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Palliative Care Outcome Scale Assessment for Cancer Patients Eligible for Palliative Care: Perspectives on the Relationship between Patient-Reported Outcome and Objective Assessments. Curr Oncol 2022; 29:7140-7147. [PMID: 36290838 PMCID: PMC9600518 DOI: 10.3390/curroncol29100561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 01/13/2023] Open
Abstract
(1) Background: The importance of patient-reported outcome (PRO), i.e., prioritizing patient voice, has increased in cancer treatment, as well as palliative and supportive settings. The Integrated Palliative Care Outcome Scale (IPOS), a hybrid evaluation consisting of "patient evaluation" (PRO) and "peer evaluation" by medical professionals, was developed as a successor version of the Support Team Assessment Schedule (STAS) in 2013 and has been utilized worldwide. The Japanese version of the IPOS (IPOS-J) was developed and released in 2019. The purpose of this study was to explore the applicability of the IPOS-J to clinical practice in the future. (2) Methods: We conducted the following two studies with terminally ill cancer patients: (i) Can an evaluation with the IPOS-J performed by medical professionals (peer evaluation) replace the STAS-J evaluation? (ii) Can the quality of palliative care improve by combining the IPOS-J patient evaluation with the peer evaluation? (3) Results: The overall intervention rate and urgent intervention rate for the STAS-J and IPOS-J was 34.4 vs. 34.1% (p = 0.91) and 10.4 vs. 9.9% (p = 0.78), respectively. The patients selected "intervention required" but the medical professionals selected "no intervention required" in 47 cases. The medical team performed appropriate intervention after re-assessment. As a result, more than 70% of the patients were "intervention-free" after 1 week of intervention. (4) Conclusions: The IPOS-J peer evaluation was as useful as the STAS-J evaluation. A hybrid type of evaluation, combining patient evaluation (PRO) and peer evaluation, may help us to understand patient needs and improve the quality of palliative care.
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Friedrichsen M, Hajradinovic Y, Jakobsson M, Brachfeld K, Milberg A. Cultures that collide: an ethnographic study of the introduction of a palliative care consultation team on acute wards. BMC Palliat Care 2021; 20:180. [PMID: 34802436 PMCID: PMC8606051 DOI: 10.1186/s12904-021-00877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
Abstract
Background Acute care and palliative care (PC) are described as different incompatible organisational care cultures. Few studies have observed the actual meeting between these two cultures. In this paper we report part of ethnographic results from an intervention study where a palliative care consultation team (PCCT) used an integrative bedside education approach, trying to embed PC principles and interventions into daily practice in acute wards. Purpose To study the meeting and interaction of two different care cultures, palliative care and curative acute wards, when a PCCT introduces consulting services to acute wards regarding end-of-life palliative care, focusing on the differences between the cultures. Methods An ethnographic study design was used, including observations, interviews and diary entries. A PCCT visited acute care wards during 1 year. The analysis was inspired by Spradleys ethnography. Results Three themes were found: 1) Anticipations meets reality; 2) Valuation of time and prioritising; and 3) The content and creation of palliative care. Conclusion There are many differences in values, and the way PC are provided in the acute care wards compared to what a PCCT expects. The didactic challenges are many and the PC require effort.
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Affiliation(s)
- Maria Friedrichsen
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, 601 82, Norrköping, Sweden.
