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Blankart CR, van Gool K, Papanicolas I, Bernal‐Delgado E, Bowden N, Estupiñán‐Romero F, Gauld R, Knight H, Abiona O, Riley K, Schoenfeld AJ, Shatrov K, Wodchis WP, Figueroa JF. International comparison of spending and utilization at the end of life for hip fracture patients. Health Serv Res 2021; 56 Suppl 3:1370-1382. [PMID: 34490633 PMCID: PMC8579204 DOI: 10.1111/1475-6773.13734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. DATA SOURCES Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC). STUDY DESIGN We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death. DATA COLLECTION/EXTRACTION METHODS We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission. PRINCIPAL FINDINGS Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs. CONCLUSIONS Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.
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Affiliation(s)
- Carl Rudolf Blankart
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
- Hamburg Center for Health EconomicsUniversität HamburgHamburgGermany
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyAustralia
| | - Irene Papanicolas
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Health PolicyLondon School of EconomicsLondonUK
| | | | - Nicholas Bowden
- Department of Women's and Children's HealthUniversity of OtagoDunedinNew Zealand
| | | | - Robin Gauld
- Otago Business School and Centre for Health Systems and TechnologyUniversity of OtagoDunedinNew Zealand
| | | | - Olukorede Abiona
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyAustralia
| | - Kristen Riley
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Andrew J. Schoenfeld
- Division of Orthopedic SurgeryBrigham & Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Kosta Shatrov
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
| | - Walter P. Wodchis
- Institute of Health Policy Management & EvaluationUniversity of TorontoTorontoOntarioCanada
- Institute for Better Health, Trillium Health PartnersMississaugaOntarioCanada
| | - Jose F. Figueroa
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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Currow DC, Burns CM, Abernethy AP. Place of Death for People with Noncancer and Cancer Illness in South Australia: A Population-Based Survey. J Palliat Care 2019. [DOI: 10.1177/082585970802400303] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A large representative population survey of 9,500 households reports the association between place of death, diagnosis (cancer vs. noncancer), and use of palliative care services of terminally ill South Australians. Thirty-one percent (1,920) indicated that someone close to them had died of a terminal illness in the preceding five years; 18% had died of noncancer illness and 82% of cancer. Sixty-two percent of deceased individuals accessed palliative care services. More patients with cancer than noncancer had had palliative care (65% vs. 48%; p<0.0001). Compared with cancer patients, those with noncancer illness had died in hospices less frequently (9% vs. 15%; p=0.0015) and in nursing homes more frequently (15% vs. 5%; p<0.0001). Similar proportions had died in hospital (60%) and at home (16%–20%). Palliative care service involvement did not reduce institutional deaths, but shifted them from hospital to hospice.
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Affiliation(s)
- David C. Currow
- Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia
| | - Catherine M. Burns
- Department of Palliative and Supportive Services, and Australian Centre for Community Services Research, Flinders University, Bedford Park, South Australia
| | - Amy P. Abernethy
- Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia, and Division of Medical Oncology, Department of Medicine, Duke University Medical Centre, Durham, North Carolina, USA
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Namisango E, Bristowe K, Allsop MJ, Murtagh FEM, Abas M, Higginson IJ, Downing J, Harding R. Symptoms and Concerns Among Children and Young People with Life-Limiting and Life-Threatening Conditions: A Systematic Review Highlighting Meaningful Health Outcomes. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 12:15-55. [DOI: 10.1007/s40271-018-0333-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Nicholson E, Murphy T, Larkin P, Normand C, Guerin S. Findings From a Thematic Synthesis of Key Messages From a Palliative Care Research Network: The KINDLE Project. Am J Hosp Palliat Care 2018; 36:241-248. [PMID: 30360632 DOI: 10.1177/1049909118806461] [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: 11/15/2022] Open
Abstract
BACKGROUND Effective palliative care requires a strong evidence base to advance clinical practice and policy-making. Calls for more collaborative and strategic approaches to research have resulted in the development of research networks at national and wider regional levels. AIM The aim was to synthesize the learning arising from the activities of the Palliative Care Research Network from the island of Ireland, in order to identify the overarching messages from these activities. The ultimate aim is to promote the communication of these messages to practice. DESIGN The study developed a systematic search process influenced by Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, with analysis of data adopting a qualitative critical interpretative synthesis approach using thematic synthesis. PARTICIPANTS In total, 142 dissemination products were sourced from 22 associated projects, including peer-reviewed publications, conference presentations, reports, and web/social media posts. RESULTS The synthesis of dissemination products identified 4 key themes relating to palliative care research and practice: (1) addressing the needs of patients while recognizing the caregiver role, (2) equal access to connected services, (3) general and specific needs in palliative care research, and (4) challenges in palliative care research. CONCLUSIONS The key themes identified relate to challenges in both practice and research, highlighting the complexity of palliative care provision that aims to support both patients and carers, and research in this area. However, an important implication is the need for a broader approach to dissemination (beyond traditional academic activities) to ensure that research in palliative care is well placed to inform both practice and policy.
