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Barker PC, Yamarik RL, Adeyemi O, Cuthel AM, Flannery M, Siman N, Goldfeld KS, Grudzen CR. Predictors of Specialty Outpatient Palliative Care Utilization Among Persons With Serious Illness. J Pain Symptom Manage 2024:S0885-3924(24)00924-2. [PMID: 39179000 DOI: 10.1016/j.jpainsymman.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 08/26/2024]
Abstract
CONTEXT Outpatient Palliative Care (OPC) benefits persons living with serious illness, yet barriers exist in utilization. OBJECTIVES To identify factors associated with OPC clinic utilization. METHODS Emergency Medicine Palliative Care Access is a multicenter, randomized control trial comparing two models of palliative care for patients recruited from the Emergency Department (ED): nurse-led telephonic case management and OPC (one visit a month for six months). Patients were aged 50+ with advanced cancer or end-stage organ failure and recruited from 19 EDs. Using a mixed effects hurdle model, we analyzed patient, provider, clinic and healthcare system factors associated with OPC utilization. RESULTS Among the 603 patients randomized to OPC, about half (53.6%) of patients attended at least one clinic visit. Those with less than high school education were less likely to attend an initial visit than those with a college degree or higher (aOR 0.44; CI 0.23, 0.85), as were patients who required considerable assistance (aOR 0.45; CI 0.25, 0.82) or had congestive heart failure only (aOR 0.46; CI 0.26, 0.81). Those with higher symptom burden had a higher attendance at the initial visit (aOR 1.05; CI 1.00, 1.10). Reduced follow up visit rates were demonstrated for those of older age (aRR 0.90; CI 0.82, 0.98), female sex (aRR 0.84; CI 0.71, 0.99), and those that were never married (aRR 0.62; CI 0.52, 0.87). CONCLUSION Efforts to improve OPC utilization should focus on those with lower education, more functional limitations, older age, female sex, and those with less social support. Trial Registration ClinicalTrials.gov Identifier: NCT03325985.
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Affiliation(s)
- Paige Comstock Barker
- Department of Medicine (P.C.B.), University of Florida Health, Gainesville, Florida, USA
| | - Rebecca Liddicoat Yamarik
- Department of Medicine (R.L.Y.), Tibor Rubin Long Beach Veteran Affairs, Long Beach, California, USA
| | - Oluwaseun Adeyemi
- Ronald O. Perelman Department of Emergency Medicine (O.A., A.M.C., M.F., N.S.), New York University School of Medicine, New York, New York, USA
| | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine (O.A., A.M.C., M.F., N.S.), New York University School of Medicine, New York, New York, USA.
| | - Mara Flannery
- Ronald O. Perelman Department of Emergency Medicine (O.A., A.M.C., M.F., N.S.), New York University School of Medicine, New York, New York, USA
| | - Nina Siman
- Ronald O. Perelman Department of Emergency Medicine (O.A., A.M.C., M.F., N.S.), New York University School of Medicine, New York, New York, USA
| | - Keith S Goldfeld
- Department of Population Health (K.S.G.), New York University Grossman School of Medicine, New York, New York, USA
| | - Corita R Grudzen
- Division of Supportive and Acute Care Services (C.R.G.), Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Ibrahim AM, Wahba NMI, Zaghamir DEF, Mersal NA, Mersal FA, Ali RAES, Eltaib FA, Mohamed HAH. Impact of a comprehensive rehabilitation palliative care program on the quality of life of patients with terminal cancer and their informal caregivers: a quasi-experimental study. BMC Nurs 2024; 23:357. [PMID: 38812027 PMCID: PMC11138029 DOI: 10.1186/s12912-024-02028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 05/20/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Palliative care schemes, which include pain management, symptom control, psychosocial support and rehabilitation, aim to boost patients' quality of life, ease the burden and anxiety of informal caregivers, and ultimately provide a comprehensive approach to enhance well-being during this challenging and sensitive period. This study aims to evaluate the impact of a comprehensive rehabilitation palliative care program on the quality of life of patients with terminal cancer and their informal caregivers. METHODS This quasi-experimental study, conducted from August 2023 to January 2024 at outpatient clinics affiliated with the Oncology Center at Mansoura University, Egypt, focused on cancer patients and their caregivers in the palliative care department. Employing pre- and post-test phases, data were gathered using a questionnaire, EORTC QLQ C30, Hospital Anxiety and Depression Scale, Short Form Health Survey, Caregiver Burden Inventory, and Beck Anxiety Inventory. The investigation evaluated a 16-week rehabilitation program comprising exercise, psychoeducation, individual counselling, and spiritual support. Exercises, led by a physiotherapist, targeted fatigue and stress through tailored aerobic and resistance training. Psychoeducation sessions aimed to bolster coping abilities, covering fatigue management and nutrition. Trained counsellors addressed spiritual and existential concerns. Personal advisory sessions were available for individual support. Caregivers received education on rehabilitation and palliative care protocols, ensuring comprehensive patient care. RESULTS The mean age for cancer patients was 65.79 ± 13.85. In contrast, the mean age for primary carers was 42.05 ± 11.15. The QOL for cancer patients during the pre-test phase was 77.8 ± 7.16 and rose to 87.34 ± 14.56 during the post-test phase. Additionally, the total anxiety level of patients before the rehabilitation palliative care program was conducted was 15.45 ± 3.05 compared to 6.12 ± 3.21 after the post test phase. Furthermore, the total depression levels of the patients during the pre-test phase were 20.89 ± 9.21. However, after implementing the rehabilitation palliative care program, it decreased to 15.5 ± 6.86. In regards to the total quality of life of informal caregivers, it was measured at 67.28 ± 32.09 before conducting the program. Nevertheless, it increased to 25.95 ± 40.29 after conducting it. Additionally, the total Caregiver Burden Inventory before implementing the program was 37.45 ± 25.7, and it decreased to 29.36 ± 16.4 after conducting it. Additionally, the total score on the Beck Anxiety Inventory decreased from 45.7 ± 4.3 during the initial testing phase to 17.35 ± 23.67. CONCLUSION The program for rehabilitation palliative care successfully achieved its goals by enhancing the overall quality of life for cancer patients and their caregivers. Additionally, it reduced the anxiety and depression levels among the patients, as well as the anxiety and caregiver burden among the caregivers. Continue research into the effectiveness of rehabilitation palliative care programs to identify best practices, improve existing programs, and expand access to these services.
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Affiliation(s)
- Ateya Megahed Ibrahim
- College of Nursing, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia.
- Family and Community Health Nursing Department, Faculty of nursing, Port Said University, Port Said, 42526, Egypt.
| | - Nadia Mohamed Ibrahim Wahba
- College of Nursing, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
- Psychiatric Nursing and Mental Health Department, Faculty of Nursing, Port Said University, Port Said, 42526, Egypt
| | - Donia Elsaid Fathi Zaghamir
- College of Nursing, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
- Pediatric Nursing Department, Faculty of Nursing, Port Said University, Port Said, 42526, Egypt
| | - Nahed Ahmed Mersal
- Medical Surgical Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fathia Ahmed Mersal
- Community Health Nursing Department, College of Nursing, Northern Border University, Arar, Saudi Arabia
| | - Rasmia Abd El-Sattar Ali
- Community Health Nursing Department, College of Nursing, Northern Border University, Arar, Saudi Arabia
| | - Fatma Abdou Eltaib
- Medical Surgical Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt
| | - Heba Ali Hamed Mohamed
- Community Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura city, Dakahlia, Egypt
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Wan J, Vaughan A, Shepherd E, Coombs S, Trethewie S, Jaaniste T. Evaluation of paediatric palliative care ambulance plans: A retrospective study. J Child Health Care 2024:13674935231225714. [PMID: 38262591 DOI: 10.1177/13674935231225714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Paediatric Palliative Care Ambulance Plans ('Plans') are used by New South Wales Ambulance (Australia) to support the care needs of children with life-limiting conditions. We aimed to describe the population of children with Plans and provide details regarding Plan completion, paramedic responses during ambulance callouts, and correspondence between Plan recommendations and paramedic responses. Plans lodged in January 2017-December 2019 were retrospectively coded for demographic information, completeness and care preferences. Associated paramedic callout notes (January 2018-December 2019) were coded for paramedic responses. Of 141 Plans retrieved, 38 (41.3% of those providing suggested medications) suggested medication use outside general paramedic scope of practice. Of 199 associated ambulance callouts, reasons for callout included symptom management, planned transfer, death notification and end-of-life care. Over two-thirds of callouts (n = 135, 67.8%) occurred after-hours. Most paramedic callouts (n = 124, 62.3%), excluding planned transfers, resulted in children being transported. Paramedic interventions corresponded with interventions suggested in Plans. However, only 24 (25.3%) of paramedic callout notes documented Plans being sighted. This study provided detailed information about children with palliative care needs for whom Plans were being used, the nature of these Plans and associated paramedic callouts. However, it is not known how paramedics were influenced by Plans.
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Affiliation(s)
- Julianna Wan
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Elizabeth Shepherd
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Sandra Coombs
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Susan Trethewie
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Tiina Jaaniste
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
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Hrdlickova L, Polakova K, Loucka M. Innovative communication approaches for initializing pediatric palliative care: perspectives of family caregivers and treating specialists. BMC Palliat Care 2023; 22:152. [PMID: 37814302 PMCID: PMC10563209 DOI: 10.1186/s12904-023-01269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Effective cooperation between a pediatric palliative care team (PPCT), primary treating specialists, patients and families is crucial for high quality care of children with complex life-limiting conditions. Several barriers among patients, families and treating specialists have been identified in the context of initializing pediatric palliative care. The aim of the study was to assess the experience with initial pediatric palliative care consultations from perspectives of family caregivers and treating physicians with a special focus on two innovative approaches: attendance of the treating specialist and the opportunity for parents to give feedback on the written report from the consultation. METHODS This was a qualitative study using semi-structured interviews with family caregivers of children with malignant and non-malignant disease and their treating specialists. Framework analysis was used to guide the data collection and data analysis. RESULTS In total, 12 family caregivers and 17 treating specialists were interviewed. Four main thematic categories were identified: (1) expectations, (2) content and evaluation, (3) respect and support from the team and (4) consultation outcomes. Parents viewed the consultation as a unique opportunity to discuss difficult topics. They perceived the attendance of the treating specialist at the initial consultation as very important for facilitating communication. Treating specialists valued the possibility to learn more about psychosocial issues of the child and the family while attending the initial palliative care consultation. All participants perceived the written report from the consultation as useful for further medical decisions. Family members appreciated the chance to give feedback on the consultation report. CONCLUSIONS Our study identified several clinically relevant issues that can help initialize pediatric palliative care and establish effective collaboration between families and PPCT and treating specialists. Supporting treating specialists in their ability to explain the role of palliative care is important in order to reduce the risk of misunderstanding or unrealistic expectations. Developing more specific expectations seems to be one of the ways to further increase the effectiveness of initial consultations. The results of the study can be especially helpful for the initial phase of implementing pediatric palliative care and initializing the process of setting up a collaborative relationship with palliative care teams in the hospital.
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Affiliation(s)
- Lucie Hrdlickova
- Department of Pediatric Hematology and Oncology, University Hospital Motol, V Uvalu 84, Prague, 5,150 06, Czech Republic.
- Pediatric Supportive Care Team, University Hospital Motol, Prague, Czech Republic.
