and trial participation. SETTING/PARTICIPANTS Of the 72 participants who were alive when the study commenced, 53 agreed to complete an in-depth, semi-structured interview regarding the ENABLE II intervention and clinical trial participation. RESULTS Participants' perceptions of intervention benefits were represented by four themes: enhanced problem-solving skills, better coping, feeling empowered, and feeling supported or reassured. Three themes related to trial participation: helping future patients and contributing to science, gaining insight through completion of questionnaires, and trial/intervention aspects to improve. CONCLUSIONS The benefits of the intervention and the positive aspects of trial participation outweighed trial "burdens". This study raises additional important questions relevant to future trial design and intervention development: when should a palliative care intervention be initiated and what aspects of self-care and healthy living should be offered in addition to palliative content for advanced cancer patients when they are feeling well?
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Affiliation(s)
- Cristine Maloney
- Department of Anesthesiology, Section of Palliative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Bakitas M, Macmartin M, Trzepkowski K, Robert A, Jackson L, Brown JR, Dionne-Odom JN, Kono A. Palliative care consultations for heart failure patients: how many, when, and why? J Card Fail 2013; 19:193-201. [PMID: 23482081 PMCID: PMC4564059 DOI: 10.1016/j.cardfail.2013.01.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/17/2013] [Accepted: 01/25/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In preparation for development of a palliative care intervention for patients with heart failure (HF) and their caregivers, we aimed to characterize the HF population receiving palliative care consultations (PCCs). METHODS AND RESULTS Reviewing charts from January 2006 to April 2011, we analyzed HF patient data including demographic and clinical characteristics, Seattle Heart Failure scores, and PCCs. Using Atlas qualitative software, we conducted a content analysis of PCC notes to characterize palliative care assessment and treatment recommendations. There were 132 HF patients with PCCs, of which 37% were New York Heart Association functional class III and 50% functional class IV. Retrospectively computed Seattle Heart Failure scores predicted 1-year mortality of 29% [interquartile range (IQR) 19-45] and median life expectancy of 2.8 years [IQR 1.6-4.2] years. Of the 132 HF patients, 115 (87%) had died by the time of the audit. In that cohort the actual median time from PCC to death was 21 [IQR 3-125] days. Reasons documented for PCCs included goals of care (80%), decision making (24%), hospice referral/discussion (24%), and symptom management (8%). CONCLUSIONS Despite recommendations, PCCs are not being initiated until the last month of life. Earlier referral for PCC may allow for integration of a broader array of palliative care services.
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Affiliation(s)
- Marie Bakitas
- Section of Palliative Medicine, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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Strother RM, Fitch M, Kamau P, Beattie K, Boudreau A, Busakhalla N, Loehrer PJ. Building cancer nursing skills in a resource-constrained government hospital. Support Care Cancer 2012; 20:2211-5. [PMID: 22565597 DOI: 10.1007/s00520-012-1482-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 04/22/2012] [Indexed: 11/26/2022]
Abstract
Cancer is a rising cause of morbidity and mortality in resource-constrained settings. Few places in the developing world have cancer care experts and infrastructure for caring for cancer patients; therefore, it is imperative to develop this infrastructure and expertise. A critical component of cancer care, rarely addressed in the published literature, is cancer nursing. This report describes an effort to develop cancer nursing subspecialty knowledge and skills in support of a growing resource-constrained comprehensive cancer care program in Western Kenya. This report highlights the context of cancer care delivery in a resource-constrained setting, and describes one targeted intervention to further develop the skill set and knowledge of cancer care providers, as part of collaboration between developed world academic institutions and a medical school and governmental hospital in Western Kenya. Based on observations of current practice, practice setting, and resource limitations, a pragmatic curriculum for cancer care nursing was developed and implemented.
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Affiliation(s)
- R M Strother
- Indiana University School of Medicine, Indianapolis, USA.
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D’Angelo D, Mastroianni C, Vellone E, Alvaro R, Casale G, Latina R, De Marinis MG. Palliative care quality indicators in Italy. What do we evaluate? Support Care Cancer 2011; 20:1983-9. [DOI: 10.1007/s00520-011-1301-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 10/25/2011] [Indexed: 11/24/2022]
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