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Affiliation(s)
- Emma Nicholson
- All Ireland Institute of Hospice and Palliative Care, Education and Research Centre, Our Lady's Hospice and Care Services, Harold's Cross, DUB, Ireland
| | - Tara Murphy
- All Ireland Institute of Hospice and Palliative Care, Education and Research Centre, Our Lady's Hospice and Care Services, Harold's Cross, DUB, Ireland
| | - Philip Larkin
- UCD School of Nursing, Midwifery and Health Systems, UCD College of Health Sciences, Belfield, DUB, Ireland.,Palliative Care Research Network, All Ireland Institute for Hospice and Palliative Care, Harold's Cross, DUB, Ireland
| | - Charles Normand
- Palliative Care Research Network, All Ireland Institute for Hospice and Palliative Care, Harold's Cross, DUB, Ireland.,Trinity College Dublin, School of Medicine, DUB, Ireland
| | - Suzanne Guerin
- Palliative Care Research Network, All Ireland Institute for Hospice and Palliative Care, Harold's Cross, DUB, Ireland.,UCD School of Psychology, Newman Building, University College Dublin, Belfield, DUB, Ireland
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McIlfatrick S, Muldrew DHL, Hasson F, Payne S. Examining palliative and end of life care research in Ireland within a global context: a systematic mapping review of the evidence. BMC Palliat Care 2018; 17:109. [PMID: 30261860 PMCID: PMC6161399 DOI: 10.1186/s12904-018-0364-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022] Open
Abstract
Background Globally the state of palliative care research remains uncertain. Questions remain regarding impact, funding, and research priorities. Building upon previous research, this review examines palliative care research in Ireland and contributes to a wider international debate on the state of palliative care research. Methods A systematic mapping review was undertaken. Eight bibliographic databases and thesis repositories were searched from May 2012 to April 2017. Palliative care related search terms were combined with “Ireland” or “Irish” to increase search sensitivity. Inclusion criteria were applied by two independent reviewers. Descriptive analysis was completed using IBM SPSS v23. Thematic analysis was undertaken using a data-driven approach to develop new themes. Results In total, 808 studies were screened and 151 papers from 117 studies were included for review. The top two areas of research focus included: (1) specific groups, services, and settings (n = 70); and (2) identification, communication and education (n = 37). A diverse variety of research methods were used including mixed methods (25%), surveys (22%), interviews (20%), and reviews (17%). One randomised control trial was conducted. The predominance of research papers focused solely on health care professionals (n = 35%), and the community setting was the most frequent location for data collection (41%). The majority of data was collected across the two jurisdictions of the Republic of Ireland (ROI) and Northern Ireland (NI) (37%), and 23% of studies included data outside of Ireland and the UK. The most frequent sources of funding were: consortiums (n = 40); government (n = 24); and philanthropic bodies (n = 20). Forty percent (n = 60) of papers were either unfunded or did not acknowledge a funder. Conclusions There is a continued increase in palliative care research in Ireland with increased collaborative working nationally and internationally. The quantity and impact of research has increased from the previous review, which can be attributed to significant investment in research funding and collaborative networks. However, research gaps continue to exist including out of hours’ care, physical and psychological symptom control, intervention studies, and the patient and family perspective. Areas for attention include the need to ensure knowledge exchange and demonstrate impact of the research on patient and family carer outcomes. Electronic supplementary material The online version of this article (10.1186/s12904-018-0364-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sonja McIlfatrick
- School of Nursing, Ulster University, Shore Road, Newtownabbey, Co Antrim, BT37 0QB, UK. .,All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland.
| | - Deborah H L Muldrew
- School of Nursing, Ulster University, Shore Road, Newtownabbey, Co Antrim, BT37 0QB, UK
| | - Felicity Hasson
- School of Nursing, Ulster University, Shore Road, Newtownabbey, Co Antrim, BT37 0QB, UK
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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Kolben T, Haberland B, Degenhardt T, Burgmann M, Koenig A, Kolben TM, Ulbach K, Mahner S, Bausewein C, Harbeck N, Wuerstlein R. Evaluation of an interdisciplinary palliative care inhouse training for professionals in gynecological oncology. Arch Gynecol Obstet 2018; 297:767-773. [PMID: 29362923 DOI: 10.1007/s00404-018-4681-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of a pilot interdisciplinary inhouse training in palliative care (PC) for gynecological oncologists. METHODS Competencies of participants from a gynecological university department were evaluated taking part in an interdisciplinary PC course in a pre and post design. The multiprofessional course covered basic principles of PC, symptom management and communication taught by PC specialists. Competencies were evaluated using self-designed questionnaires before (ISPG-1), right after (ISPG-2), and 6 months after the training (ISPG-3) (inhouse seminar palliative care in gynecology: ISPG). RESULTS 31 persons from the department of gynecology took part in the course, of which 27 answered the first questionnaire (seven nurses (26%), 19 doctors (71%), one profession not indicated (3%), median working experience in gynecological oncology: 5 years). Return rates were: ISPG-1 27/31 (87.1%), ISPG-2 20/31 (64.5%) and IPSG-3 14/31 (45.2%). A more positive attitude towards PC could be observed in the majority of participants after the course (ISPG-2 62%, ISPG-3 71%). They felt more competent in the care of palliative patients (46%). PC would be initiated earlier and the interaction with other disciplines was improved (ISPG-2 85%, ISPG-3 100%). The participants assessed a significant improvement of their skills in all palliative fields which were analyzed. CONCLUSION PC inhouse training improves the understanding of PC and the interdisciplinary approach in the management of patients with advanced disease. It is a feasible and useful instrument to improve the competencies in generalist PC of specialists in gynecological oncology.
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Affiliation(s)
- Thomas Kolben
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Birgit Haberland
- Department for Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Tom Degenhardt
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximiliane Burgmann
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Koenig
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Theresa Maria Kolben
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kristina Ulbach
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department for Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
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Fox S, FitzGerald C, Harrison Dening K, Irving K, Kernohan WG, Treloar A, Oliver D, Guerin S, Timmons S. Better palliative care for people with a dementia: summary of interdisciplinary workshop highlighting current gaps and recommendations for future research. BMC Palliat Care 2017; 17:9. [PMID: 28705196 PMCID: PMC5512895 DOI: 10.1186/s12904-017-0221-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/29/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Dementia is the most common neurological disorder worldwide and is a life-limiting condition, but very often is not recognised as such. People with dementia, and their carers, have been shown to have palliative care needs equal in extent to those of cancer patients. However, many people with advanced dementia are not routinely being assessed to determine their palliative care needs, and it is not clear why this is so. MAIN BODY An interdisciplinary workshop on "Palliative Care in Neurodegeneration, with a focus on Dementia", was held in Cork, Ireland, in May 2016. The key aim of this workshop was to discuss the evidence base for palliative care for people with dementia, to identify 'gaps' for clinical research, and to make recommendations for interdisciplinary research practice. To lead the discussion throughout the day a multidisciplinary panel of expert speakers were brought together, including both researchers and clinicians from across Ireland and the UK. Targeted invitations were sent to attendees ensuring all key stakeholders were present to contribute to discussions. In total, 49 experts representing 17 different academic and practice settings, attended. Key topics for discussion were pre-selected based on previously identified research priorities (e.g. James Lind Alliance) and stakeholder input. Key discussion topics included: i. Advance Care Planning for people with Dementia; ii. Personhood in End-of-life Dementia care; iii. Topics in the care of advanced dementia at home. These topics were used as a starting point, and the ethos of the workshop was that the attendees could stimulate discussion and debate in any relevant area, not just the key topics, summarised under iv. Other priorities. CONCLUSIONS The care experienced by people with dementia and their families has the potential to be improved; palliative care frameworks may have much to offer in this endeavour. However, a solid evidence base is required to translate palliative care into practice in the context of dementia. This paper presents suggested research priorities as a starting point to build this evidence base. An interdisciplinary approach to research and priority setting is essential to develop actionable knowledge in this area.