- First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Kristyna Polakova
- Center for Palliative Care, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Loucka
- Center for Palliative Care, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Maksymowicz-Śliwińska A, Lulé D, NieporĘcki K, Ciećwierska K, Ludolph AC, Kuźma-Kozakiewicz M. The quality of life and depression in primary caregivers of patients with amyotrophic lateral sclerosis is affected by patient-related and culture-specific conditions. Amyotroph Lateral Scler Frontotemporal Degener 2022; 24:317-326. [PMID: 36510650 DOI: 10.1080/21678421.2022.2126322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To analyze the quality of life (QoL) and frequency of depression in primary caregivers of patients with amyotrophic lateral sclerosis (ALS) in two neighboring European countries. Methods: a cross-sectional study performed in 164 dyads of ALS patients and caregivers followed at clinical ALS centers in Poland and Germany between 2015 and 2018. The quality of life (Anamnestic Comparative Self-Assessment - ACSA, Quality of Life in Life-Threatening Illness - Family Carer Version - QOLLTI-F) and depression (ALS-Depression-Inventory 12-Items - ADI-12) of the caregivers was assessed and correlated with caregivers- and patient-related factors. Patient's clinical status was assessed by ALS Functional Rating Scale - revised and the Behavioral Score of the Edinburgh Cognitive and Behavioral ALS Screen. Results: the caregivers reported a positive QoL associated with functional and behavioral status of the patient, disease duration and caregivers's depression The most impaired domains of the QoL differed depending on the country of provenance, cultural background and/or social support of the caregivers. Depression was present in 1/3 of the caregivers and was significantly more frequent in the Polish group. It positively correlated with female gender, disease duration, sleep disturbances and functional decline. Both QoL and mood were significantly lower in the caregivers more burdened with the functional care of the patients. Conclusions: the wellbeing of caregivers of ALS patients is affected by patient-related and culture-specific conditions. Understanding the needs and background of psychological adaptation of the caregivers from various countries may translate into better QoL and local patient care.
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Affiliation(s)
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Krzysztof NieporĘcki
- Department of Neurology, University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Ciećwierska
- Department of Neurology, University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
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McNeil MJ, Ehrlich B, Yakimkova T, Wang H, Mishkova V, Bezler Z, Kumirova E, Madni A, Movsisyan N, Williams K, Baizakova B, Borisevich M, Chatman G, Erimbetova I, Quintero XG, Golban R, Kirby B, Nunez P, Ranadive R, Sakhar N, Sonnenfelt J, Volkova A, Moreira D, Friedrichsdorf SJ, Wolfe J, Remke S, Hauser J, Devidas M, Baker JN, Agulnik A. Regional adaptation of the education in palliative and end-of-life Care Pediatrics (EPEC-Pediatrics) curriculum in Eurasia. Cancer Med 2022; 12:3657-3669. [PMID: 36073348 PMCID: PMC9939085 DOI: 10.1002/cam4.5213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pediatric palliative care (PPC) is a priority to improve pediatric hematology oncology (PHO) care in Eurasia. However, there are limited regional opportunities for PPC education. We describe the adaptation and implementation of a bilingual end-user Education in Palliative and End-of-Life Care (EPEC)-Pediatrics course for PHO clinicians in Eurasia. METHODS Due to COVID-19, this course was delivered virtually, consisting of prerecorded, asynchronous lectures, and a bilingual workshop with interactive lectures and small group sessions. A pre-postcourse design was used to evaluate the knowledge acquisition of the participants including their knowledge alignment with World Health Organization (WHO) guidance, ideal timing of palliative care, and comfort in providing palliative care to their patients. Questions were mostly quantitative with multiple choice or Likert scale options, supplemented by free-text responses. RESULTS A total of 44 (76%) participants from 14 countries completed all components of the course including pre- and postcourse assessments. Participant alignment with WHO guidance improved from 75% in the pre- to 90% in the postcourse assessments (p < 0.001). After participation, 93% felt more confident controlling the suffering of children at the end of life, 91% felt more confident in prescribing opioids and managing pain, and 98% better understood how to hold difficult conversations with patients and families. Most participants (98%) stated that they will change their clinical practice based on the skills and knowledge gained in this course. CONCLUSIONS We present a successful regional adaptation of the EPEC-Pediatrics curriculum, including novel delivery of course content via a virtual bilingual format. This course resulted in significant improvement in participant attitudes and knowledge of PPC along with an understanding of the ideal timing of palliative care consultation and comfort in providing PPC to children with cancer. We plan to incorporate participant feedback to improve the course and repeat it annually to improve access to high-quality palliative care education for PHO clinicians in Eurasia.
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Affiliation(s)
| | - Bella Ehrlich
- St. Jude Children's Research HospitalMemphisTennesseeUSA,Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | | | - Huiqi Wang
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Volha Mishkova
- Belarusian Research Center for Pediatric OncologyHematology and ImmunologyMinskBelarus
| | - Zhanna Bezler
- Belarusian Clinical Center of Palliative Care for ChildrenMinskBelarus
| | - Ella Kumirova
- Dmitry Rogachev National Research Center of Pediatric HematologyOncology and ImmunologyMoscowRussia,Russian Scientific Center of Roengenology and RadiologyMoscowRussia,Pyrogov Medical UniversityMoscowRussia,Morozovskaya Children's City Clinical HospitalMoscowRussia,N.N. Blokhin National Medical Research Center of OncologyMoscowRussia
| | - Arshia Madni
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Narine Movsisyan
- Yerevan State Medical University After Mkhitar HeratsiYerevanArmenia
| | - Karen Williams
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Baglan Baizakova
- George Washington UniversityThe Milken Institute School of Public HealthWashington, District of ColumbiaUSA
| | - Marina Borisevich
- Belarusian Research Center for Pediatric OncologyHematology and ImmunologyMinskBelarus
| | | | - Indira Erimbetova
- The Republican Center for Hematology and Blood TransfusionTashkentUzbekistan
| | | | - Rodica Golban
- Institute of Oncology of Republic of MoldovaMoldovaChisinau
| | - Brandi Kirby
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Paola Nunez
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Nadezhda Sakhar
- Republican Scientific and Practical Center for Pediatric SurgeryMinskBelarus
| | | | - Alisa Volkova
- Raisa Gorbacheva Memorial Research Institute for Pediatric OncologyHematology and TransplantationSt. PetersburgRussia
| | - Daniel Moreira
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Joanne Wolfe
- Dana Farber Cancer InstituteBostonMassachusettsUSA
| | - Stacy Remke
- University of MinnesotaMinneapolisMinnesotaUSA
| | | | | | | | - Asya Agulnik
- St. Jude Children's Research HospitalMemphisTennesseeUSA
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Salek M, Woods C, Gattas M, Gattuso JS, Mandrell B, Baker JN, Kaye EC. Multidisciplinary Clinician Perspectives on Embedded Palliative Care Models in Pediatric Cancer. J Pain Symptom Manage 2022; 64:222-233. [PMID: 35649459 DOI: 10.1016/j.jpainsymman.2022.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 11/20/2022]
Abstract
CONTEXT Integration of palliative care (PC) into pediatric cancer care is considered best practice by national oncology and pediatric organizations. Optimal strategies for PC integration remain understudied, although growing evidence suggests that embedded models improve quality of care and quality of life for patients and families. OBJECTIVES To describe the perspectives and preferences of multidisciplinary clinicians regarding ideal models for PC integration in pediatric cancer care; to introduce clinicians to the theoretical concept of an embedded care model; to empower clinicians in co-design of a new institutional model through collaborative discussion of anticipated benefits and challenges of embedded model implementation. METHODS Trained facilitators conducted 24 focus groups, stratified by discipline and care team. Focus groups were audio-recorded and transcribed for inductive content analysis using MAXQDA software. RESULTS 174 clinicians participated (25 physicians, 30 advanced practice providers [APPs], 70 nurses, 49 psychosocial clinicians). Clinicians across disciplines verbalized that an embedded PC model would improve access to PC; however, identified benefits and challenges varied by discipline. Benefits included earlier integration of PC (physicians, APPs), normalization of PC as an integral aspect of care by patients/families (nurses, psychosocial), collaboration (physicians, psychosocial clinicians), and communication (APPs, psychosocial). Anticipated challenges included inadequate resources and physician resistance (physicians, APPs, nurses) and multidisciplinary role confusion (APPs, nurses, psychosocial). CONCLUSION Pediatric clinicians recognize the potential value of an embedded PC model. Although some concepts overlapped, multidisciplinary clinicians offered unique beliefs, highlighting the importance of including representative perspectives to ensure that pediatric PC models align with priorities of diverse stakeholders.
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Affiliation(s)
- Marta Salek
- Department of Oncology, St. Jude Children's Research Hospital (M.S., C.W., M.G., B.M., J.N.B., E.C.K.), Memphis, Tennessee, USA.
| | - Cameka Woods
- Department of Oncology, St. Jude Children's Research Hospital (M.S., C.W., M.G., B.M., J.N.B., E.C.K.), Memphis, Tennessee, USA
| | - Melanie Gattas
- Department of Oncology, St. Jude Children's Research Hospital (M.S., C.W., M.G., B.M., J.N.B., E.C.K.), Memphis, Tennessee, USA
| | - Jami S Gattuso
- Division of Nursing Research, Department of Pediatrics (J.S.G.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Belinda Mandrell
- Department of Oncology, St. Jude Children's Research Hospital (M.S., C.W., M.G., B.M., J.N.B., E.C.K.), Memphis, Tennessee, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital (M.S., C.W., M.G., B.M., J.N.B., E.C.K.), Memphis, Tennessee, USA
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital (M.S., C.W., M.G., B.M., J.N.B., E.C.K.), Memphis, Tennessee, USA
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8
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Brock KE, DeGroote NP, Roche A, Lee A, Wasilewski K. The Supportive Care Clinic: A Novel Model of Embedded Pediatric Palliative Oncology Care. J Pain Symptom Manage 2022; 64:287-297.e1. [PMID: 35618251 DOI: 10.1016/j.jpainsymman.2022.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
CONTEXT Pediatric palliative care (PPC) improves quality of life and end-of-life outcomes for children with cancer, but often occurs late in the disease course. The Supportive Care Clinic (SCC) was launched in 2017 to expand outpatient PPC access. OBJECTIVES To describe the inaugural four years (2017-2021) of an academic, consultative, embedded SCC within pediatric oncology. METHODS Descriptive statistics (demographic, disease, treatment, visit, and end-of-life) and change over time were calculated. RESULTS During the first four years, 248 patients (51.6% male; 58.1% White; 35.5% Black; 13.7% Hispanic/Latino) were seen in SCC, totaling 1,143 clinic visits (median 4, IQR 2,6), including 248 consultations and 895 follow-up visits. Clinic visits grew nearly 300% from year one to four. Primary diagnoses were central nervous system tumor (41.9%), solid tumor (37.5%), and leukemia/lymphoma (17.3%). The first point of PPC contact became SCC (70.6%) for most referred patients. Among the 136 deceased patients (54.8%), 77.9% had a do-not-resuscitate or Physician Orders for Life Sustaining Treatment in place, and 72.8% received hospice care. When known (n = 112), 89.3% died in their preferred location. The time from SCC consultation to death increased from 74 to 226 days over the four years (P < 0.0001). The proportion of SCC consultations that occurred greater than 90 days from death increased from 39.1% in year one to 85.0% in year four. CONCLUSION Embedded SCC clinics can be successful, achieve steady growth, improve referrals and timing of PPC, and enhance end-of-life care for children with cancer. Large pediatric cancer centers should include SCC outpatient services.