| | | | - Maria Jakobsson
- Department of Palliative Medicine, Vrinnevi Hospital, Norrköping, Sweden
| | - Kerstin Brachfeld
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, 601 82, Norrköping, Sweden
| | - Anna Milberg
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, 601 82, Norrköping, Sweden.,Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
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3
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Kawabata N, Nin M. Effect of continual quality improvement of palliative care consultation teams by iterative, customer satisfaction survey-driven evaluation. BMC Palliat Care 2021; 20:46. [PMID: 33740950 PMCID: PMC7978439 DOI: 10.1186/s12904-021-00741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/11/2021] [Indexed: 11/22/2022] Open
Abstract
Background Current consensus recognizes the benefits of early intervention in palliative care consultation teams (PCCTs). As consultants, we should now attempt to improve the quality of our teams by utilizing a method mainly used in the business field. We aimed to investigate the effects of iterative evaluation of customer satisfaction surveys, filled by physicians and ward nurses in this study, for quality improvement of PCCTs. Methods In October 2019, the participants filled the first questionnaire survey about palliative care and PCCTs at a 678-bed hospital, and improvement areas were uncovered. Refinements were planned and implemented, and then reevaluated using the second questionnaire survey in March 2020. Results In addition to the characteristics of our clients evaluated from approximately 500 valid responses, the first survey showed that the response rate of the questionnaire, knowledge of palliative care and PCCTs, and publicity of the PCCT were recognized as issues needing attention. We planned to contrive ways to collect questionnaires, hold monthly workshops for palliative care, launch newsletters of palliative care, and go on client rounds. The second survey revealed improvements in the physicians’ response rate (p = 0.02), the accuracy rate of application of PCCTs in Japan (p < 0.01), and ward nurses’ confidence in opioid use (p = 0.04) and tendency toward easier accessibility to the PCCT (p = 0.07). Conclusion Continual quality improvements through iterative, customer satisfaction survey-driven evaluation are a widely established practice in the business field. By using this appropriately, we could enable PCCTs to improve their quality. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00741-2.
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Affiliation(s)
- Noriyuki Kawabata
- Department of Palliative Care, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai City, Osaka, Japan.
| | - Mikio Nin
- Department of Palliative Care, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai City, Osaka, Japan
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Janberidze E, Poláková K, Bankovská Motlová L, Loučka M. Impact of palliative care consult service in inpatient hospital setting: a systematic literature review. BMJ Support Palliat Care 2020; 11:351-360. [PMID: 32958505 DOI: 10.1136/bmjspcare-2020-002291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/08/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Despite a number of studies on effectiveness of palliative care, there is a lack of complex updated review of the impact of in-hospital palliative care consult service. The objective is to update information on the impact of palliative care consult service in inpatient hospital setting. METHODS This study was a systematic literature review, following the standard protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Joanna Briggs Institute tools) to ensure the transparent and robust review procedure. The effect of palliative care consult service was classified as being associated with improvement, no difference, deterioration or mixed results in specific outcomes. PubMed, Scopus, Academic Search Ultimate and SocINDEX were systematically searched up to February 2020. Studies were included if they focused on the impact of palliative care consult service caring for adult palliative care patients and their families in inpatient hospital setting. RESULTS After removing duplicates, 959 citations were screened of which 49 full-text articles were retained. A total of 28 different outcome variables were extracted. 18 of them showed positive effects within patient, family, staff and healthcare system domains. No difference was observed in patient survival and depression. Inconclusive results represented patient social support and staff satisfaction with care. CONCLUSIONS Palliative care consult service has a number of positive effects for patients, families, staff and healthcare system. More research is needed on factors such as patient spiritual well-being, social support, performance, family understanding of patient diagnosis or staff stress.
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Affiliation(s)
- Elene Janberidze
- Department of Psychiatry and Medical Psychology - Division of Medical Psychology, Charles University, Third Faculty of Medicine, Praha, Czech Republic .,Department of Gerontology and Palliative Medicine, Iv. Javakhishvili Tbilisi State University/Institute of Morphology, Tbilisi, Georgia.,Faculty of Medicine, School of Health Sciences and Public Health, University of Georgia, Tbilisi, Georgia
| | - Kristýna Poláková
- Department of Psychiatry and Medical Psychology - Division of Medical Psychology, Charles University, Third Faculty of Medicine, Praha, Czech Republic.,Center for Palliative Care, Praha, Czech Republic
| | - Lucie Bankovská Motlová
- Department of Psychiatry and Medical Psychology - Division of Medical Psychology, Charles University, Third Faculty of Medicine, Praha, Czech Republic
| | - Martin Loučka
- Department of Psychiatry and Medical Psychology - Division of Medical Psychology, Charles University, Third Faculty of Medicine, Praha, Czech Republic.,Center for Palliative Care, Praha, Czech Republic
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5
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Böling S, Berlin JM, Berglund H, Öhlén J. No ordinary consultation - a qualitative inquiry of hospital palliative care consultation services. J Health Organ Manag 2020; ahead-of-print. [PMID: 32744038 DOI: 10.1108/jhom-04-2020-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Considering the great need for palliative care in hospitals, it is essential for hospital staff to have palliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care. However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need for further knowledge about the process of palliative consultations. The purpose of this study therefore was to examine how palliative consultations in hospitals are practised, as perceived by consultants and health care professionals on receiving wards. DESIGN/METHODOLOGY/APPROACH Focus groups with palliative care consultation services, health care personnel from receiving wards and managers of consultation services. Interpretive description and constant comparative method guided the analysis. FINDINGS Variations were seen in several aspects of practice, including approach to practice and represented professions. The palliative consultants were perceived to contribute by creating space for palliative care, adding palliative knowledge and approach, enhancing cooperation and creating opportunity to ameliorate transition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultation services utilised proactive practices that took the initiative in relation to the receiving wards. ORIGINALITY/VALUE A lack of policy and divergent views on how to conceptualise palliative care appeared to be associated with variations in consultation practices, tentative approaches and a bottom-up driven development. This study adds knowledge, implying theoretical transferability as to how palliative care consultations can be practised, which is useful when designing and starting new consultation services.