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Affiliation(s)
- Siobhán Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St Finbarr's Hospital, Douglas road, Cork, T21XH60, Republic of Ireland.
| | - Carol FitzGerald
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St Finbarr's Hospital, Douglas road, Cork, T21XH60, Republic of Ireland
| | | | - Kate Irving
- Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - W George Kernohan
- Institute of Nursing and Health Research, Ulster University, Co., Antrim, UK
| | | | - David Oliver
- Tizard Centre, University of Kent, Canterbury, UK.,EAPC Board Member, European Association of Palliative Care, Vilvoorde, Belgium
| | - Suzanne Guerin
- Research Design & Analysis, School of Psychology, University College Dublin, Dublin, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St Finbarr's Hospital, Douglas road, Cork, T21XH60, Republic of Ireland
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Seymour J, Cassel B. Palliative care in the USA and England: a critical analysis of meaning and implementation towards a public health approach. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/13576275.2016.1270262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jane Seymour
- School of Nursing and Midwifery, the University of Sheffield, Barber House Annex, Sheffield, UK
| | - Brian Cassel
- Cancer Informatics, Massey Cancer Centre, Virginia Commonwealth University, Richmond, VA, USA
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Ahmed N, Hughes P, Winslow M, Bath PA, Collins K, Noble B. A Pilot Randomized Controlled Trial of a Holistic Needs Assessment Questionnaire in a Supportive and Palliative Care Service. J Pain Symptom Manage 2015; 50:587-98. [PMID: 26087472 DOI: 10.1016/j.jpainsymman.2015.05.010] [Citation(s) in RCA: 20] [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: 09/26/2014] [Revised: 05/05/2015] [Accepted: 05/23/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT At present, there is no widely used systematic evidence-based holistic approach to assessment of patients' supportive and palliative care needs. OBJECTIVES To determine whether the use of a holistic needs assessment questionnaire, Sheffield Profile for Assessment and Referral for Care (SPARC), will lead to improved health care outcomes for patients referred to a palliative care service. METHODS This was an open, pragmatic, randomized controlled trial. Patients (n = 182) referred to the palliative care service were randomized to receive SPARC at baseline (n = 87) or after a period of two weeks (waiting-list control n = 95). Primary outcome measure is the difference in score between Measure Yourself Concerns and Wellbeing (MYCAW) patient-nominated Concern 1 on the patient self-scoring visual analogue scale at baseline and the two-week follow-up. Secondary outcomes include difference in scores in the MYCAW, EuroQoL (EQ-5D), and Patient Enablement Instrument (PEI) scores at Weeks 2, 4, and 6. RESULTS There was a significant association between change in MYCAW score and whether the patients were in the intervention or control group (χ(2)trend = 5.51; degrees of freedom = 1; P = 0.019). A higher proportion of patients in the control group had an improvement in MYCAW score from baseline to Week 2: control (34 of 70 [48.6%]) vs. intervention (19 of 66 [28.8%]). There were no significant differences (no detectable effect) between the control and intervention groups in the scores for EQ-5D and Patient Enablement Instrument at 2-, 4-, or 6-week follow-up. CONCLUSION This trial result identifies a potential negative effect of SPARC in specialist palliative care services, raising questions that standardized holistic needs assessment questionnaires may be counterproductive if not integrated with a clinical assessment that informs the care plan.
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Affiliation(s)
- Nisar Ahmed
- Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences.
| | | | | | - Peter A Bath
- Health Informatics Research Group, Information School, University of Sheffield, Sheffield, United Kingdom
| | - Karen Collins
- Centre for Health and Social Care Research, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom
| | - Bill Noble
- Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences
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11
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Mummudi N, Jalali R. Palliative care and quality of life in neuro-oncology. F1000PRIME REPORTS 2014; 6:71. [PMID: 25165570 PMCID: PMC4126540 DOI: 10.12703/p6-71] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Health-related quality of life has become an important end point in modern day clinical practice in patients with primary or secondary brain tumors. Patients have unique symptoms and problems from diagnosis till death, which require interventions that are multidisciplinary in nature. Here, we review and summarize the various key issues in palliative care, quality of life and end of life in patients with brain tumors, with the focus on primary gliomas.
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O'Sullivan EM, Higginson IJ. ‘I'll continue as long as I can, and die when I can't help it’: a qualitative exploration of the views of end-of-life care by those affected by head and neck cancer (HNC). BMJ Support Palliat Care 2014; 6:43-51. [DOI: 10.1136/bmjspcare-2014-000664] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/25/2014] [Indexed: 11/04/2022]
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13
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McIlfatrick SJ, Murphy T. Palliative care research on the island of Ireland over the last decade: a systematic review and thematic analysis of peer reviewed publications. BMC Palliat Care 2013; 12:33. [PMID: 24006932 PMCID: PMC3848123 DOI: 10.1186/1472-684x-12-33] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
Background As palliative care research continues to expand across Europe, and the world, questions exist about the nature and type of research undertaken in addition to the research priorities for the future. This systematic review, which is the first stage of a larger scale study to identify the research priorities for palliative care on the island of Ireland, examined palliative care research conducted on the island over the last decade. Methods A comprehensive search strategy was implemented and strict eligibility criteria were applied in order to identify relevant peer-reviewed journal articles. Inclusion criteria were all of the palliative care studies undertaken on the island of Ireland and published between January 2002 and May 2012. These were assessed in relation to year, setting, sample size, research methodology, and relevant findings. Results 412 publications were identified for screening and their abstracts obtained. After eliminating articles that did not meet the inclusion criteria, 151 remained for further analysis. A thematic analysis of 128 studies published between 2006 and 2012 revealed eight core themes: (1) specific groups/populations; (2) services and settings; (3) management of symptoms (physical, psychological, social); (4) bereavement; (5) communication and education; (6) death and dying; (7) spirituality; and (8) complementary and alternative medicine/intervention (CAM). There was an upward trend in the number of publications in palliative care research over the last ten years with over 72% of studies being published within the previous four years. A slightly higher number of studies were quantitative in nature (surveys, questionnaires, standardised assessments) followed by qualitative (individual and focus group interviews, case studies, documentary analysis and retrospective case note reviews), mixed methods, and systematic reviews. Conclusions Whilst there has been a welcome growth in palliative care research across Ireland, this has largely been needs-based and small scale studies. In contrast, international researchers and decision makers recommend the need for more outcomes focused multidisciplinary research. An examination of palliative care research is an essential first step in seeking to develop future priority areas for further research, highlighting opportunities for future collaboration both nationally and internationally.