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Affiliation(s)
- Katharine E Brock
- Aflac Cancer & Blood Disorders Center of Children's Healthcare of Atlanta (K.E.B., N.P.D., A.R., K.W.), Atlanta, Georgia, USA; Department of Pediatrics, Division of Pediatric Hematology/Oncology (K.E.B., K.W.), Emory University. Atlanta, Georgia, USA; Department of Pediatrics, Division of Pediatric Palliative Care (K.E.B.), Emory University, Atlanta, Georgia, USA.
| | - Nicholas P DeGroote
- Aflac Cancer & Blood Disorders Center of Children's Healthcare of Atlanta (K.E.B., N.P.D., A.R., K.W.), Atlanta, Georgia, USA
| | - Anna Roche
- Aflac Cancer & Blood Disorders Center of Children's Healthcare of Atlanta (K.E.B., N.P.D., A.R., K.W.), Atlanta, Georgia, USA
| | - Annika Lee
- Emory University School of Medicine (A.L.), Atlanta, Georgia, USA
| | - Karen Wasilewski
- Aflac Cancer & Blood Disorders Center of Children's Healthcare of Atlanta (K.E.B., N.P.D., A.R., K.W.), Atlanta, Georgia, USA; Department of Pediatrics, Division of Pediatric Hematology/Oncology (K.E.B., K.W.), Emory University. Atlanta, Georgia, USA
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Grudzen CR, Barker PC, Bischof JJ, Cuthel AM, Isaacs ED, Southerland LT, Yamarik RL. Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician. EMERGENCY CANCER CARE 2022; 1:10. [PMID: 35966217 PMCID: PMC9362452 DOI: 10.1186/s44201-022-00010-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022]
Abstract
Eighty-one percent of persons living with cancer have an emergency department (ED) visit within the last 6 months of life. Many cancer patients in the ED are at an advanced stage with high symptom burden and complex needs, and over half is admitted to an inpatient setting. Innovative models of care have been developed to provide high quality, ambulatory, and home-based care to persons living with serious, life-limiting illness, such as advanced cancer. New care models can be divided into a number of categories based on either prognosis (e.g., greater than or less than 6 months), or level of care (e.g., lower versus higher intensity needs, such as intravenous pain/nausea medication or frequent monitoring), and goals of care (e.g., cancer-directed treatment versus symptom-focused care only). We performed a narrative review to (1) compare models of care for seriously ill cancer patients in the ED and (2) examine factors that may hasten or impede wider dissemination of these models.
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Chen Y, Jiang J, Peng W, Zhang C. Palliative sedation for children at end of life: a retrospective cohort study. BMC Palliat Care 2022; 21:57. [PMID: 35473555 PMCID: PMC9044579 DOI: 10.1186/s12904-022-00947-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Palliative sedation is consciously reducing the patient's consciousness to alleviate the refractory symptoms. However, studies on palliative sedation for children are scarce. We aimed to survey the symptom control and risks for children with sedative therapy in end of life. METHOD This study was a single center retrospective cohort study. Children who died in the Department of Palliative Medicine were divided into palliative sedation (Group A) and non-palliative sedation group (Group B). The symptoms relief, survival time, and last hospitalization time were compared between two groups. RESULTS From January 2012 to November 2019, 41 children died in department of palliative care. 24 children were sedated (Group A), meanwhile 17 children were not (Group B). The symptoms in Group A were more complex than Group B (p = 0.013). Overall symptom relief in Group A was higher than that in Group B (24/24, 10/15 p = 0.041). Pain relief rates (7/7, 20/21 p = 0.714), maximum/pre-death opioid dose [30(20, 77.5), 18(9, 45) p = 0.175, 30(20, 60), 18(9, 45) p = 0.208] and pain intensity difference [5(4,6.5), 4(2,6) p = 0.315] did not differ significantly in either groups. After diagnosis, the survival time of the Group A was longer than the Group B (p = 0.047). However, the length of hospitalization before death was similar in two groups (p = 0.385). CONCLUSION Palliative sedation controls complicated, painful symptoms at the end of life and does not shorten the hospitalization time in children.
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Affiliation(s)
- Yang Chen
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 18, Section 3, South Renmin Road, Wuhou District, Chengdu, Sichuan province China
| | - Jianjun Jiang
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University; West China – PUMC C.C. Chen Institute of Health, Sichuan University, No. 18, Section 3, South Renmin Road, Wuhou District, Chengdu, Sichuan province China
| | - Wei Peng
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 18, Section 3, South Renmin Road, Wuhou District, Chengdu, Sichuan province China
| | - Chuan Zhang
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 18, Section 3, South Renmin Road, Wuhou District, Chengdu, Sichuan province China
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11
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Vemuri S, Butler AE, Brown K, Wray J, Bluebond-Langner M. Palliative care for children with complex cardiac conditions: survey results. Arch Dis Child 2022; 107:282-287. [PMID: 34312164 PMCID: PMC8862095 DOI: 10.1136/archdischild-2020-320866] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore perspectives of paediatric cardiac and palliative care professionals on providing palliative care to children with complex cardiac conditions. DESIGN A national survey including closed-ended and open-ended questions as well as clinical scenarios designed to capture referral practices, attitudes towards palliative care, confidence delivering key components of palliative care and perspectives on for whom to provide palliative care. Responses to closed-ended questions and scenarios were analysed using descriptive statistics. Open-ended responses were analysed thematically. PARTICIPANTS Paediatric cardiac and palliative care professionals caring for children with complex cardiac conditions in the UK. RESULTS 177 professionals (91 cardiac care and 86 palliative care) responded. Aspects of advance care planning were the most common reasons for referral to palliative care. Palliative care professionals reported greater confidence than cardiac colleagues with such discussions. Clinicians agreed that children with no further surgical management options, comorbid genetic disorders, antenatal diagnosis of a single ventricle, ventricular device in situ, symptomatic heart failure and those awaiting heart transplantation would benefit from palliative care involvement. CONCLUSIONS Components of palliative care, such as advance care planning, can be provided by cardiac care professionals alongside the disease-directed care of children with complex cardiac conditions. Further research and training are needed to address confidence levels in cardiac care professionals in delivering components of palliative care as well as clarification of professional roles and parent preferences in delivery of family-centred care for children with complex cardiac conditions.
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Affiliation(s)
- Sidharth Vemuri
- Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia,Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute for Child Health, London, UK
| | - Ashleigh E Butler
- Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute for Child Health, London, UK,Austin Health Clinical School, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Katherine Brown
- Institute of Cardiovascular Science, University College London, London, UK,Heart Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Institute of Cardiovascular Science, University College London, London, UK,Heart Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK,Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute for Child Health, London, UK .,Rutgers University, Camden, New Jersey, USA
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12
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Gebel C, Rothaug J, Kruschel I, Lehmann T, Jansky M, Nauck F, Freytag A, Bauer A, Krauss SH, Schneider W, Nageler C, Meißner W, Wedding U. [Patient-reported outcomes and quality of care in specialized palliative home care: a nationwide, prospective longitudinal cohort trial]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 168:40-47. [PMID: 34955440 DOI: 10.1016/j.zefq.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/01/2021] [Accepted: 10/21/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Since 2007, patients receiving palliative care have been entitled to specialised outpatient palliative care (SAPV). Until now, the quality of care of the SAPV was only regionally focussed or in relation to individual SAPV teams. A nationwide analysis of outcome quality is still awaited. The organisation and design of structures and processes vary greatly from region to region, which complicates a comparative assessment of implementation. One way to measure the quality of the heterogeneous structures and processes is to collect patient-reported outcomes. Here, it is possible to use symptom burden, quality of care and patient satisfaction with SAPV care, since patients' quality of life is a central focus of SAPV care. This article is part of the research project SAVOIR, which is funded by the G-BA Innovation Fund. METHODS For this prospective longitudinal survey of the outcome quality of SAPV, structured data were collected at two measurement points (t1 and t2 [4-10 days after t1]). A nationwide, representative sample of SAPV teams was targeted. These teams performed consecutive recruitment of patients included in SAPV. Two questionnaire instruments were used: the IPOS (Integrated Palliative Outcome Scale) at t1 and t2, and the QUAPS (quality control in specialized palliative home care) questionnaire at t2. Patient-reported outcomes measured improvement in symptom burden, patient satisfaction, and quality of care from the patient perspective. In addition, an exploratory stepwise regression analysis of factors associated with satisfaction was conducted. RESULTS 42 SAPV teams agreed to participate in the study. They recruited a total of 964 patients at measurement time t1 (t2: 690 patients). The analyses show that the number and intensity of symptoms from the patient perspective decreased significantly during the course of SAPV treatment, especially pain, gastrointestinal symptoms, but also psychological complaints. 74.7 % of the patients reported a high level of satisfaction with SAPV. Also, the quality of care was considered to be high by the patients. Exploratively, five factors were extracted that explain 55 % of the satisfaction with SAPV: respect for the patient's decision, quality of communication, support with practical problems, and referral to care measures as well as symptom relief between the two measurement points. CONCLUSIONS The SAPV patients recruited from a total of nine KV regions reported a reduced symptom burden and a high level of satisfaction with SAPV and rated the quality of care provided by SAPV as high.
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Affiliation(s)
- Cordula Gebel
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland.
| | - Judith Rothaug
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | - Isabel Kruschel
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | - Thomas Lehmann
- Zentrum für Klinische Studien, Universitätsklinikum Jena, Jena, Deutschland
| | - Maximiliane Jansky
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Friedemann Nauck
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Antje Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Anna Bauer
- Zentrum für Interdisziplinäre Gesundheitsforschung, Universität Augsburg, Augsburg, Deutschland
| | - Sabine H Krauss
- Zentrum für Interdisziplinäre Gesundheitsforschung, Universität Augsburg, Augsburg, Deutschland
| | - Werner Schneider
- Zentrum für Interdisziplinäre Gesundheitsforschung, Universität Augsburg, Augsburg, Deutschland
| | - Cornelia Nageler
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Meißner
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | - Ulrich Wedding
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
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13
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Uber A, Ebelhar JS, Lanzel AF, Roche A, Vidal-Anaya V, Brock KE. Palliative Care in Pediatric Oncology and Hematopoietic Stem Cell Transplantation. Curr Oncol Rep 2022; 24:161-174. [DOI: 10.1007/s11912-021-01174-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
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14
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Components for providing person-centred palliative healthcare: An umbrella review. Int J Nurs Stud 2021; 125:104111. [PMID: 34773736 DOI: 10.1016/j.ijnurstu.2021.104111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Person-centred palliative healthcare is an important approach to maintaining and improving patients' quality of life living with a chronic non-communicable disease and their partners. Such an approach can reduce unnecessary hospitalisation, holistically address the patient and their partners' needs, and help develop an advance care plan. OBJECTIVES Assess, analyse, and synthesise the currently existing international guidelines for providing person-centred palliative care and identify the key components for providing a high-quality approach. METHODS An umbrella review methodology of systematic reviews with the method of examination, analysis and synthesis of literature and the compilation method. Relevant systematic reviews of guidelines for providing person-centred palliative care in English, German and/or Slovenian language in PubMed, CINAHL, Web of Science and Cochrane Library databases, until November 2020. RESULTS Out of 3,910 records, we included seven reviews for thematic synthesis. We identified four key elements of flourishing in person-centred palliative healthcare: (i) Healthcare staff prerequisites and traits; (ii) Palliative healthcare environment; (iii) Palliative healthcare processes; and (iv) Palliative healthcare outcomes. CONCLUSIONS We concluded that person-centred palliative healthcare plays an important role in the comprehensive treatment of patients living with a non-communicable disease accompanied by disturbing symptoms. Therefore, it is necessary to raise awareness amongst healthcare professionals and especially general practitioners about the possibilities of including patients with a non-communicable disease in early person-centred palliative healthcare. Tweetable Abstract: #UmbrellaReview of components for providing #personcentredpalliative #healthcare. Components provide healthcare professionals and interdisciplinary #palliative teams with the steps on how to give #personcentredpalliative #healthcare to #patient and #support to #carepartners.