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Affiliation(s)
- Susanna Böling
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan M Berlin
- Department of Social and Behavioural Studies, University West, Trollhättan, Sweden
| | - Helene Berglund
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
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6
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Coym A, Oechsle K, Kanitz A, Puls N, Blum D, Bokemeyer C, Ullrich A. Impact, challenges and limits of inpatient palliative care consultations - perspectives of requesting and conducting physicians. BMC Health Serv Res 2020; 20:86. [PMID: 32019562 PMCID: PMC7001248 DOI: 10.1186/s12913-020-4936-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Inpatient palliative care consultation (IPCC) teams have been established to improve care for patients with specialist palliative care (PC) needs throughout all hospital departments. The objective is to explore physicians’ perceptions on the impact of IPCC, its triggers, challenges and limits, and their suggestions for future service improvements. Methods A Qualitative study drawing on semi-structured interviews with 10 PC specialists of an IPCC team and nine IPCC requesting physicians from oncology and non-oncological departments of a university hospital. Analysis was performed using qualitative content analysis. Results PC specialists and IPCC requesting physicians likewise considered organization of further care and symptom-burden as main reasons for IPCC requests. The main impact however was identified from both as improvement of patients’ (and their caregivers’) coping strategies and relief of the treating team. Mostly, PC specialists emphasized a reduction of symptom burden, and improvement of further care. Challenges in implementing IPCC were lack of time for both. PC specialists addressed requesting physicians’ skepticism towards PC. Barriers for realization of IPCC included structural aspects for both: limited time, staff capacities and setting. PC specialists saw problems in implementing recommendations like disagreement towards their suggestions. All interviewees considered education in PC a sensible approach for improvement. Conclusions IPCC show various positive effects in supporting physicians and patients, but are also limited due to structural problems, lack of knowledge, insecurity, and skepticism by the requesting physicians. To overcome some of these challenges implementation of PC education programs for all physicians would be beneficial.
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Affiliation(s)
- Anja Coym
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Alena Kanitz
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Nora Puls
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - David Blum
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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7
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Evans BA, Turner MC, Gloria JN, Pickett LC, Galanos AN. Palliative Care Consultation Is Underutilized in Critically Ill General Surgery Patients. Am J Hosp Palliat Care 2019; 37:149-153. [DOI: 10.1177/1049909119864025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: American College of Surgeons recommends palliative care and surgeons collaborate on the care of patients with poor prognoses. These collaborations are done to discuss symptom management and goals of care. However, contemporary practice patterns of palliative care consultation for surgical patients are poorly defined. We aim to describe the use of palliative care consultation for patients admitted to our institution’s surgical services who died during their index hospital admission. Methods: The Duke Enterprise Data Unified Content Explorer 2014 to 2016 was queried for patients admitted to general surgery services who died during their admission. Secondary measures included length of stay, time spent in consultation, days from consultation to death, and execution of a care plan. Results: Of the 105 patients identified, 6 died on the day of admission, and 39 (37%) received palliative care consultation. Our data showed that patients who received consultation were generally older, white, and insured. Median number of days between palliative consult and death was 3 days (interquartile range: 1-8). Goals-of-care conversations were the indication for consultation in 62.5% of patients. The proposed plan by the consultants was congruent with the primary team in 66.7% of cases. Conclusions: Palliative care consultations were underutilized in surgical patients who died while admitted to the general surgical service at our institution. When palliative care is consulted, the plan of the primary surgical team and the palliative team align. Identification of barriers to consultation and promotion of the benefits of palliative care among surgical teams is warranted.