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Affiliation(s)
- Sonja J McIlfatrick
- All Ireland Institute of Hospice and Palliative Care c/o Education and Research Centre, Our, Lady's Hospice and Care Services, Harold's Cross, Dublin 6w, Ireland.
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14
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Beccaro M, Lora Aprile P, Scaccabarozzi G, Cancian M, Costantini M. Survey of Italian general practitioners: knowledge, opinions, and activities of palliative care. J Pain Symptom Manage 2013. [PMID: 23195391 DOI: 10.1016/j.jpainsymman.2012.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT General practitioners (GPs) play a key role in the end-of-life care of patients; however, currently in Italy, there are no national population-based studies available of the knowledge and activities of GPs in palliative care. OBJECTIVES This survey aimed to investigate the knowledge, opinions, and activities of Italian GPs regarding palliative care. METHODS A telephone survey of 1690 GPs was performed. Information was gathered through an ad hoc questionnaire. RESULTS Valid interviews were obtained for 88% of the sampled GPs (n=1489). Regarding knowledge, 25% of GPs recognized a correct definition of palliative care, 41% the objectives of palliative care, 66% that palliative care should be provided by a multiprofessional team including GPs, and 60% that in-home care for patients at the end of life requires an individual plan care. Furthermore, 92% of them reported that "there is no maximum daily morphine dose for the management of pain." Regarding opinions, most of the GPs strongly agreed that for patients at the end of life, the GPs' duties included availability during working hours to break bad news to patients and families and to collaborate with the multiprofessional team in establishing an individual care plan. Finally, regarding activities, most GPs reported that, in their daily practice with patients at the end of life, they discontinue the drugs that are not beneficial to symptom management and seek advice from palliative care physicians when symptom management is ineffective. CONCLUSION This survey reveals the uncertainty of GPs regarding many theoretical issues but a strong willingness to integrate with the multiprofessional palliative care team. To further enhance the skills of GPs and facilitate the collaboration with palliative care services, it might be useful to realize ad hoc training schemes tailored to the different organizational procedures of in-home palliative care services.
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Affiliation(s)
- Monica Beccaro
- Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy.
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Iliffe S, Davies N, Vernooij-Dassen M, van Riet Paap J, Sommerbakk R, Mariani E, Jaspers B, Radbruch L, Manthorpe J, Maio L, Haugen D, Engels Y. Modelling the landscape of palliative care for people with dementia: a European mixed methods study. BMC Palliat Care 2013; 12:30. [PMID: 23937891 PMCID: PMC3751306 DOI: 10.1186/1472-684x-12-30] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/02/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Palliative care for people with dementia is often sub-optimal. This is partly because of the challenging nature of dementia itself, and partly because of system failings that are particularly salient in primary care and community services. There is a need to systematize palliative care for people with dementia, to clarify where changes in practice could be made.To develop a model of palliative care for people with dementia that captures commonalities and differences across Europe, a technology development approach was adopted, using mixed methods including 1) critical synthesis of the research literature and policy documents, 2) interviews with national experts in policy, service organisation, service delivery, patient and carer interests, and research in palliative care, and 3) nominal groups of researchers tasked with synthesising data and modelling palliative care. DISCUSSION A generic model of palliative care, into which quality indicators can be embedded. The proposed model includes features deemed important for the systematisation of palliative care for people with dementia. These are: the division of labour amongst practitioners of different disciplines; the structure and function of care planning; the management of rising risk and increasing complexity; boundaries between disease-modifying treatment and palliative care and between palliative and end-of-life care; and the process of bereavement. SUMMARY The co-design approach to developing a generic model of palliative care for people with dementia has placed the person needing palliative care within a landscape of services and professional disciplines. This model will be explored further in the intervention phase of the IMPACT project.
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Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, England
| | - Nathan Davies
- Research Department of Primary Care & Population Health, University College London, London, England
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jasper van Riet Paap
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ragni Sommerbakk
- Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elena Mariani
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Birgit Jaspers
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
- Centre for Palliative Medicine, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Jill Manthorpe
- Social Care Workforce Research Unit, Kings College London, London, England
| | - Laura Maio
- Research Department of Primary Care & Population Health, University College London, London, England
| | - Dagny Haugen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yvonne Engels
- Department of anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Gao W, Ho YK, Verne J, Glickman M, Higginson IJ. Changing patterns in place of cancer death in England: a population-based study. PLoS Med 2013; 10:e1001410. [PMID: 23555201 PMCID: PMC3608543 DOI: 10.1371/journal.pmed.1001410] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 02/15/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Most patients with cancer prefer to die at home or in a hospice, but hospitals remain the most common place of death (PoD).This study aims to explore the changing time trends of PoD and the associated factors, which are essential for end-of-life care improvement. METHODS AND FINDINGS The study analysed all cancer deaths in England collected by the Office for National Statistics during 1993-2010 (n = 2,281,223). Time trends of age- and gender-standardised proportion of deaths in individual PoDs were evaluated using weighted piecewise linear regression. Variables associated with PoD (home or hospice versus hospital) were determined using proportion ratio (PR) derived from the log-binomial regression, adjusting for clustering effects. Hospital remained the most common PoD throughout the study period (48.0%; 95% CI 47.9%-48.0%), followed by home (24.5%; 95% CI 24.4%-24.5%), and hospice (16.4%; 95% CI 16.3%-16.4%). Home and hospice deaths increased since 2005 (0.87%; 95% CI 0.74%-0.99%/year, 0.24%; 95% CI 0.17%-0.32%/year, respectively, p<0.001), while hospital deaths declined (-1.20%; 95% CI -1.41 to -0.99/year, p<0.001). Patients who died from haematological cancer (PRs 0.46-0.52), who were single, widowed, or divorced (PRs 0.75-0.88), and aged over 75 (PRs 0.81-0.84 for 75-84; 0.66-0.72 for 85+) were less likely to die in home or hospice (p<0.001; reference groups: colorectal cancer, married, age 25-54). There was little improvement in patients with lung cancer of dying in home or hospice (PRs 0.87-0.88). Marital status became the second most important factor associated with PoD, after cancer type. Patients from less deprived areas (higher quintile of the deprivation index) were more likely to die at home or in a hospice than those from more deprived areas (lower quintile of the deprivation index; PRs 1.02-1.12). The analysis is limited by a lack of data on individual patients' preferences for PoD or a clinical indication of the most appropriate PoD. CONCLUSIONS More efforts are needed to reduce hospital deaths. Health care facilities should be improved and enhanced to support the increased home and hospice deaths. People who are single, widowed, or divorced should be a focus for end-of-life care improvement, along with known at risk groups such as haematological cancer, lung cancer, older age, and deprivation. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, King's College London, School of Medicine, Cicely Saunders Institute, London, United Kingdom.