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15
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Holgín EA, Arias-Rojas M, Moreno SC. Quality of life of family caregivers of people with cancer in palliative care. Rev Esc Enferm USP 2021; 55:e03740. [PMID: 34105684 DOI: 10.1590/s1980-220x2020015103740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe quality of life and related factors in a sample of Colombian caregivers of people with cancer in palliative care. METHOD A correlational, descriptive and cross-sectional study conducted with 208 family caregivers of people with cancer in outpatient palliative care in Medellín, Colombia. The Quality of Life in Life-Threatening Illness - Family Caregiver Version (QOLLTI-F) instrument was used. RESULTS Quality of life obtained scores between 116.36 and 122.35 (95%CI). The dimensions with the lowest scores were Patient condition (2.4-3.2, 95%CI), Caregiver's own state (36.2-39.9, 95% CI) and Environment (14.4-15.7, 95%CI). The patient's and caregiver's ages and the Karnofsky index presented a positive correlation, from weak to moderate and significant with the caregiver's quality of life. The daily hours devoted to care presented a weak correlation, negative and significant, with the overall quality of life and with the Caregiver's own state dimension. CONCLUSION It is necessary to develop interventions to improve quality of life in caregivers of people with advanced cancer in the palliative phase, considering the importance of relief actions and the management of the patient's functional dependence.
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Affiliation(s)
- Edith Arredondo Holgín
- Universidad de Antioquia, Facultad de Enfermería, Grupo de investigación GIPECS, Medellín, Antioquia, Colombia
| | - Mauricio Arias-Rojas
- Universidad de Antioquia, Facultad de Enfermería, Grupo de investigación GIPECS, Medellín, Antioquia, Colombia
| | - Sonia Carreño Moreno
- Universidad Nacional de Colombia, Facultad de Enfermería, Grupo de Investigación Cuidado de Enfermería al Paciente Crónico, Bogotá, Cundinamarca, Colombia
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16
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Bolzani A, Ramsenthaler C, Hodiamont F, Burner-Fritsch IS, Bausewein C. Monitoring of Palliative Care Symptoms and Concerns in Specialized Palliative Home Care Using an Electronic Version of the Integrated Palliative care Outcome Scale (Palli-MONITOR): protocol for a mixed-methods study. BMJ Open 2021; 11:e042266. [PMID: 34078632 PMCID: PMC8173291 DOI: 10.1136/bmjopen-2020-042266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Over the last decades, patient-reported outcome (PRO) measures have been developed to better understand the patient's perspective and enable patient-centred care. In palliative care, the Integrated Palliative care Outcome Scale (IPOS) is recommended as a PRO tool. Its implementation in specialised palliative home care (SPHC) would benefit from an electronic version validated for the setting.Following the Medical Research Council (MRC) guidance, the study Palli-MONITOR is developing (phase 1) and testing the feasibility (phase 2) of implementing the electronic version of IPOS (eIPOS) in the SPHC setting to inform a cluster-randomised phase 3 trial. METHODS AND ANALYSIS Palli-MONITOR is a multicentre, sequential mixed-methods, two-phase development and feasibility study. The study consists of four substudies. In phase 1 (MRC development phase), qualitative patient interviews and focus groups with SPHC professionals are used to identify barriers and facilitators of eIPOS (substudy I). Substudy II tests the equivalence of eIPOS and IPOS in a crossover randomised controlled trial. Phase 2 (MRC feasibility/piloting phase) includes a quasi-experimental study with two control groups (substudy III), and qualitative interviews as well as focus groups to explore the feasibility and acceptability of the developed intervention (substudy IV).Qualitative data will be analysed with thematic analysis following the framework approach. Quantitative analysis uses a two-way intraclass correlation coefficients model for the equivalence testing. Quantitative analysis of the quasi-experimental study will focus on the primary outcomes, recruitment rates and completeness of eIPOS. Secondary outcomes will include intraindividual change in palliative symptoms and concerns, quality of life and symptom burden. ETHICS AND DISSEMINATION Approval of the ethics committee of the Ludwig Maximilian University Munich was received for all study parts. Results and experiences will be presented at congresses and in written form. Additionally, participating SPHC teams will receive summarised results. TRIAL REGISTRATION NUMBER NCT03879668.
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Affiliation(s)
- Anna Bolzani
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christina Ramsenthaler
- Department of Palliative Medicine, Albert Ludwig University of Freiburg, Freiburg im Breisgau, Germany
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | | | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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17
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Kaye EC, Weaver MS, DeWitt LH, Byers E, Stevens SE, Lukowski J, Shih B, Zalud K, Applegarth J, Wong HN, Baker JN, Ullrich CK. The Impact of Specialty Palliative Care in Pediatric Oncology: A Systematic Review. J Pain Symptom Manage 2021; 61:1060-1079.e2. [PMID: 33348034 PMCID: PMC9896574 DOI: 10.1016/j.jpainsymman.2020.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Children with cancer and their families have complex needs related to symptoms, decision-making, care planning, and psychosocial impact extending across the illness trajectory, which for some includes end of life. Whether specialty pediatric palliative care (SPPC) is associated with improved outcomes for children with cancer and their families is unknown. OBJECTIVE We conducted a systematic review following PRISMA guidelines to investigate outcomes associated with SPPC in pediatric oncology with a focus on intervention delivery, collaboration, and alignment with National Quality Forum domains. METHODS We searched PubMed, Embase, Scopus, Web of Science, and CINAHL databases from inception until April 2020 and reviewed references manually. Eligible articles were published in English, involved pediatric patients aged 0-18 years with cancer, and contained original data regarding patient and family illness and end-of-life experiences, including symptom management, communication, decision-making, quality of life, satisfaction, and healthcare utilization. RESULTS We screened 6682 article abstracts and 82 full-text articles; 32 studies met inclusion criteria, representing 15,635 unique children with cancer and 342 parents. Generally, children with cancer who received SPPC had improved symptom burden, pain control, and quality of life with decreased intensive procedures, increased completion of advance care planning and resuscitation status documentation, and fewer end-of-life intensive care stays with higher likelihood of dying at home. Family impact included satisfaction with SPPC and perception of improved communication. CONCLUSION SPPC may improve illness experiences for children with cancer and their families. Multisite studies utilizing comparative effectiveness approaches and validated metrics may support further advancement of the field.
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Affiliation(s)
- Erica C Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Leila Hamzi DeWitt
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Elizabeth Byers
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah E Stevens
- Departments of Psychosocial Oncology and Palliative Care and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joe Lukowski
- The University of Nebraska, Omaha, Nebraska, USA
| | - Brandon Shih
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristina Zalud
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob Applegarth
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christina K Ullrich
- Departments of Psychosocial Oncology and Palliative Care and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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18
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Tutelman PR, Lipak KG, Adewumi A, Fults MZ, Humphrey LM, Gerhardt CA. Concerns of Parents With Children Receiving Home-Based Pediatric Palliative Care. J Pain Symptom Manage 2021; 61:705-712. [PMID: 32931905 DOI: 10.1016/j.jpainsymman.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/03/2023]
Abstract
CONTEXT Caring for a child who will die from a life-limiting illness is one of the most difficult experiences a parent may face. Pediatric palliative care (PPC) has grown as a specialty service to address the unique needs of children and families with serious illness. However, gaps remain between the needs of families in PPC and the support received. OBJECTIVES The objective of this study was to explore the concerns of parents who have a child in home-based PPC. METHODS Semistructured interviews were conducted with 25 mothers and 10 fathers from 25 families shortly after their child's referral to home-based PPC. Children (57% male, Mage = 10.5 years, SD = 3.95, range = 4-18 years) had a range of diagnoses. Data were analyzed using inductive content analysis. RESULTS Parents' concerns clustered into four main themes: 1) ensuring that their child's remaining days were spent living well physically, emotionally, and socially; 2) uncertainty regarding their child's diagnosis, prognosis, and treatments; 3) their child's death (e.g., the process of dying and when it will occur); and 4) the family, including the impact of the child's illness and death on siblings and wanting to cherish as much time together with family as possible. CONCLUSION Parents of children receiving home-based PPC expressed concerns across a range of domains, both about their seriously ill child and the broader family. These results highlight salient worries among parents of children in PPC and point to critical areas for intervention for seriously ill children and the broader family.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Keagan G Lipak
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Aminat Adewumi
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marci Z Fults
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa M Humphrey
- Division of Palliative Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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19
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Farooki S, Olaiya O, Tarbell L, Clark NA, Linebarger JS, Stroh J, Ellis K, Lewing K. A quality improvement project to increase palliative care team involvement in pediatric oncology patients. Pediatr Blood Cancer 2021; 68:e28804. [PMID: 33211394 DOI: 10.1002/pbc.28804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric palliative care (PPC) for oncology patients improves quality of life and the likelihood of goal-concordant care. However, barriers to involvement exist. OBJECTIVES We aimed to increase days between PPC consult and death for patients with refractory cancer from a baseline median of 13.5 days to ≥30 days between March 2019 and March 2020. METHODS Outcome measure was days from PPC consult to death; process measure was days from diagnosis to PPC consult. The project team surveyed oncologists to identify barriers. Plan-do-study-act cycles included establishing target diagnoses, offering education, standardizing documentation, and sending reminders. RESULTS The 24-month baseline period included 30 patients who died and 25 newly diagnosed patients. The yearlong intervention period included six patients who died and 16 newly diagnosed patients. Interventions improved outcome and process measures. Targeted patients receiving PPC ≥30 days prior to death increased from 43% to 100%; median days from consult to death increased from 13.5 to 159.5. Targeted patients receiving PPC within 30 days of diagnosis increased from 28% to 63%; median days from diagnosis to consult decreased from 221.5 to 14. Of those without PPC consult ≤ 30 days after diagnosis, 17% had template documentation of the rationale. CONCLUSION Interventions utilized met the global aim, outcome, and process measures. Use of QI methodology empowered providers to involve PPC. Poor template use was a barrier to identifying further drivers. Future directions for this project relate to expanding the target list, creating long-term sustainability, formalizing standards, and surveying patients and families.
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Affiliation(s)
- Sana Farooki
- Department of Pediatrics, Division of Hematology Oncology, Children's Mercy Hospital, Kansas City, Missouri
| | - Oluwaseun Olaiya
- Department of Pediatrics, Division of Hematology Oncology, Children's Mercy Hospital, Kansas City, Missouri
| | - Lisa Tarbell
- Department of Pediatrics, Division of Hematology Oncology, Children's Mercy Hospital, Kansas City, Missouri
| | - Nicholas A Clark
- Department of Pediatrics, Division of Hospital Medicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Jennifer S Linebarger
- Department of Pediatrics, Section of Palliative Care, Children's Mercy Hospital, Kansas City, Missouri
| | - John Stroh
- Department of Pediatrics, Section of Palliative Care, Children's Mercy Hospital, Kansas City, Missouri
| | - Kelstan Ellis
- Department of Pediatrics, Section of Palliative Care, Children's Mercy Hospital, Kansas City, Missouri
| | - Karen Lewing
- Department of Pediatrics, Division of Hematology Oncology, Children's Mercy Hospital, Kansas City, Missouri
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20
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Ehrlich BS, Movsisyan N, Batmunkh T, Kumirova E, Borisevich MV, Kirgizov K, Graetz DE, McNeil MJ, Yakimkova T, Vinitsky A, Ferrara G, Li C, Lu Z, Kaye EC, Baker JN, Agulnik A. A multicountry assessment in Eurasia: Alignment of physician perspectives on palliative care integration in pediatric oncology with World Health Organization guidelines. Cancer 2020; 126:3777-3787. [PMID: 32530519 DOI: 10.1002/cncr.33001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/10/2020] [Accepted: 05/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The World Health Organization (WHO) advocates for early integration of palliative care for all children with life-threatening illness. Provider awareness and misperceptions, however, can impede this imperative. In the Eurasian region, little is known about physician knowledge and perspectives on palliative care. METHODS The Assessing Doctors' Attitudes on Palliative Treatment survey was developed as an evidence-based and culturally relevant assessment of physician perceptions on palliative care integration into childhood cancer care in Eurasia. Iteratively tested by American and Eurasian palliative care experts, the survey was culturally adapted, translated, and piloted in English, Russian, and Mongolian. The survey was distributed to physicians caring for children with cancer. Fifteen statements were scored in accordance with WHO guidelines to evaluate provider knowledge. The statistical analysis was complemented by a qualitative analysis of open-ended responses. RESULTS This study received 424 responses from 11 countries in Eurasia. The mean alignment between provider perspectives and WHO recommendations was 70% (range, 7%-100%). Significant independent predictors of higher alignment included country, prior palliative care education, and greater experience with patient death. Respondents primarily described palliative care as end-of-life care and symptom management. Two-thirds of respondents (67%) reported not feeling confident about delivering at least 1 component of palliative care. CONCLUSIONS This is the first study assessing physician perspectives and knowledge of palliative care in Eurasia and reveals wide variability in alignment with WHO guidelines and limited confidence in providing palliative care. Study findings will inform targeted educational interventions, which must be tailored to the local political, economic, and cultural context.