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Affiliation(s)
| | | | | | - Lisa C. Pickett
- Department of Surgery, Duke University, Durham, NC, USA
- Duke University Hospital, Durham, NC, USA
| | - Anthony N. Galanos
- Division of Palliative Care, Duke Department of Medicine, Duke University, Durham, NC, USA
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8
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Brinkman-Stoppelenburg A, Witkamp FE, van Zuylen L, van der Rijt CCD, van der Heide A. Palliative care team consultation and quality of death and dying in a university hospital: A secondary analysis of a prospective study. PLoS One 2018; 13:e0201191. [PMID: 30138316 PMCID: PMC6107115 DOI: 10.1371/journal.pone.0201191] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 07/10/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Involvement of palliative care experts improves the quality of life and satisfaction with care of patients who are in the last stage of life. However, little is known about the relation between palliative care expert involvement and quality of dying (QOD) in the hospital. We studied the association between palliative care team (PCT) consultation and QOD in the hospital as experienced by relatives. METHODS We conducted a secondary analysis of data from a prospective study among relatives of patients who died from cancer in a university hospital and compared characteristics and QOD of patients for whom the PCT was or was not consulted. RESULTS 175 out of 343 (51%) relatives responded to the questionnaire. In multivariable linear regression PCT was associated with a 1.0 point better QOD (95% CI 0.07-1.96). In most of the subdomains of QOD, we found a non-significant trend towards a more favorable outcome for patients for whom the PCT was consulted. Patients for whom the PCT was consulted had more often discussed their preferences for medical treatment, had more often been aware of their imminent death and had more often been at peace with their imminent death. Further, patients for whom the PCT was consulted and their relatives had more often been able to say goodbye. Relatives had also more often been present at the moment of death when a PCT had been consulted. CONCLUSION For patients dying in the hospital, palliative care consultation is associated with a favorable QOD.
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Affiliation(s)
| | - Frederika E. Witkamp
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
- Faculty of Nursing and Center of Expertise in Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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9
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Akizuki S, Akizuki N, Nakazawa Y, Abo H, Ise Y, Okamoto Y, Kaizu M, Shinada Y, Yamashiro A, Sakashita A, Kato M. Multi-center Study to Assess the Feasibility of the Self-Check Program for Palliative Care Team. ACTA ACUST UNITED AC 2018. [DOI: 10.2512/jspm.13.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shoko Akizuki
- Division of Palliative Medicine, Chiba Cancer Center
| | - Nobuya Akizuki
- Psycho-Oncology Division, Chiba Cancer Center
- Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
| | - Yoko Nakazawa
- Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center
- Working Practitioner Group of Palliative Care Team Self-Check, Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
| | - Hirofumi Abo
- Working Practitioner Group of Palliative Care Team Self-Check, Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
- Department of Palliative Medicine, Rokko Hospital
| | - Yuya Ise
- Working Practitioner Group of Palliative Care Team Self-Check, Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
- Section of Pharmaceutical Services, Nippon Medical School Hospital
| | - Yoshiaki Okamoto
- Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
- Department of Pharmacy, Ashiya Municipal Hospital
| | - Mikiko Kaizu
- Working Practitioner Group of Palliative Care Team Self-Check, Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
- Graduate School of Health Management Doctoral Program, Keio University
| | - Yuichi Shinada
- Working Practitioner Group of Palliative Care Team Self-Check, Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
- Comprehensive Counseling and Support Center, Oncology Counseling and Social Work Division, Tokyo Medical University Hospital
| | - Akiko Yamashiro
- Working Practitioner Group of Palliative Care Team Self-Check, Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine
| | - Akihiro Sakashita
- Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
- Working Practitioner Group of Palliative Care Team Self-Check, Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Masashi Kato
- Committee on Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center
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10