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Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health 2012; 58:257-67. [DOI: 10.1007/s00038-012-0394-5] [Citation(s) in RCA: 263] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 07/02/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022] Open
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Gaertner J, Frechen S, Sladek M, Ostgathe C, Voltz R. Palliative care consultation service and palliative care unit: why do we need both? Oncologist 2012; 17:428-35. [PMID: 22357732 DOI: 10.1634/theoncologist.2011-0326] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Palliative care (PC) infrastructure has developed differently around the globe. Whereas some institutions consider the palliative care unit (PCU) a valuable component, others report that the sole provision of a state-of-the art palliative care consultation service (PCCS) suffices to adequately care for the severely ill and dying. OBJECTIVE To aid institutional planning, this study aimed at gathering patient data to distinguish assignments of a concomitantly run PCU and PCCS at a large hospital and academic medical center. METHODS Demographics, Eastern Cooperative Oncology Group performance status, symptom/problem burden, discharge modality, and team satisfaction with care for all 601 PCU and 851 PCCS patients treated in 2009 and 2010 were retrospectively analyzed. RESULTS Patients admitted to the PCU versus those consulted by the PCCS: (a) had a significantly worse performance status (odds ratio [OR], 1.48); (b) were significantly more likely to suffer from severe symptoms and psychosocial problems (OR, 2.05), in particular concerning physical suffering and complexity of care; and (c) were significantly much more likely to die during hospital stay (OR, 11.03). For patients who were dying or in other challenging clinical situations (suffering from various severe symptoms), self-rated team satisfaction was significantly higher for the PCU than the PCCS. CONCLUSION This study presents a direct comparison between patients in a PCU and a PCCS. Results strongly support the hypothesis that the coexistence of both institutions in one hospital contributes to the goal of ensuring optimal high-quality PC for patients in complex and challenging clinical situations.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Care, University Hospital Cologne, 50924 Cologne, Germany.
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Bloomer MJ, Moss C, Cross WM. End-of-life care in acute hospitals: an integrative literature review. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1752-9824.2011.01094.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gaertner J, Wuerstlein R, Klein U, Scheicht D, Frechen S, Wolf J, Hellmich M, Mallmann P, Harbeck N, Voltz R. Integrating Palliative Medicine into Comprehensive Breast Cancer Therapy - a Pilot Project. ACTA ACUST UNITED AC 2011; 6:215-220. [PMID: 21779227 DOI: 10.1159/000328162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND: To comply with the World Health Organization (WHO) recommendations, our institution's administrative directives were adopted to advocate the provision of palliative care (PC) early in the disease trajectory of breast cancer (BC). To assess the outcome of this recommendation, this study evaluated the effects of this approach. METHODS: A retrospective systematic chart analysis of a 2-year period was performed. The first PC consultation of patients was analyzed according to (a) physical condition, (b) symptom burden of the patients, and (c) reasons for PC consultation. RESULTS: Many patients were already in a reduced physical state and experienced burdening symptoms when first counselled by PC. After a 1-year experience with PC consultations, the number of burdening symptoms identified at first PC consultation decreased and senologists increasingly requested PC support also for non-somatic issues. CONCLUSIONS: A development towards a better understanding of PC competencies after a 1-year initiation period could be demonstrated, but BC patients continued to be in late stages of the disease at the time of first PC contact. Disease-specific guidelines may facilitate and optimize the integration of PC into breast cancer therapy.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital, Cologne, Cologne, Germany
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Gaertner J, Wuerstlein R, Ostgathe C, Mallmann P, Harbeck N, Voltz R. Facilitating Early Integration of Palliative Care into Breast Cancer Therapy. Promoting Disease-Specific Guidelines. ACTA ACUST UNITED AC 2011; 6:240-244. [PMID: 21779232 DOI: 10.1159/000329007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To comply with patients' needs as well as ASCO and WHO recommendations, our institution aims to integrate palliative care (PC) early in the course of breast cancer (BC) therapy. The evaluation of relevant pilot project data revealed that these recommendations were too vague to trigger PC integration. Therefore, a standard operating procedure (SOP) was developed by our interdisciplinary working group to provide disease-specific information to overcome the ambiguity of the WHO recommendations and guide PC integration. Literally, the SOP states that 'Specialized PC is recommended regularly for all BC patients without curative treatment options, specifically for patients with i) metastasized and inoperable, or ii) locally advanced and inoperable, or iii) relapsing BC, who are receiving intravenous chemotherapy'. This SOP for the first time presents disease-specific guidelines for PC integration into comprehensive BC therapy by defining 'green flags' for early integration of PC and delineating PC from senology assignments. Although disease-specific SOPs have also been developed by this working group for other malignancies, the decision when to first integrate PC into BC therapy differs substantially because of the different clinical characteristics of the disease.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital Cologne, Germany
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Standardizing integration of palliative care into comprehensive cancer therapy--a disease specific approach. Support Care Cancer 2011; 19:1037-43. [PMID: 21432009 DOI: 10.1007/s00520-011-1131-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Our comprehensive cancer centre adopted the WHO recommendation literally in the cancer care guidelines to implement the early integration (EI) of palliative care (PC). Evaluation of the first 2 years of this approach revealed that this guideline was too vague to trigger EI. OBJECTIVE As a consequence, an interdisciplinary working group was set up to propose and implement a more effective concept. METHODS An interdisciplinary (PC, oncology, radiotherapy, etc.) working group identified the need to (a) specify the timing of EI and (b) specify PC assignments by (c) providing more clear cut semantic and clinical definitions. As a result of repeated discussion in the different interdisciplinary working groups in charge of developing and consenting a once-yearly update of treatment guidelines [standard operating procedure (SOP)] for each malignancy, the need for disease-specific EI SOPs was identified. RESULTS SOPs were developed for 19 malignancies (a) to identify a disease-specific point in each disease trajectory to initiate EI ("green flags") and to provide (b) a clear delineation and semantic differentiation of PC assignments ["palliative care" vs. "supportive" or "palliative therapies" ("green" vs. "red flags")]. DISCUSSION To date, ASCO and WHO recommendations for EI lack detailed information about timing and infrastructure. The guidelines presented here aim to provide the missing information by reporting our developed and consented interdisciplinary guidelines for EI. CONCLUSION With this concept, the authors provide a framework for realizing EI and hope to initiate a discussion about specific recommendations for EI.