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Affiliation(s)
- Bella S Ehrlich
- Brown University, Providence, Rhode Island.,Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Narine Movsisyan
- Yerevan State Medical University After Mkhitar Heratsi, Yerevan, Armenia
| | | | - Ella Kumirova
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Marina V Borisevich
- Belarusian Center for Pediatric Oncology, Hematology, and Immunology, Minsk, Belarus
| | - Kirill Kirgizov
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Dylan E Graetz
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michael J McNeil
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Taisiya Yakimkova
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Anna Vinitsky
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gia Ferrara
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Chen Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
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21
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Cuviello A, Raisanen JC, Donohue PK, Wiener L, Boss RD. Defining the Boundaries of Palliative Care in Pediatric Oncology. J Pain Symptom Manage 2020; 59:1033-1042.e1. [PMID: 31838131 PMCID: PMC8979408 DOI: 10.1016/j.jpainsymman.2019.11.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
Abstract
CONTEXT Although palliative care (PC) continues to be integrated into pediatric oncological care, only a minority of patients with cancer receive a formal PC consult. OBJECTIVES We sought to describe oncologists' current understanding of PC and how primary PC is provided for children with cancer. METHODS This mixed-methods study explored pediatric oncology providers' definitions of PC and self-reported PC practices through semistructured audiotaped interviews. Conventional content analysis was applied to interview transcripts. RESULTS Seventy-seven participants with diverse training backgrounds (30 attending physicians, 21 nurses, 18 fellows, five nurse practitioners, and two child life specialists) completed an interview. Approximately 75% provided a modern definition of PC (e.g., not limited to end-of-life care); all participants acknowledged primary PC skills as part of their daily clinical activities. However, participants expressed wide variation in the comfort and time spent performing primary PC tasks (i.e., symptom management, addressing mental health and psychosocial needs) and over half reported that patients' PC needs are not adequately met. In addition, some reported confusion about the benefits of PC consultation, despite acknowledging that PC needs to be better integrated into the care of pediatric oncology patients. CONCLUSION Our findings demonstrate that although most pediatric oncologists accept a modern definition of PC in theory, how to integrate PC into pediatric oncology practice is less understood. Formalized training and standardization of practice surrounding identification of PC needs in patients who may require secondary or tertiary PC services may help to overcome current barriers for PC integration in pediatric oncology.
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Affiliation(s)
- Andrea Cuviello
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA; National Institutes of Health, Bethesda, Maryland, USA.
| | | | | | - Lori Wiener
- National Institutes of Health, Bethesda, Maryland, USA
| | - Renee D Boss
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
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22
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Bischoff KE, Zapata C, Sedki S, Ursem C, O'Riordan DL, England AE, Thompson N, Alfaro A, Rabow MW, Atreya CE. Embedded palliative care for patients with metastatic colorectal cancer: a mixed-methods pilot study. Support Care Cancer 2020; 28:5995-6010. [PMID: 32285263 DOI: 10.1007/s00520-020-05437-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/27/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Palliative care is recommended for patients with metastatic cancer, but there has been limited research about embedded palliative care for specific patient populations. We describe the impact of a pilot program that provided routine, early, integrated palliative care to patients with metastatic colorectal cancer. METHODS Mixed methods pre-post intervention cohort study at an academic cancer center. Thirty control then 30 intervention patients with metastatic colorectal cancer were surveyed at baseline and 1, 3, 6, 9, and 12 months thereafter about symptoms, quality-of-life, and likelihood of cure. We compared survey responses, trends over time, rates of advance care planning, and healthcare utilization between groups. Patients, family caregivers, and clinicians were interviewed. RESULTS Patients in the intervention group were followed for an average of 6.5 months and had an average of 3.5 palliative care visits. At baseline, symptoms were mild (average 1.85/10) and 78.2% of patients reported good/excellent quality-of-life. Half (50.9%) believed they were likely to be cured of cancer. Over time, symptoms and quality-of-life metrics remained similar between groups, however intervention patients were more realistic about their likelihood of cure (p = 0.008). Intervention patients were more likely to have a surrogate documented (83.3% vs. 26.7%, p < 0.0001), an advance directive completed (63.3% vs. 13.3%, p < 0.0001), and non-full code status (43.3% vs. 16.7%, p < 0.03). All patients and family caregivers would recommend the program to others with cancer. CONCLUSIONS We describe the impact of an embedded palliative care program for patients with metastatic colorectal cancer, which improved prognostic awareness and rates of advance care planning.
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Affiliation(s)
- Kara E Bischoff
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, Box 0131, 533 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Carly Zapata
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, Box 0131, 533 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Sarah Sedki
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, Box 0131, 533 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Carling Ursem
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - David L O'Riordan
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, Box 0131, 533 Parnassus Avenue, San Francisco, CA, 94143, USA
| | | | - Nicole Thompson
- Osher Center for Integrative Medicine, Department of Medicine, University of California. San Francisco, San Francisco, CA, USA
| | - Ariceli Alfaro
- Division of Hematology and Oncology, Department of Medicine and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Michael W Rabow
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, Box 0131, 533 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Chloe E Atreya
- Division of Hematology and Oncology, Department of Medicine and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
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23
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Snaman J, McCarthy S, Wiener L, Wolfe J. Pediatric Palliative Care in Oncology. J Clin Oncol 2020; 38:954-962. [PMID: 32023163 DOI: 10.1200/jco.18.02331] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pediatric palliative care aims to alleviate suffering and improve the quality of life of children with serious disease and increase support for their parents and other family members. Integration of palliative care into the routine care of children, adolescents, and young adults with cancer has resulted in improved outcomes in patients and their families. The field of pediatric palliative oncology-encompassing primary palliative care provided by the multidisciplinary oncology team as well as subspecialty palliative care provided by the palliative care team for more complex cases-is unique from palliative care in adults given its focus on care of the child and the larger family. In this review, we focus on advancements in the specific domains within pediatric palliative oncology care including family-centered communication, assessment and management of physical symptoms and distress, psychosocial concerns, and spiritual considerations of the patient, parents, and siblings.
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Affiliation(s)
- Jennifer Snaman
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
| | | | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
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24
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Wiener L, Tager J, Mack J, Battles H, Bedoya SZ, Gerhardt CA. Helping parents prepare for their child's end of life: A retrospective survey of cancer-bereaved parents. Pediatr Blood Cancer 2020; 67:e27993. [PMID: 31595653 PMCID: PMC8330433 DOI: 10.1002/pbc.27993] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most parents vividly recall the weeks, days, and moments preceding their child's death for years to come. Dissatisfaction with communication about their child's condition and lack of guidance can contribute to stress prior to a child's death. Based on findings from a study assessing the degree of preparation bereaved parents received and our collective clinical experience, the authors provide suggestions on end-of-life communication and guidance for parents. METHODS Caregivers of a child who died from cancer were invited to complete a 46-item survey through a closed social media (Facebook) group ("Parents who lost children to cancer"). In four months' time, 131 bereaved caregivers completed the survey. Results were analyzed using descriptive statistics, chi-square analyses, and a thematic content analysis framework. The mean age of the child at the time of death was 12. RESULTS Approximately 40% of the parents in this study felt unprepared for both the medical problems their child faced and how to respond to their child's emotional needs; fewer than 10% felt very prepared for either. Parents were more likely to feel unprepared when perceived suffering was high, highlighting the critical importance of communication and support from the healthcare team as an adjunct to optimal symptom control. CONCLUSIONS Through quantitative and open-ended responses, this study identified specific medical and emotional issues about which parents wanted greater preparation. Future research to evaluate guidance strategies to reduce parental suffering prior to the child's death is needed.
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Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Julia Tager
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
- University of Massachusetts Amherst, Amherst, Massachusetts
| | | | - Haven Battles
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Sima Zadeh Bedoya
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
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25
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Effect of patient education on palliative care knowledge and acceptability of outpatient palliative care services among gynecologic oncology patients: A randomized controlled trial. Gynecol Oncol 2020; 156:482-487. [DOI: 10.1016/j.ygyno.2019.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/13/2019] [Accepted: 11/16/2019] [Indexed: 12/25/2022]
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26
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Jadalla A, Ginex P, Coleman M, Vrabel M, Bevans M. Family Caregiver Strain and Burden: A Systematic Review of Evidence-Based Interventions When Caring for Patients With Cancer. Clin J Oncol Nurs 2020; 24:31-50. [DOI: 10.1188/20.cjon.31-50] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Brock KE, Snaman JM, Kaye EC, Bower KA, Weaver MS, Baker JN, Wolfe J, Ullrich C. Models of Pediatric Palliative Oncology Outpatient Care-Benefits, Challenges, and Opportunities. J Oncol Pract 2019; 15:476-487. [PMID: 31322987 DOI: 10.1200/jop.19.00100] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although the bulk of current pediatric palliative care (PPC) services are concentrated in inpatient settings, the vast majority of clinical care, symptom assessment and management, decision-making, and advance care planning occurs in the outpatient and home settings. As integrated PPC/pediatric oncology becomes the standard of care, novel pediatric palliative oncology (PPO) outpatient models are emerging. The optimal PPO model is unknown and likely varies on the basis of institutional culture, resources, space, and personnel. METHODS We review five institutions' unique outpatient PPO clinical models with their respective benefits and challenges. This review offers pragmatic guidance regarding PPO clinic development, implementation, and resource allocation. RESULTS Specific examples include a floating clinic model, embedded disease-specific PPC experts, embedded consultative or trigger-based supportive care clinics, and telehealth clinics. CONCLUSION Organizations that have overcome personnel, funding, and logistical challenges can serve as role models for centers developing PPO clinic models. In the absence of a one-size-fits-all model, pediatric oncology and PPC groups can select, tailor, and implement the model that best suits their respective personnel, needs, and capacities. Emerging PPO clinics must balance the challenges and opportunities unique to their organization, with the goal of providing high-quality PPC for children with cancer and their families.
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Affiliation(s)
- Katharine E Brock
- Children's Healthcare of Atlanta, Atlanta, GA.,Emory University, Atlanta, GA
| | - Jennifer M Snaman
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
| | - Erica C Kaye
- St Jude Children's Research Hospital, Memphis, TN
| | | | | | | | - Joanne Wolfe
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
| | - Christina Ullrich
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
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28
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Nagano H, Obara H, Takayama Y. A brief home-based palliative care learning experience for medical students and resident doctors in Okinawa, Japan. PLoS One 2019; 14:e0218780. [PMID: 31237900 PMCID: PMC6592560 DOI: 10.1371/journal.pone.0218780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 06/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The clinical component of medical education for students and resident doctors in Japan occurs almost entirely in the hospital setting. Because of this inpatient focus, graduate medical education clinical training often fails to expose physicians-in-training to the challenges that patients may face in the outpatient or home setting. This is a descriptive study in which we explore what participating students and resident doctors learned through our brief home-based teaching experience. METHODS From June 2016 to December 2017, attending physicians on the internal medicine service had medical students and resident doctors accompany them on home care visits. Participants were selected by convenience sampling based on their rotation availability. After the home visit and the interactive discussion, the participants were expected to prepare a reflective journal on their experience and learning. Thematic analysis was applied, and key themes were developed based on Kolb's ELT (Experiential learning theory). Three months after completion of the experience, semi-structured interviews were individually conducted assessing participants' self-perceived changes. RESULTS Thirty-two medical students(10) or residents(22)participated in a home visit. Thirty of these learners were able to complete a reflective journal. Using thematic analysis, we identified 2 domains and 6 key themes from the participants' perceptions. Participants recognized the importance of patient-centered care, inter-professional collaboration of the home care team, and reconceptualized the meaning of medical practice and their professional identity as a doctor. Three month post-experience interviews were completed on 12 of the original 30 participants who completed the reflective journal. 2 domains and 6 key themes from the residents' experiences and perceptions were generated. The participants reported an increased attention to the daily lives and social situations of their hospitalized patients, and an extension of their focus beyond the clinical medical treatment of the patient. CONCLUSION The experience of a brief visit to a patient's home is a novel educational approach that may potentially provide medical students and resident doctors with opportunities to learn about out-of-hospital, patient-centered, home-based medical care.