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Bagcivan G, Dionne-Odom JN, Frost J, Plunkett M, Stephens LA, Bishop P, Taylor RA, Li Z, Tucker R, Bakitas M. What happens during early outpatient palliative care consultations for persons with newly diagnosed advanced cancer? A qualitative analysis of provider documentation. Palliat Med 2018; 32:59-68. [PMID: 28952887 DOI: 10.1177/0269216317733381] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early outpatient palliative care consultations are recommended by clinical oncology guidelines globally. Despite these recommendations, it is unclear which components should be included in these encounters. AIM Describe the evaluation and treatment recommendations made in early outpatient palliative care consultations. DESIGN Outpatient palliative care consultation chart notes were qualitatively coded and frequencies tabulated. SETTING/PARTICIPANTS Outpatient palliative care consultations were automatically triggered as part of an early versus delayed randomized controlled trial (November 2010 to April 2013) for patients newly diagnosed with advanced cancer living in the rural Northeastern US. RESULTS In all, 142 patients (early = 70; delayed = 72) had outpatient palliative care consultations. The top areas addressed in these consultations were general evaluations-marital/partner status (81.7%), spirituality/emotional well-being (80.3%), and caregiver/family support (79.6%); symptoms-mood (81.7%), pain (73.9%), and cognitive/mental status (68.3%); general treatment recommendations-counseling (39.4%), maintaining current medications (34.5%), and initiating new medication (23.9%); and symptom-specific treatment recommendations-pain (22.5%), constipation (12.7%), depression (12.0%), advanced directive completion (43.0%), identifying a surrogate (21.8%), and discussing illness trajectory (21.1%). Compared to the early group, providers were more likely to evaluate general pain ( p = 0.035) and hospice awareness ( p = 0.005) and discuss/recommend hospice ( p = 0.002) in delayed group participants. CONCLUSION Outpatient palliative care consultations for newly diagnosed advanced cancer patients can address patients' needs and provide recommendations on issues that might not otherwise be addressed early in the disease course. Future prospective studies should ascertain the value of early outpatient palliative care consultations that are automatically triggered based on diagnosis or documented symptom indicators versus reliance on oncologist referral.
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Affiliation(s)
- Gulcan Bagcivan
- 1 UAB School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA.,2 Gulhane Training and Research Hospital, Ankara, Turkey
| | | | - Jennifer Frost
- 1 UAB School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Margaret Plunkett
- 3 The Center for Nursing Excellence, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Lisa A Stephens
- 4 Palliative Care, Sentara Martha Jefferson Hospital, Charlottesville, VA, USA
| | - Peggy Bishop
- 4 Palliative Care, Sentara Martha Jefferson Hospital, Charlottesville, VA, USA
| | - Richard A Taylor
- 1 UAB School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zhongze Li
- 5 Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Rodney Tucker
- 6 UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie Bakitas
- 1 UAB School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA.,6 UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Yang GM, Neo SHS, Lim SZZ, Krishna LKR. Effectiveness of Hospital Palliative Care Teams for Cancer Inpatients: A Systematic Review. J Palliat Med 2016; 19:1156-1165. [DOI: 10.1089/jpm.2016.0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Grace Meijuan Yang
- Department of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Shirlyn Hui-Shan Neo
- Department of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Shawn Zhi Zheng Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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12
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Friedrichsen M, Hajradinovic Y, Jakobsson M, Milberg P, Milberg A. Palliative care consultation team on acute wards-an intervention study with pre-post comparisons. Support Care Cancer 2016; 25:371-380. [PMID: 27637479 PMCID: PMC5196011 DOI: 10.1007/s00520-016-3406-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/05/2016] [Indexed: 11/28/2022]
Abstract
ᅟ: There is little evidence regarding primary healthcare team members' perceptions concerning palliative care consultation team (PCCT) and palliative care (PC) issues on their own wards. PURPOSE This study aimed to study whether a PCCT can influence and change primary healthcare team members' perceptions regarding the palliative care at the end of life they are providing to patients in their own acute wards. METHODS The intervention was a PCCT visiting surgical and internal medicine wards in 1 year. We used a quasi-experimental design with pre-post-testing, measuring at baseline, and after 1 year's intervention. A questionnaire was answered by all primary healthcare team members in three acute wards. RESULTS A total of 252 team members (pre-post-intervention n = 132/n = 120) participated in the study. Overall, 11 of the 12 statements scored significantly higher after the intervention than before. Responses varied significantly between different professions and depending on the number of dying patients cared for during the last month. The five with the highest Wald values were as follows: the presence of a break point dialogue with a patient, where the changed aim and focus of care was discussed; early detection of impending death; adequate symptom relief and psychological and existential issues. CONCLUSION It is possible to change perceptions about end-of-life care in primary healthcare team members on acute wards. Palliative care consultation teams should be a natural part wherever dying patients are cared for.