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The development of evidence-based European guidelines on the management of depression in palliative cancer care. Eur J Cancer 2011; 47:702-12. [DOI: 10.1016/j.ejca.2010.11.027] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 11/18/2010] [Accepted: 11/26/2010] [Indexed: 11/19/2022]
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Gaertner J, Wolf J, Scheicht D, Frechen S, Klein U, Hellmich M, Ostgathe C, Hallek M, Voltz R. Implementing WHO recommendations for palliative care into routine lung cancer therapy: a feasibility project. J Palliat Med 2010; 13:727-32. [PMID: 20597705 DOI: 10.1089/jpm.2009.0399] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) explicitly recommends the integration of palliative care (PC) early in the disease trajectory as part of the WHO definition of PC. Our comprehensive cancer centre decided to include this recommendation in the administrative directives for principles of cancer care. The aim of this study was to assess, for patients with lung cancer, (a) at what point in the disease trajectory the patients were first provided PC and (b) whether - over one year - an earlier integration of PC could be achieved. OBJECTIVE A retrospective systematic chart analysis of a two year period was performed. We assumed that seeing patients relatively early during the course of the illness would be reflected by seeing patients that would be not already (i) in a reduced performance status, (ii) experiencing symptoms that are indicators for advanced disease (e.g., dyspnoea and pain) and (iii) close to death. Therefore, the first PC consultation for every lung cancer patient was analyzed to assess in what physical condition patients receive first PC consultation, what burdening symptoms they already experienced and how long the patients lived after their first consultations. RESULTS Most patients were already in a reduced physical state, were experiencing burdening symptoms and many died shortly after the first PC consultation. After a one year period, the number of burdening symptoms identified at first PC consultation and the admissions to the in-patient PC was decreased while non-PC physicians increasingly requested PC support for psychosocial interventions. CONCLUSION Though some degree of development towards a better understanding of PC competencies and the "early integration" approach could be demonstrated, the adoption of the WHO recommendation alone did not suffice to integrate PC into routine cancer care early in the course of the illness. Therefore, the development of disease specific guidelines is advocated by our working group.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital, Cologne, Germany.
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Gaertner J, Wolf J, Ostgathe C, Toepelt K, Glossmann JP, Hallek M, Voltz R. Specifying WHO Recommendation: Moving toward Disease-Specific Guidelines. J Palliat Med 2010; 13:1273-6. [DOI: 10.1089/jpm.2010.0016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
- Clinical Trials Center Cologne, Cologne, Germany
| | - Juergen Wolf
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Karin Toepelt
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Jan-Peter Glossmann
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Raymond Voltz
- Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
- Clinical Trials Center Cologne, Cologne, Germany
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Becker G, Momm F, Deibert P, Xander C, Gigl A, Wagner B, Baumgartner J. Planning training seminars in palliative care: a cross-sectional survey on the preferences of general practitioners and nurses in Austria. BMC MEDICAL EDUCATION 2010; 10:43. [PMID: 20540757 PMCID: PMC2893516 DOI: 10.1186/1472-6920-10-43] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 06/11/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND Training in palliative care is frequently requested by health care professionals. However, little is known in detail about the subject matters and the educational preferences of physicians and staff or assistant nurses in this field. METHODS All 897 registered GPs and all 933 registered home care nurses in the district of Steiermark/Austria were sent postal questionnaires. RESULTS Results from 546 (30%) respondents revealed that GPs prefer evening courses and weekend seminars, whereas staff and assistant nurses prefer one-day courses. Multidisciplinary sessions are preferred by almost 80% of all professional groups. GPs preferred multi disciplinary groups most frequently when addressing psychosocial needs (88.8%) and ethical questions (85.8%). Staff and assistant nurses preferred multidisciplinary groups most frequently in the area of pain management (88%) and opted for multi disciplinary learning to a significantly higher extent than GPs (69%; p < 0.01). Those topics were ranked first which are not only deepening, but supplementing the professional training. On average, GPs were willing to spend a maximum amount of euro 400 per year for training seminars in palliative care, whereas nurses would spend approximately euro 190 for such classes.The results provide a detailed analysis of the preferences of GPs and nurses and offer guidance for the organisation of training seminars in palliative care. CONCLUSIONS Medical and nursing education programs often pursue separate paths. Yet our findings indicate that in palliative care multidisciplinary training seminars are favoured by both, doctors and nurses. Also, both groups prefer topics that are not only deepening, but supplementing their professional knowledge.
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Affiliation(s)
- Gerhild Becker
- Department of Internal Medicine II, University Medical Center Freiburg, Freiburg, Germany
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Felix Momm
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Peter Deibert
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Carola Xander
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Annemarie Gigl
- Red Cross Austria, National Association Styria, Graz, Austria
| | - Brigitte Wagner
- External consultantions for Socioscientific Studies, Methodology and Statistics Graz, Austria
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Švecová K. A description and comparison of palliative care services in the United Kingdom and Czech Republic. Int J Palliat Nurs 2009; 15:422, 424, 426 passim. [DOI: 10.12968/ijpn.2009.15.9.44254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Higginson IJ, Foley KM. Palliative care: no longer a luxury but a necessity? J Pain Symptom Manage 2009; 38:1-3. [PMID: 19615620 DOI: 10.1016/j.jpainsymman.2009.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 04/08/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, School of Medicine, London, United Kingdom.