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Affiliation(s)
- Hiroaki Nagano
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Haruo Obara
- Department of General Internal Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Yoshihiro Takayama
- Department of Infectious Disease, Okinawa Chubu Hospital, Okinawa, Japan
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29
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Schlick CJR, Bentrem DJ. Timing of palliative care: When to call for a palliative care consult. J Surg Oncol 2019; 120:30-34. [DOI: 10.1002/jso.25499] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Cary Jo R. Schlick
- Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of MedicineNorthwestern UniversityEvanston Illinois
| | - David J. Bentrem
- Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of MedicineNorthwestern UniversityEvanston Illinois
- Surgery ServiceJesse Brown VA Medical CenterChicago Illinois
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30
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Rossfeld ZM, Miller R, Tumin D, Tobias JD, Humphrey LM. Implications of Pediatric Palliative Consultation for Intensive Care Unit Stay. J Palliat Med 2019; 22:790-796. [PMID: 30835155 DOI: 10.1089/jpm.2018.0292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: The impact of specialty pediatric palliative care (PPC) on intensive care unit (ICU) length of stay for children is unclear. Objective: To estimate the impact of PPC consultation by analyzing ICU stay as a dynamic outcome over the course of hospitalization. Patients and Methods: Retrospective cohort study of children hospitalized with diagnoses suggested as referral triggers for PPC at a large academic children's hospital. We assessed ICU stay according to PPC consultation and, using a patient-day analysis, applied multivariable mixed effects logistic regression to predict the odds of being in the ICU on a given day. Results: The analytic sample included 777 admissions (11,954 hospital days), of which 100 admissions (13%) included PPC consultation. Principal patient demographics were age 8 ± 6 years, 55% male sex, 71% white race, and 52% commercial insurance. Cardiac diagnoses were most frequent (29%) followed by gastrointestinal (22%) and malignant (20%) conditions. Although total ICU stay was longer for admissions, including PPC consultation (compared to admissions where PPC was not consulted), the odds of being in the ICU on a given day were reduced by 79% after PPC consultation (odds ratio [OR] = 0.21; 95% confidence interval [CI]: 0.13-0.34; p < 0.001) for children with cancer and 85% (OR = 0.15; 95% CI: 0.08-0.26; p < 0.001) for children with nononcologic conditions. Conclusions: Among children hospitalized with a diagnosis deemed eligible for specialty PPC, the likelihood of being in the ICU on a given day was strongly reduced after PPC consultation, supporting the value of PPC.
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Affiliation(s)
| | - Rebecca Miller
- 2 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Dmitry Tumin
- 3 Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Joseph D Tobias
- 2 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,4 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Lisa M Humphrey
- 2 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,4 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,5 Section of Hospice and Palliative Care, Nationwide Children's Hospital, Columbus, Ohio
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31
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Cheng BT, Rost M, De Clercq E, Arnold L, Elger BS, Wangmo T. Palliative care initiation in pediatric oncology patients: A systematic review. Cancer Med 2018; 8:3-12. [PMID: 30525302 PMCID: PMC6346252 DOI: 10.1002/cam4.1907] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/06/2018] [Accepted: 11/08/2018] [Indexed: 02/06/2023] Open
Abstract
Palliative care (PC) aims to improve quality of life for patients and their families. The World Health Organization and American Academy of Pediatrics recommend that PC starts at diagnosis for children with cancer. This systematic review describes studies that reported PC timing in the pediatric oncology population. The following databases were searched: PubMed, Web of Science, CINAHL, and PsycInfo databases. Studies that reported time of PC initiation were independently screened and reviewed by 2 researchers. Studies describing pilot initiatives, published prior to 1998, not written in English, or providing no empirical time information on PC were excluded. Extracted data included sample characteristics and timing of PC discussion and initiation. Of 1120 identified citations, 16 articles met the inclusion criteria and comprised the study cohort. Overall, 54.5% of pediatric oncology patients received any palliative service prior to death. Data revealed PC discussion does not occur until late in the illness trajectory, and PC does not begin until close to time of death. Despite efforts to spur earlier initiation, many pediatric oncology patients do not receive any palliative care service, and those who do, predominantly receive it near the time of death. Delays occur both at first PC discussion and at PC initiation. Efforts for early PC integration must recognize the complex determinants of PC utilization across the illness timeline. This systematic review examines the timing of palliative care initiation in pediatric oncology patients to assess the state of palliative care integration. Many pediatric oncology patients do not receive any palliative service, and those who do, typically receive it late in the illness trajectory.
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Affiliation(s)
- Brian T Cheng
- Department of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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32
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Symptoms and management of children with incurable cancer in mainland China. Eur J Oncol Nurs 2018; 38:42-49. [PMID: 30717935 DOI: 10.1016/j.ejon.2018.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/22/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE This study was designed to report information regarding symptomology of incurable pediatric cancer to promote proactive medicine and support for children and their families in the palliative phase in Mainland China. METHOD A multi-center retrospective cohort study including 205 children who died from incurable cancer between June 2008 and September 2013 were analyzed. RESULTS An incurable diagnosis was confirmed between 0 and 1726 (median, 279) days from initial diagnosis with death occurring between 1 and 239(median, 83) days. The most frequent symptoms were fatigue (93.7%), pain (87.3%), and poor appetite (76.1%). The earliest symptoms were pain and fatigue. Children with leukemia and lymphoma also complained early of nausea/vomiting, and children with solid tumors complained early of disturbed sleep. Later in the palliative phase, altered consciousness and seizures were found in children with central nervous system tumors and solid tumors, while children with leukemia and lymphoma were found to have fever, diarrhea, and bleeding. However, these symptoms only persisted for a short time. DNR discussions were held in 89 cases (43.4%) at a median of 37 (range, 4-178) days before death. A total of 154 patients (75.1%) died at home and 51 patients (24.9%) in the hospital. CONCLUSIONS This study provides new knowledge about symptomology to health care professionals and parents of children in Mainland China. Given our results, an improved alternative care plan should be developed and implemented earlier to facilitate end-of-life planning.
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Abstract
OBJECTIVES To describe pediatric palliative care (PPC) in pediatric oncology, the importance of PPC for pediatric oncology patients, disparities within pediatric palliative oncology, innovative strategies for improving PPC access in underserved populations, and implications for oncology nursing practice. DATA SOURCES Published pediatric oncology and palliative peer-reviewed articles and guidance documents. CONCLUSION Disparities exist within pediatric palliative oncology. There is much work needed to improve the reach and quality of PPC for pediatric oncology patients, especially those from underserved populations. IMPLICATIONS FOR NURSING PRACTICE Nurses serve a critical role in advocating for PPC for seriously ill pediatric cancer patients and their families.
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34
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Kaye EC, Jerkins J, Gushue CA, DeMarsh S, Sykes A, Lu Z, Snaman JM, Blazin L, Johnson LM, Levine DR, Morrison RR, Baker JN. Predictors of Late Palliative Care Referral in Children With Cancer. J Pain Symptom Manage 2018; 55:1550-1556. [PMID: 29427739 PMCID: PMC6223026 DOI: 10.1016/j.jpainsymman.2018.01.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 01/15/2023]
Abstract
CONTEXT Early integration of palliative care (PC) in the management of children with high-risk cancer is widely endorsed by patients, families, clinicians, and national organizations. However, optimal timing for PC consultation is not standardized, and variables that influence timing of PC integration for children with cancer remain unknown. OBJECTIVES To investigate associations between demographic, disease, treatment, and end-of-life attributes and timing of PC consultation for children with high-risk cancer enrolled on a PC service. METHODS A comprehensive standardized tool was used to abstract data from the medical records of 321 patients treated at a large academic pediatric cancer center, who died between 2011 and 2015. RESULTS Gender, race, ethnicity, enrollment on a Phase I protocol, number of high-acuity hospitalizations, and receipt of cardiopulmonary resuscitation were not associated with timing of PC involvement. Patients with hematologic malignancy, those who received cancer-directed therapy during the last month of life, and those with advance directives documented one week or less before death had higher odds of late PC referral (malignancy: odds ratio [OR] 3.24, P = 0.001; therapy: OR 4.65, P < 0.001; directive: OR 4.81, P < 0.0001). Patients who received hospice services had lower odds of late PC referral <30 days before death (OR 0.31, P < 0.001). CONCLUSION Hematologic malignancy, cancer-directed therapy at the end of life, and delayed documentation of advance directives are associated with late PC involvement in children who died of cancer. Identification of these variables affords opportunities to study targeted interventions to enhance access to earlier PC resources and services for children with high-risk cancer and their families.
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Affiliation(s)
- Erica C Kaye
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
| | - Jonathan Jerkins
- Le Bonheur Children's Hospital, Memphis, Tennessee, USA; University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Samantha DeMarsh
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, Ohio, USA
| | - April Sykes
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Zhaohua Lu
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer M Snaman
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lindsay Blazin
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Deena R Levine
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - R Ray Morrison
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Pediatric Patients Receiving Specialized Palliative Home Care According to German Law: A Prospective Multicenter Cohort Study. CHILDREN-BASEL 2018; 5:children5060066. [PMID: 29857504 PMCID: PMC6028915 DOI: 10.3390/children5060066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 12/03/2022]
Abstract
In Germany, every child with a life-limiting condition suffering from symptoms that cannot sufficiently be controlled is eligible by law for specialized pediatric palliative home care (SPPHC). It is the aim of this study to describe the demographic and clinical characteristics of children referred to SPPHC and to compare patients with cancer and non-cancer conditions. The prospective multicenter study includes data on 75 children (median age 7.7 years, 50.7% male). The majority had non-cancer conditions (72%). The most common symptoms were cognitive impairment, somatic pain, impairment in communication or swallowing difficulties. Swallowing difficulties, seizures, and spasticity occurred significantly more often in non-cancer patients (p < 0.01). Cancer patients received antiemetics significantly more often (permanent and on demand) than non-cancer patients (p < 0.01). Significantly more non-cancer patients had some type of feeding tube (57.3%) or received oxygen (33.3%) (p < 0.01). Central venous catheters had been fitted in 20% of the patients, mostly in cancer patients (p < 0.001). Tracheostomy tubes (9.3%) or ventilation (14.7%) were only used in non-cancer patients. In conclusion, patients referred to SPPHC are a diverse cohort with complex conditions including a large range of neurologically originating symptoms. The care of pediatric palliative care patients with cancer is different to the care of non-cancer patients.
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Dunbar SB, Khavjou OA, Bakas T, Hunt G, Kirch RA, Leib AR, Morrison RS, Poehler DC, Roger VL, Whitsel LP. Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association. Circulation 2018; 137:e558-e577. [DOI: 10.1161/cir.0000000000000570] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction:
In a recent report, the American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2035. Although the burden is significant, the estimate does not include the costs of family, informal, or unpaid caregiving provided to patients with CVD. In this analysis, we estimated projections of costs of informal caregiving attributable to CVD for 2015 to 2035.