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Affiliation(s)
- Maria Friedrichsen
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, Norrköping, Sweden. .,Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden.
| | - Yvonne Hajradinovic
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, Norrköping, Sweden
| | - Maria Jakobsson
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, Norrköping, Sweden
| | - Per Milberg
- IFM Biology, Linköping University, Linköping, Sweden
| | - Anna Milberg
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, Norrköping, Sweden.,Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
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Morikawa M, Shirai Y, Ochiai R, Miyagawa K. Barriers to the Collaboration Between Hematologists and Palliative Care Teams on Relapse or Refractory Leukemia and Malignant Lymphoma Patients’ Care. Am J Hosp Palliat Care 2016; 33:977-984. [DOI: 10.1177/1049909115611081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Palliative care service (PCS) has been shown to be utilized less in patients with leukemia and malignant lymphoma than in those with solid tumors. Previous studies have suggested hematologists’ limited awareness of PCS as one of the reason for low PCS referral in hematology. However, little is known about such an awareness and potential barriers to collaboration between hematologists and PCS. Aim: The present study aimed to assess ematologists and palliative care specialists’ perception about the roles of the hospital-based palliative care team (HPCT) and the barriers to collaboration between hematologists and palliative care teams on relapse or refractory leukemia and malignant lymphoma patients’ care Materials and Methods: A qualitative study was conducted using semistructured interviews with hematologists and palliative care specialists recruited from a hospital that provides hematology and palliative care by the HPCT. Data were evaluated via content analysis. Results: The study included 11 hematologists and 10 palliative care specialists. Our results revealed that they shared many common perceptions about the roles and expectations of the HPCT. Additionally, 7 categories of barriers to collaboration were identified, including not feeling the need to refer, the difficulty in referral timing, the lack of aggressive approach, the negative image of the HPCT, the need for hematologic malignancy-oriented management, the lack of communication, and others. Conclusion: We have identified hematologists’ and palliative care specialists’ perceptions of the HPCT’s roles and the barriers to their collaboration. A better understanding of such barriers may lead to effective collaboration between hematologists and the HPCT.
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Affiliation(s)
- Miharu Morikawa
- The Jikei University Hospital, Tokyo, Japan
- Certified Nurse Specialist Course in Cancer Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Shirai
- School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Asoka Vihara Hospital, Kyoto, Japan
| | - Ryota Ochiai
- School of Medicine Nursing Course, Yokohama City University, Yokohama, Japan
| | - Kiyoshi Miyagawa
- Laboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Firn J, Preston N, Walshe C. What are the views of hospital-based generalist palliative care professionals on what facilitates or hinders collaboration with in-patient specialist palliative care teams? A systematically constructed narrative synthesis. Palliat Med 2016; 30:240-56. [PMID: 26873984 DOI: 10.1177/0269216315615483] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital-based specialist palliative care services are common, yet existing evidence of inpatient generalist providers' perceptions of collaborating with hospital-based specialist palliative care teams has never been systematically assessed. AIM To assess the existing evidence of inpatient generalist palliative care providers' perceptions of what facilitates or hinders collaboration with hospital-based specialist palliative care teams. DESIGN Narrative literature synthesis with systematically constructed search. DATA SOURCES PsycINFO, PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature and ProQuest Social Services databases were searched up to December 2014. Individual journal, citation and reference searching were also conducted. Papers with the views of generalist inpatient professional caregivers who utilised hospital-based specialist palliative care team services were included in the narrative synthesis. Hawker's criteria were used to assess the quality of the included studies. RESULTS Studies included (n = 23) represented a variety of inpatient generalist palliative care professionals' experiences of collaborating with specialist palliative care. Effective collaboration is experienced by many generalist professionals. Five themes were identified as improving or decreasing effective collaboration: model of care (integrated vs linear), professional onus, expertise and trust, skill building versus deskilling and specialist palliative care operations. Collaboration is fostered when specialist palliative care teams practice proactive communication, role negotiation and shared problem-solving and recognise generalists' expertise. CONCLUSION Fuller integration of specialist palliative care services, timely sharing of information and mutual respect increase generalists' perceptions of effective collaboration. Further research is needed regarding the experiences of non-physician and non-nursing professionals as their views were either not included or not explicitly reported.