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Brooksbank M. Palliative care: Where have we come from and where are we going? Pain 2009; 144:233-235. [PMID: 19564077 DOI: 10.1016/j.pain.2009.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 06/04/2009] [Indexed: 10/20/2022]
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Abstract
BACKGROUND The End-of-Life in Dementia (EOLD) scales comprise the most specific set of instruments developed for evaluations of patients' end of life by their families. It is not known whether the EOLD scales are useful for cross-national comparisons. METHODS We used a mortality follow-back design in multi-center studies in the Netherlands (pilot study 2005-2007) and the U.S.A. (1999), and we compared EOLD Satisfaction With Care (SWC; last three months of life), Symptom Management (SM; last three months) and Comfort Assessment in Dying (CAD) scores for 54 Dutch and 76 U.S. nursing home residents. RESULTS SWC total scores did not differ significantly between the Dutch and U.S. studies (31.9, SD 4.7 versus 30.4, SD 6.1), but three of ten items were rated more favorable for Dutch residents, as were SM total scores (29.1, SD 9.2 versus 20.4, SD 10.6). CAD total scores did not differ (32.0, SD 5.4 versus 30.5, SD 5.9, respectively), but the "well-being" subscale was rated more favorably for Dutch residents. Results were similar after adjustment for demographics and dementia severity. CONCLUSION The Dutch families rated end of life with dementia in nursing homes as somewhat better than did U.S. families. Although differences were small, the observed patterns were consistent. This suggests validity of the SM and CAD to assess differences in quality of dying and possible sensitivity to differences between countries or time frames. Larger, simultaneous, cross-national studies are needed to confirm usefulness of the scales and to detect areas which need improvement in the respective countries.
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Bonin-Scaon S, Sastre MTM, Chasseigne G, Sorum PC, Mullet E. End-of-Life Preferences: A Theory-Driven Inventory. Int J Aging Hum Dev 2009; 68:1-26. [DOI: 10.2190/ag.68.1.a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The study aimed at making a theory-driven inventory of end-of-life preferences. Participants were asked about a variety of preferences representing all eight motivational states described in Apter's Metamotivational Theory (AMT; Apter, 2001). Data from a convenience sample of 965 community participants and a convenience sample of 81 persons suffering from a terminal illness were examined using exploratory and confirmatory factor analysis. Ten factors were evidenced; they were easily interpretable in the AMT framework. In decreasing order of importance, people would, at the time of their death, like to have an understanding doctor, to be at peace with themselves, to remain autonomous, to keep a sense of humor, to remain able to oppose any decision taken without their consent, to remain an object of love, to remain a reference for others, to have resolved conflicts with others, to leave their businesses in good order, and to find themselves at peace with God.
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Österlind J, Hansebo G, Lantz G, Ternestedt BM. Pathways in end-of-life care for older people: care managers’ reasoning. Int J Palliat Nurs 2008; 14:420-5. [DOI: 10.12968/ijpn.2008.14.9.31122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jane Österlind
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Göran Lantz
- Ersta Sköndal University College, Stockholm, Sweden
| | - Britt-Marie Ternestedt
- Department of Health Care Sciences and Research Director, Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden
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van der Steen JT, Kruse RL, Szafara KL, Mehr DR, van der Wal G, Ribbe MW, D'Agostino RB. Benefits and pitfalls of pooling datasets from comparable observational studies: combining US and Dutch nursing home studies. Palliat Med 2008; 22:750-9. [PMID: 18715975 DOI: 10.1177/0269216308094102] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Different research groups sometimes carry out comparable studies. Combining the data can make it possible to address additional research questions, particularly for small observational studies such as those frequently seen in palliative care research. We present a systematic approach to pool individual subject data from observational studies that addresses differences in research design, illustrating the approach with two prospective observational studies on treatment and outcomes of lower respiratory tract infection in US and Dutch nursing home residents. Benefits of pooling individual subject data include enhanced statistical power, the ability to compare outcomes and validate models across sites or settings, and opportunities to develop new measures. In our pooled dataset, we were able to evaluate treatments and end-of-life decisions for comparable patients across settings, which suggested opportunities to improve care. In addition, greater variation in participants and treatments in the combined dataset allowed for subgroup analyses and interaction hypotheses, but required more complex analytic methods. Pitfalls included the large amount of time required for equating study procedures and variables and the need for additional funding.
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Affiliation(s)
- J T van der Steen
- Department of Nursing Home Medicine, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
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Ferrell B, Paice J, Koczywas M. New standards and implications for improving the quality of supportive oncology practice. J Clin Oncol 2008; 26:3824-31. [PMID: 18688048 DOI: 10.1200/jco.2007.15.7552] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of this article is to review current guidelines and national initiatives to improve the quality of supportive oncology care. Review of the literature in this area has documented important advances in supportive oncology. This article focuses on work by the National Consensus Project for Quality Palliative Care and the National Quality Forum. The mandate to improve the quality of care in oncology has been the focus of several national reports, including those by the Institute of Medicine addressing end-of-life care in cancer and cancer survivorship. Patients with cancer face significant needs for support in areas such as pain and symptom management and psychosocial and spiritual support, as well as diverse quality-of-life concerns. These reports recommending changes in practice have been reinforced by clinical practice guidelines developed by the National Consensus Project for Quality Palliative Care and preferred practices defined by the National Quality Forum. This article applies these national mandates and guidelines to the field of supportive care in oncology. Improving the quality of supportive oncology will require commitment by oncology professionals in areas of education, clinical practice, and research.
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Affiliation(s)
- Betty Ferrell
- Department of Nursing Research and Education, and Division of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA 91010, USA.