Methods:
We used data from the 2014 Health and Retirement Survey to estimate hours of informal caregiving for individuals with CVD by age/sex/race using a zero-inflated binomial model and controlling for sociodemographic factors and health conditions. Costs of informal caregiving were estimated separately for hypertension, coronary heart disease, heart failure, stroke, and other heart disease. We analyzed data from a nationally representative sample of 16 731 noninstitutionalized adults ≥54 years of age. The value of caregiving hours was monetized by the use of home health aide workers’ wages. The per-person costs were multiplied by census population counts to estimate nation-level costs and to be consistent with other American Heart Association analyses of burden of CVD, and the costs were projected from 2015 through 2035, assuming that within each age/sex/racial group, CVD prevalence and caregiving hours remain constant.
Results:
The costs of informal caregiving for patients with CVD were estimated to be $61 billion in 2015 and are projected to increase to $128 billion in 2035. Costs of informal caregiving of patients with stroke constitute more than half of the total costs of CVD informal caregiving ($31 billion in 2015 and $66 billion in 2035). By age, costs are the highest among those 65 to 79 years of age in 2015 but are expected to be surpassed by costs among those ≥80 years of age by 2035. Costs of informal caregiving for patients with CVD represent an additional 11% of medical and productivity costs attributable to CVD.
Conclusions:
The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers.
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Kaye EC, Gushue CA, DeMarsh S, Jerkins J, Sykes A, Lu Z, Snaman JM, Blazin L, Johnson LM, Levine DR, Morrison RR, Baker JN. Illness and end-of-life experiences of children with cancer who receive palliative care. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26895. [PMID: 29218773 PMCID: PMC6159948 DOI: 10.1002/pbc.26895] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The field of pediatric palliative oncology is newly emerging. Little is known about the characteristics and illness experiences of children with cancer who receive palliative care (PC). METHODS A retrospective cohort study of 321 pediatric oncology patients enrolled in PC who died between 2011 and 2015 was conducted at a large academic pediatric cancer center using a comprehensive standardized data extraction tool. RESULTS The majority of pediatric palliative oncology patients received experimental therapy (79.4%), with 40.5% enrolled on a phase I trial. Approximately one-third received cancer-directed therapy during the last month of life (35.5%). More than half had at least one intensive care unit hospitalization (51.4%), with this subset demonstrating considerable exposure to mechanical ventilation (44.8%), invasive procedures (20%), and cardiopulmonary resuscitation (12.1%). Of the 122 patients who died in the hospital, 44.3% died in the intensive care unit. Patients with late PC involvement occurring less than 30 days before death had higher odds of dying in the intensive care unit over the home/hospice setting compared to those with earlier PC involvement (OR: 4.7, 95% CI: 2.47-8.97, P < 0.0001). CONCLUSIONS Children with cancer who receive PC experience a high burden of intensive treatments and often die in inpatient intensive care settings. Delayed PC involvement is associated with increased odds of dying in the intensive care unit. Prospective investigation of early PC involvement in children with high-risk cancer is needed to better understand potential impacts on cost-effectiveness, quality of life, and delivery of goal concordant care.
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Affiliation(s)
| | - Courtney A. Gushue
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Samantha DeMarsh
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Jonathan Jerkins
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - April Sykes
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Zhaohua Lu
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer M. Snaman
- Dana-Farber Cancer Institute, Boston, MA
- Boston Children’s Hospital, Boston, MA
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Nordström M, Strang P. High Degree of Satisfaction With the Support Given by Multidisciplinary Palliative Home Care Teams in the County of Stockholm. J Palliat Care 2018. [DOI: 10.1177/0825859718759880] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: At the initiative of Stockholm County Council, a survey was performed by an independent investigator to evaluate satisfaction among patients and their families with the advanced palliative home care teams in the county of Stockholm. The survey was performed in 2010 and compiled in 2011. The aim was to evaluate the impressions of patients and their families of the support given by the palliative home care teams in the Stockholm area and to evaluate the management of symptom control, availability, continuity, confidence, and quality of communication. Methods: A questionnaire was sent to 1424 patients and 329 family members to evaluate the views of the users of the home care service. Results: The response rate was 78% among both patients and their families or other caregivers. The proportion of positive and very positive responses among those who needed the specific help of the team was as follows: information about the service 86%, availability around the clock 96%, influence and feeling of shared responsibility 88%, and possibility of family members to have supportive discussions 95%. Eighty-three percent of patients experienced total pain relief and 99% total or partial relief. The corresponding figures for anxiety were 77% and 97% and for other symptom reliefs 79% and 98%, respectively. These figures were comparable to a smaller survey in 2014 and were high compared to the results from other medical services using similar questionnaires. Significance of the Results: A high quality of care is possible to achieve within palliative home care services.
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Affiliation(s)
| | - Peter Strang
- Stockholm Sjukhem Foundation, Stockholm, Sweden
- Karolinska Institutet, Solna, Sweden
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39
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Seibl-Leven M, von Reeken C, Goldbrunner R, Grau S, Ruge MI, Galldiks N, Dunkl V, Kocher M, Voltz R, Golla H. Clinical routine assessment of palliative care symptoms and concerns and caregiver burden in glioblastoma patients: an explorative field study. J Neurooncol 2018; 138:321-333. [PMID: 29464662 DOI: 10.1007/s11060-018-2800-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/09/2018] [Indexed: 12/12/2022]
Abstract
The implementation of self-reported outcome measurements into clinical routine was tested to help facilitate early access to palliative care (PC) for glioblastoma (GBM)-patients. Measures detail PC symptoms and concerns and caregiver burden. Between January 2014 and December 2016, a total of 337 GBM-patients were discussed during meetings of the neuro-oncology tumor board to examine further treatment options. Each patient, along with their caregivers, was requested to participate in self-assessment using the palliative outcome scale (POS) and the Zarit Burden Interview (ZBI). Analyses encompassed summary statistics, non-parametric tests, visual graphic analysis, content analysis and assessing the utilization of the specialized PC consulting service (SPCCS). Ninety-five (28%) GBM-patients and 71 (21%) caregivers completed the self-assessment. Of these, 20 patients and 12 caregivers repeated the assessment at least once more during follow-up. POS total scores were similar in the group of patients with initial diagnosis [10 (0-31)] and those with later disease stages like recurrent diagnosis [9 (0-25)], but ZBI total scores differed [14 (0-51) vs. 24 (2-62)]. Single item analysis demonstrated that anxiety and worries about the future predominated. Caregivers were torn between high engagement in caring and feeling overburdened. Still, requests for the SPCCS showed no increase. Actual implementation of measures like POS and ZBI for detecting PC concerns and caregiver burden with GBM-patients in the field remains challenging as indicated by the limited response rate and lack of increased requests for the SPCCS. Modified clinical routines including strengthening awareness of PC, and allowing proxy-assessment might help to overcome barriers.
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Affiliation(s)
- Matthias Seibl-Leven
- Center of Neurosurgery, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany
| | - Christian von Reeken
- Department of Palliative Medicine, University Hospital of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | - Roland Goldbrunner
- Center of Neurosurgery, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany
| | - Stefan Grau
- Center of Neurosurgery, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany
| | - Maximilian Ingolf Ruge
- Center of Neurosurgery, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany.,Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Norbert Galldiks
- Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany.,Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Institute for Neuroscience and Medicine (INM-3), Forschungszentrum Juelich, Juelich, Germany
| | - Veronika Dunkl
- Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany.,Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Martin Kocher
- Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany.,Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany.,Department of Palliative Medicine, University Hospital of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.,Center for Clinical Trials, University Hospital of Cologne, Cologne, Germany.,Medical Faculty, Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany. .,Department of Palliative Medicine, University Hospital of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
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Abstract
PURPOSE OF REVIEW Pediatric palliative oncology (PPO) is an emerging field that integrates the principles of palliative care early into the illness trajectory of children with cancer. PPO providers work with interdisciplinary clinicians to provide optimal medical and psychosocial care to children with cancer and their families. Ongoing advances in the field of pediatric oncology, including new treatment options for progressive cancers, necessitate the early integration of palliative care tenets including holistic care, high-quality communication, and assessment and management of refractory symptoms. RECENT FINDINGS Research in this emerging field has expanded dramatically over the past several years. This review will focus on advancements within several key areas of the field, specifically regarding investigation of the communication needs and preferences of patients and families, exploration of educational initiatives and interventions to teach PPO principles to clinicians, study of patient-reported and parent-reported tools to better assess and manage refractory symptoms, and development of novel models to integrate palliative care within pediatric oncology. SUMMARY Research findings in the field of PPO, concurrent with advances in the treatment of pediatric cancer, may help improve survival and quality of life for children with cancer.
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Badger NJ, Frizelle D, Adams D, Johnson MJ. Impact of specialist palliative care on coping with Parkinson's disease: patients and carers. BMJ Support Palliat Care 2018; 8:180-183. [PMID: 29321159 DOI: 10.1136/bmjspcare-2017-001423] [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: 08/14/2017] [Revised: 10/20/2017] [Accepted: 11/29/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES UK guidelines recommend palliative care access for people with Parkinson's disease; however, this remains sporadic, and it is unknown whether specialist palliative care helps patients and carers cope with this distressing condition. This study aimed to explore whether, and how, access to specialist palliative care services affected patients' and carers' coping with Parkinson's disease. METHODS Semistructured interviews were conducted, audio-recorded and verbatim transcribed. Data were analysed using interpretative phenomenological analysis. Participants were patients with advanced idiopathic Parkinson's disease (n=3), and carers of people with Parkinson's disease (n=5, however, one diagnosis was reviewed) receiving care from an integrated specialist palliative care and Parkinson's disease service in North East England. RESULTS Access to specialist palliative care helped participants cope with some aspects of advanced Parkinson's disease. Three superordinate themes were developed:' managing uncertainty', 'impacts on the self' and 'specialist palliative care maintaining a positive outlook'. CONCLUSIONS Specialist palliative care helped patients and carers cope with advanced Parkinson's disease. Specialist palliative care is a complex intervention that acknowledges the complex and holistic nature of Parkinson's disease, enabling health in some domains despite continued presence of pathology. These exploratory findings support the utility of this approach for people living with Parkinson's disease.