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Affiliation(s)
- Janice Firn
- Division of Geriatric and Palliative Medicine, University of Michigan Health System, Ann Arbor, MI, USA Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Patterson KR, Croom AR, Teverovsky EG, Arnold R. Current state of psychiatric involvement on palliative care consult services: results of a national survey. J Pain Symptom Manage 2014; 47:1019-27. [PMID: 24095286 DOI: 10.1016/j.jpainsymman.2013.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 06/18/2013] [Accepted: 07/07/2013] [Indexed: 11/26/2022]
Abstract
CONTEXT Palliative care consult services have emerged as an excellent resource for physicians seeking help with patients' symptoms. Symptoms include those of a psychiatric nature (e.g., depression, anxiety, delirium); however, little information is known about whether palliative care services include psychiatric input as part of multidisciplinary teams. OBJECTIVES To explore 1) the current level of collaboration between psychiatrists and palliative care consult services across the U.S. and 2) the factors that support or restrict such involvement. METHODS A national survey was developed and distributed electronically to program directors identified in the National Palliative Care Registry maintained by the Center to Advance Palliative Care. Analyses examined trends in psychiatry involvement with hospital-based palliative care teams. RESULTS The survey had a 59% response rate, with final analyses including surveys completed by 260 palliative care program directors (67% inclusion rate from total respondents). Seventy-two percent of respondents reported some form of involvement with a psychiatrist on their palliative care service, with only 10% of those identifying a psychiatrist as a full- or part-time member of the team. Most respondents reported that they would like psychiatrists to be more involved with the palliative care services (71%). Secondary analyses of qualitative responses identified common impediments to increased psychiatry involvement, which included financial constraints, provider interest, and perceived disciplinary disconnect. CONCLUSION There are shared objectives between psychiatry and palliative care; however, currently, co-involvement on treatment teams is quite limited. Future research is needed to identify ways to facilitate the interface of palliative care and psychiatry.
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Affiliation(s)
- Kevin R Patterson
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | - Andrea R Croom
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Robert Arnold
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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16
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Sasahara T, Watakabe A, Aruga E, Fujimoto K, Higashi K, Hisahara K, Hori N, Ikenaga M, Izawa T, Kanai Y, Kinoshita H, Kobayakawa M, Kobayashi K, Kohara H, Namba M, Nozaki-Taguchi N, Osaka I, Saito M, Sekine R, Shinjo T, Suga A, Tokuno Y, Yamamoto R, Yomiya K, Morita T. Assessment of reasons for referral and activities of hospital palliative care teams using a standard format: a multicenter 1000 case description. J Pain Symptom Manage 2014; 47:579-587.e6. [PMID: 23972575 DOI: 10.1016/j.jpainsymman.2013.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 04/09/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT The many benefits of hospital palliative care teams (PCTs) are well known. However, their specific activities have not been fully clarified, and no standardized methods for reporting PCT activities are available. OBJECTIVES The aim of this study was to investigate, through the use of a standard format, the activities performed by hospital PCTs in Japan. METHODS This was a prospective observational study. A total of 21 hospital PCTs were included in this study, and each recruited approximately 50 consecutively referred patients. Participating PCTs filled in a standard form for reporting activities. RESULTS We obtained data from 1055 patients who were referred to PCTs. Of the 1055 patients, 1005 patients (95%) had cancer. The median number of reasons for referral and problems identified by PCTs was two (0-22) and four (0-18), respectively. The two major reasons for referral were pain (63%) and anxiety/depression/grief/emotional burden (22%). The major recommendations were pharmacological treatment (74%), care for the patient's physical symptoms (49%), and support for patient's decision making (38%). The major activities performed by the PCTs were comprehensive assessment (90%), care for the patient's physical symptoms (77%), and pharmacological treatment (74%). CONCLUSION The components of hospital PCT activities were successfully measured using the Standard Format for Reporting Hospital PCT Activity. The results of this study and the format for reporting hospital PCT activity could be effective in improving hospital PCT practice and for the education of new hospital PCT members.