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Jakobsson E, Bergh I, Ohlén J, Odén A, Gaston-Johansson F. Utilization of health-care services at the end-of-life. Health Policy 2007; 82:276-87. [PMID: 17097757 DOI: 10.1016/j.healthpol.2006.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 10/12/2006] [Accepted: 10/18/2006] [Indexed: 11/19/2022]
Abstract
End-of-life care poses a growing clinical and policy concern since most people who are dying utilize health-care services during this period of life. Hence, end-of-life care is a common and integral part of the care provided by health-care systems. There is a growing call for the implementation of a palliative approach as an integral part of all end-of-life care. The purpose of this study was thus to provide policy-makers, health-care providers and professional caregivers with increased knowledge about mainstream patterns of health-care utilization during end-of-life. The patterns of use of health-care services in a Swedish population who accessed the health-care system during their last 3 months of life were in this study examined through a retrospective examinations of medical and nursing records (n=229). We found high prevalences of use of both hospital care, primary care and care provided in people's homes and nearly three quarters of the persons included in the study used between two and three health-care services. However, the probability of using different health-care services was found to be strongly depending on demographic, social, functional and disease related characteristics. The study reveals a considerable use of different health-care services during end-of-life. It is hence essential to, on one hand delineate how such health-care services best can support people at the end-of-life, and on the other hand develop policies which facilitate the process of dying, both in hospitals as well as in peoples' homes. Implications for policy are discussed.
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Affiliation(s)
- Eva Jakobsson
- Faculty of Health Caring Sciences, The Sahlgrenska Academy at Göteborg University, Institute of Nursing, Gothenburg, Sweden.
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Lewis D, Anthony D. A patient and carer survey in a community clinical nurse specialist service. Int J Palliat Nurs 2007; 13:230-6. [PMID: 17577175 DOI: 10.12968/ijpn.2007.13.5.23496] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The community clinical nurse specialist (CNS) team provides specialist palliative care to clients with cancer and non-malignant, life-limiting diseases in clients' homes, community hospitals, and residential and nursing homes. CNSs are based in health centres, community hospitals (geographically spread around the county) or at the local hospice. There has been no systematic review of patient and carer levels of satisfaction since the conception of the CNS service in 1984. Accredited as a nursing development unit (Flint and Wright, 2001) by Leeds University, the team has been encouraged to obtain service users' views. National guidelines in the UK (National Institute for Health and Clinical Excellence (NICE), 2004) also recommend that systems be put in place to enable clients to make their voices heard in a variety of ways. The principle aim was to identify the level of patient and carer satisfaction and to highlight aspects of care that warranted alteration or improvement. The CNS team were also keen to identify the aspects of their role most helpful to patients and carers, enabling CNSs to spend their time in a way that is most beneficial to clients.
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Abstract
As a result of limited access to antiretroviral treatment, many South Africans die yearly of AIDS. It is important that the end-of-life needs of these people be met. This article examines the major challenges involved in providing quality end-of-life care to people with AIDS in South Africa. Published reports are reviewed, as is the author's experience living and working in KwaZulu-Natal, South Africa. The issues discussed include the nature of the South African health care system, with emphasis on the scarcity of palliative care resources for AIDS patients, ineffective control of pain, models of care such as the integrated community-based home care model that relies heavily on community caregivers to meet the needs of people dying of AIDS, the living conditions of AIDS patients and their families, and AIDS-related stigma. Broad recommendations are presented for improving palliative care services for people with AIDS in the South African context.
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Affiliation(s)
- Craig Demmer
- Department of Health Sciences, Lehman College, City University of New York, Bronx, NY, USA.
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Jakobsson E, Bergh I, Gaston-Johansson F, Stolt CM, Ohlén J. The Turning Point: Clinical Identification of Dying and Reorientation of Care. J Palliat Med 2006; 9:1348-58. [PMID: 17187543 DOI: 10.1089/jpm.2006.9.1348] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Palliative care is increasingly organized within the setting of formal health care systems but the demarcation has become unclear between, on the one hand, care directed at cure and rehabilitation and palliative care aimed at relief of suffering on the other. With the purpose to increase the understanding about the turning point reflecting identification of dying and reorientation of care, this study explores this phenomenon as determined from health care records of a representative sample (n = 229). A turning point was identified in 160 records. Presence of circulatory diseases, sporadic confinement to bed, and deterioration of condition had a significant impact upon the incidence of such turning point. The time interval between the turning point and actual death ranged between one and 210 days. Thirty percent of these turning points were documented within the last day of life, 33% during the last 2-7 days, 19.5% during the last 8-30 days, 13% during the last 31-90 days, and 4.5% during the last 91-210 days of life. The time interval between the turning point and actual death was significantly longer among individuals with neoplasm(s) and significantly shorter among individuals suffering from musculoskeletal diseases. Perhaps this reflects a discrepancy between the ideals of palliative care, and a misinterpretation of the meaning of palliative care in everyday clinical practice. The findings underscore that improvement in timing of clinical identification of dying and reorientation of care will likely favour a shift from life-extending care to palliative care.
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Affiliation(s)
- Eva Jakobsson
- Faculty of Health Caring Sciences, The Sahlgrenska Academy at Göteborg University, Institute of Nursing, Gothenburg, Sweden.
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Easom LR, Galatas S, Warda M. End-of-life care: an educational intervention for rural nurses in southeastern USA. Int J Palliat Nurs 2006; 12:526-34. [PMID: 17170670 DOI: 10.12968/ijpn.2006.12.11.22400] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To assess the impact of three educational presentations as an intervention for increasing knowledge of end-of-life care for rural nurses in assisted living and nursing home environments. DESIGN A repeated measures design (quantitative component) evaluated the effects of the educational intervention. Two open-ended questions yielded qualitative data. SAMPLE AND SETTING A convenience sample (n = 9) of Registered Nurses and Licensed Practical Nurses employed in an assisted living facility or nursing home in the rural, southeastern region of the USA. Level of nursing experience ranged from 6 to 28 years. ANALYSIS Frequency distributions, difference of means test for paired samples. RESULTS Post test scores were significantly higher (t = 6.999; p < 0.001) than pretest scores regarding overall knowledge on end-of-life care. Attitudes and perceptions of participants changed in defining what constitutes a 'good death'. CONCLUSIONS Classroom educational presentations are an effective means of changing attitudes and improving end-of-life care knowledge. Additional education and support for rural nursing personnel involved with residents of long-term care may enhance end-of-life care.
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Affiliation(s)
- Leisa R Easom
- Macon State College, Division of Nursing and Health Sciences, 100 College Station Drive, Macon, Georgia 31206 USA.
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