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Affiliation(s)
- Tomoyo Sasahara
- Division of Health Innovation and Nursing, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
| | | | - Etsuko Aruga
- Department of Palliative Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Koji Fujimoto
- Palliative Care Team, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | | | - Ko Hisahara
- Department of Palliative Care, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Natsuki Hori
- Palliative Care Unit, NTT Medical Center Tokyo, Tokyo, Japan
| | - Masayuki Ikenaga
- Children's Hospice Hospital, Yodogawa Christian Hospital, Osaka, Japan
| | | | | | - Hiroya Kinoshita
- Department of Palliative Medicine, National Cancer Center Hospital, East, Chiba, Japan
| | - Makoto Kobayakawa
- Palliative Care Team, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Hiroyuki Kohara
- Department of Palliative Care, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | | | - Natsuko Nozaki-Taguchi
- Department of Anesthesiology and Palliative Medicine, Chiba University Hospital, Chiba, Japan
| | - Iwao Osaka
- Division of Palliative Medicine, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Mari Saito
- Division of Chemotherapy and Palliative Care, Yokohama City University Medical Center, Kanagawa, Japan
| | | | - Takuya Shinjo
- Palliative Care Unit, Shakaihoken Kobe Central Hospital, Hyogo, Japan
| | - Akihiko Suga
- Department of Palliative Medicine, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | | | - Ryo Yamamoto
- Department of General Internal Medicine, Saku Central Hospital, Nagano, Japan
| | - Kinomi Yomiya
- Department of Palliative Care, Saitama Cancer Center, Saitama, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan
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Yang GM, Ewing G, Booth S. What is the role of specialist palliative care in an acute hospital setting? A qualitative study exploring views of patients and carers. Palliat Med 2012; 26:1011-7. [PMID: 22005106 DOI: 10.1177/0269216311425097] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since the medical specialty of palliative medicine was recognized in 1988, the role of hospital specialist palliative care services has been developing, extending to patients who have a life-limiting illness but are not in the terminal phase. AIM This qualitative study aims to explore patient and carer perspectives of the role of palliative care in the acute hospital setting, with patients not imminently dying. DESIGN Semi-structured interviews with 12 patients and 10 carers. Data were analysed using framework analysis. SETTING/PARTICIPANTS Patients recruited were adults who had palliative care input for symptom control or psychological support and were discharged either to general ward care or to home. The family member/friend designated as their carer was also approached to take part. RESULTS All patients in this study were treated in an acute hospital, described as a bewildering and pressured environment of care. Initial perceptions of palliative care were varied, some interpreting referral as an indication that they were approaching the end of life. However, after palliative care input, patients and carers developed an understanding of their role which they saw as three-fold: physical symptom control, psychological support and a reliable liaison. The theme of cross-cutting interviews was that the palliative care team made time for patients, giving them a sense of value and worth. Feeling their care was a priority and being listened to made palliative care input effective. CONCLUSIONS These findings will aid continuing development and evaluation of palliative care teams, in the domains of effectiveness as well as patient experience.
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Affiliation(s)
- Grace M Yang
- Department of Palliative Medicine, National Cancer Centre Singapore, Singapore
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Shinke H, Sakashita A, Ishibashi Y, Otagaki K, Fujiwara Y, Ioroi T, Tamiya Y, Kotani Y, Mukohara T, Minami H, Nishimura Y. Evaluation of QOL in cancer patients under intervention by a palliative care team. ACTA ACUST UNITED AC 2012. [DOI: 10.2512/jspm.7.368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bausewein C, Le Grice C, Simon S, Higginson I. The use of two common palliative outcome measures in clinical care and research: a systematic review of POS and STAS. Palliat Med 2011; 25:304-13. [PMID: 21464119 DOI: 10.1177/0269216310395984] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The Palliative Care Outcome Scale (POS) and the Support Team Assessment Schedule (STAS) are outcome measures assessing quality of care in palliative care patients. This review aims to appraise their use in clinical care and research. Five electronic databases were searched (February 2010) for original papers describing the validation or use of POS and/or STAS. Of the 83 papers included, 43 studies were on POS, 39 on STAS and one study using both. Eight STAS studies validated the original version, four an adaptation; 20 studies applied the STAS in another culture and 19 in other languages. POS papers reported included: 14 adapted POS versions, 12 translations of the POS and 15 studies of use in different cultures. Both measures have been used in cancer, HIV/AIDS and in mixed groups. POS has also been applied in neurological, kidney, pulmonary and heart disease. Both tools were used in different areas such as the evaluation of care or interventions, description of symptom prevalence and implementation of outcome measures in clinical practice. Overall, they seem to be well accepted tools for outcome measurement in palliative care, both in clinical care and research.
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Affiliation(s)
- C Bausewein
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.
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