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Affiliation(s)
- Nathan J Badger
- Department of Psychological Health and Wellbeing, University of Hull, Hull, UK
| | - Dorothy Frizelle
- Department of Psychological Health and Wellbeing, University of Hull, Hull, UK
| | - Debi Adams
- Saint Catherine's Hospice, Scarborough, UK
| | - Miriam J Johnson
- Saint Catherine's Hospice, Scarborough, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Widger K, Vadeboncoeur C, Zelcer S, Liu Y, Kassam A, Sutradhar R, Rapoport A, Nelson K, Wolfe J, Earle C, Pole JD, Gupta S. The Validity of Using Health Administrative Data To Identify the Involvement of Specialized Pediatric Palliative Care Teams in Children with Cancer in Ontario, Canada. J Palliat Med 2017; 20:1210-1216. [DOI: 10.1089/jpm.2017.0028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kimberley Widger
- Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Christina Vadeboncoeur
- Palliative Care Team, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Roger Neilson House Children's Hospice, Ottawa, Ontario, Canada
| | - Shayna Zelcer
- Hematology and Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Ying Liu
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Alisha Kassam
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Southlake Regional Health Centre, Newmarket, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Adam Rapoport
- Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Emily's House Children's Hospice, Toronto, Ontario, Canada
| | - Katherine Nelson
- Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Craig Earle
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jason D. Pole
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Sumit Gupta
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
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Porta-Sales J, Guerrero-Torrelles M, Moreno-Alonso D, Sarrà-Escarré J, Clapés-Puig V, Trelis-Navarro J, Sureda-Balarí A, Fernández De Sevilla-Ribosa A. Is Early Palliative Care Feasible in Patients With Multiple Myeloma? J Pain Symptom Manage 2017; 54:692-700. [PMID: 28807703 DOI: 10.1016/j.jpainsymman.2017.04.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/11/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022]
Abstract
CONTEXT Evidence for the benefits of early palliative care (EPC) in patients with solid tumors is strong, but EPC has received scant attention in hematologic malignancies. OBJECTIVE To assess the benefits of outpatient-based EPC for symptom control in patients with multiple myeloma. METHODS Retrospective study of patients attending the Multiple Myeloma Palliative Care Clinic at our hospital in the year 2013 (February 1-December 31). The following symptoms were assessed at baseline and at three follow-up consultations using a Numerical Visual Scale (0 = no symptoms; 10 = worst possible): pain, anorexia, constipation, insomnia, nausea/vomiting, dyspnea, anxiety, and sadness. Physical and emotional symptom burden scores were calculated. Pain interference with general activity, sleep, and mood was also evaluated. RESULTS About 67 patients were included. The proportion of patients reporting moderate-to-severe pain (Numerical Visual Scale ≥5) decreased significantly from baseline to the final follow-up: worst pain decreased from 57% to 18% (P < 0.0001), whereas average pain fell from 24% to 2% (P < 0.0001). The percentage of patients reporting no pain interference increased significantly from baseline: general activity (52% vs. 82%; P = 0.0001), sleep (73% vs. 91%; P = 0.01), and mood (52% vs. 87.5%; P = 0.0001). Physical and emotional symptom burden also improved, with significantly fewer patients reporting depression (13% vs. 5%; P = 0.001). Most patients (86.6%) were alive and still attending the Multiple Myeloma Palliative Care Clinic at study end. CONCLUSIONS These findings indicate that EPC is feasible in patients with multiple myeloma. Pain and other symptoms were well controlled.
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Affiliation(s)
- Josep Porta-Sales
- Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat. Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Maria Guerrero-Torrelles
- Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | | | - Victòria Clapés-Puig
- Hematology Service, Institut Català d'Oncologia-L'Hospitalet L.-Barcelona, Barcelona, Spain
| | - Jordi Trelis-Navarro
- Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat. Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna Sureda-Balarí
- Hematology Service, Institut Català d'Oncologia-L'Hospitalet L.-Barcelona, Barcelona, Spain
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Palliative therapy for stage IV rectal adenocarcinoma: how frequently is it used? J Surg Res 2017; 218:1-8. [DOI: 10.1016/j.jss.2017.05.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/21/2017] [Accepted: 05/08/2017] [Indexed: 01/04/2023]
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45
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Hansen L, Lyons KS, Dieckmann NF, Chang MF, Hiatt S, Solanki E, Lee CS. Background and design of the symptom burden in end-stage liver disease patient-caregiver dyad study. Res Nurs Health 2017; 40:398-413. [PMID: 28666053 PMCID: PMC5597485 DOI: 10.1002/nur.21807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/05/2017] [Indexed: 12/25/2022]
Abstract
Over half a million Americans are affected by cirrhosis, the cause of end-stage liver disease (ESLD). Little is known about how symptom burden changes over time in adults with ESLD and their informal caregivers, which limits our ability to develop palliative care interventions that can optimize symptom management and quality of life in different patient-caregiver dyads. The purpose of this article is to describe the background and design of a prospective, longitudinal descriptive study, "Symptom Burden in End-Stage Liver Disease Patient-Caregiver Dyads," which is currently in progress. The study is designed to (i) identify trajectories of change in physical and psychological symptom burden in adults with ESLD; (ii) identify trajectories of change in physical and psychological symptom burden in caregivers of adults with ESLD; and (iii) determine predictors of types of patient-caregiver dyads that would benefit from tailored palliative care interventions. We aim for a final sample of 200 patients and 200 caregivers who will be followed over 12 months. Integrated multilevel and latent growth mixture modeling will be used to identify trajectories of change in symptom burden, linking those changes to clinical events, and quality of life outcomes and characterizing types of patient-caregiver dyads based on patient-, caregiver-, and dyad-level factors. Challenges we have encountered include unexpected attrition of study participants, participants not returning their baseline questionnaires, and hiring and training of research staff. The study will lay the foundation for future research and innovation in ESLD, end-of-life and palliative care, and caregiving.
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Affiliation(s)
- Lissi Hansen
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Karen S Lyons
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Michael F Chang
- Gastroenterology and Hepatology, VA Portland Healthcare System, Portland, Oregon
| | - Shirin Hiatt
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Emma Solanki
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Christopher S Lee
- School of Nursing, Oregon Health and Science University, Portland, Oregon
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46
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Kaye EC, Snaman JM, Baker JN. Pediatric Palliative Oncology: Bridging Silos of Care Through an Embedded Model. J Clin Oncol 2017; 35:2740-2744. [DOI: 10.1200/jco.2017.73.1356] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Erica C. Kaye
- Erica C. Kaye, Jennifer M. Snaman, and Justin N. Baker, St Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer M. Snaman
- Erica C. Kaye, Jennifer M. Snaman, and Justin N. Baker, St Jude Children’s Research Hospital, Memphis, TN
| | - Justin N. Baker
- Erica C. Kaye, Jennifer M. Snaman, and Justin N. Baker, St Jude Children’s Research Hospital, Memphis, TN
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Bender HU, Riester MB, Borasio GD, Führer M. "Let's Bring Her Home First." Patient Characteristics and Place of Death in Specialized Pediatric Palliative Home Care. J Pain Symptom Manage 2017; 54:159-166. [PMID: 28602938 DOI: 10.1016/j.jpainsymman.2017.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 03/08/2017] [Accepted: 04/11/2017] [Indexed: 01/09/2023]
Abstract
CONTEXT Specialized pediatric palliative home care (SPPHC) is the main pediatric palliative care structure in Germany. Detailed data on patient characteristics and care are sparse. Describing this population in terms of diagnoses and care needs is essential for further development of palliative care services for these patients. OBJECTIVES We asked whether the population at our center 1) was representative compared with national mortality statistics; 2) showed differences in the clinical course among the four diagnostic categories established by the Association for Children with Terminal Conditions/Royal College of Paediatrics and Child Health; and 3) was different to published populations in pediatric palliative care regarding diagnoses, care, and place of death. METHODS Retrospective single center chart analysis of 212 consecutive patients on SPPHC (2009-2015). RESULTS Main International Statistical Classification of Diseases and Related Health Problems, 10th Revision groups were nervous system, congenital abnormalities, neoplasia, and metabolic disease, reflecting the mortality statistics for patients one to 20 years. Thirty-six percent of patients were assigned to ACT-3, 34% to ACT-4, 26% to ACT-1, and 4% to ACT-2. ACT-1 patients mostly needed high-intensity care for short durations, ACT-4 patients showed long survival times with mostly intermittent care. Seventy-five percent of patients showed nervous system involvement. Eighty-four percent died at home, 12% in hospital, and 4% in a hospice, with 96% dying at their preferred place. CONCLUSION Our data on SPPHC show 1) significant differences between Association for Children with Terminal Conditions/Royal College of Paediatrics and Child Health groups in terms of care needs and survival; 2) a high prevalence of children with neurological problems; and 3) a large majority of children dying at home.
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Affiliation(s)
- Hans Ulrich Bender
- Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
| | | | - Gian Domenico Borasio
- Palliative Care Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Monika Führer
- Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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48
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Kozlov E, Reid MC, Carpenter BD. Improving patient knowledge of palliative care: A randomized controlled intervention study. PATIENT EDUCATION AND COUNSELING 2017; 100:1007-1011. [PMID: 28034612 PMCID: PMC5879772 DOI: 10.1016/j.pec.2016.12.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To determine if laypersons' knowledge about palliative care can improve with a brief education intervention. METHODS 152 adults were recruited to participate in a web-based randomized intervention trial that followed a 2 (content)×2 (format) between-subjects design. Groups received either a video intervention, an information page intervention, a video control, or an information page control. An ANCOVA with contrast coding of two factors was utilized to assess if knowledge, as measured by the Palliative Care Knowledge Scale (PaCKS), increased post intervention. RESULTS There was a significant difference between intervention group means and control group means on PaCKS scores from T1 to T2 F(1, 139)=11.10, p=0.00, ηp2=0.074. There was no significant difference in PaCKS change scores between the video intervention and information page intervention. CONCLUSIONS This study demonstrates that an information page and a brief video can improve knowledge of palliative care in laypersons. PRACTICE IMPLICATIONS Self-administered educational interventions could be made available in diverse settings in order to reach patients and their families who may benefit from but are unaware of palliative care. Interventions more intensive than the one tested in this study might result in even more significant improvements in knowledge.
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Affiliation(s)
- Elissa Kozlov
- Weill Cornell Medical College, Department of Medicine, New York, NY, United States.
| | - M Carrington Reid
- Weill Cornell Medical College, Department of Medicine, New York, NY, United States
| | - Brian D Carpenter
- Washington University in St. Louis, Department of Psychological & Brain Sciences, St. Louis, MO, United States
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49
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Isenberg SR, Lu C, McQuade J, Razzak R, Weir BW, Gill N, Smith TJ, Holtgrave DR. Economic Evaluation of a Hospital-Based Palliative Care Program. J Oncol Pract 2017; 13:e408-e420. [PMID: 28418761 PMCID: PMC5455160 DOI: 10.1200/jop.2016.018036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Establish costs of an inpatient palliative care unit (PCU) and conduct a threshold analysis to estimate the maximum possible costs for the PCU to be considered cost effective. METHODS We used a hospital perspective to determine costs on the basis of claims from administrative data from Johns Hopkins PCU between March 2013 and March 2014. Using existing literature, we estimated the number of quality-adjusted life years (QALYs) that the PCU could generate. We conducted a threshold analysis to assess the maximum costs for the PCU to be considered cost effective, incorporating willingness to pay ($180,000 per QALY). Three types of costs were considered, which included variable costs alone, contribution margin (ie, revenue minus variable costs), and PCU cost savings compared with usual care (from a separate publication). RESULTS The data showed that there were 153 patient encounters (PEs), variable costs of $1,050,031 ($1,343 per PE per day), a contribution margin of $318,413 ($407 per PE per day), and savings compared with usual care of $353,645 ($452 savings per PE per day). On the basis of the literature, the program could generate 3.11 QALYs from PEs (0.05 QALY) and caregivers (3.06 QALYs). The threshold analysis determined that the maximum variable cost required to be cost effective was $559,800 (an additional $716 per PE per day could be spent). CONCLUSION According to variable costs, the PCU was not cost effective; however, when considering savings of the PCU compared with usual care, the PCU was cost saving. The contribution margin showed that the PCU was cost saving. This study supports efforts to expand PCUs, which enhance care for patients and their caregivers and can generate hospital savings. Future research should prospectively explore the cost utility of PCUs.
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Affiliation(s)
- Sarina R. Isenberg
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - Chunhua Lu
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - John McQuade
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - Rab Razzak
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - Brian W. Weir
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - Natasha Gill
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - Thomas J. Smith
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - David R. Holtgrave
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
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50
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van der Plas AGM, Francke AL, Deliens L, Jansen WJJ, Vissers KC, Onwuteaka-Philipsen BD. Informal care givers' experiences with support in primary palliative care when a case manager is involved: A descriptive study in the Netherlands. INTERNATIONAL JOURNAL OF CARE COORDINATION 2016. [DOI: 10.1177/2053434516685738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal care givers. The case manager provides support in addition to the care provided by the home care nurse and general practitioner, potentially leading to more complexities in care coordination. This study describes what informal care givers think about the number of professionals involved in primary palliative care and what support is and is not provided by the general practitioner, the community nurse and the case manager according to the informal care givers. Methods A questionnaire was filled in by the case manager upon referral, and the informal care giver ( n = 178) completed a questionnaire two months after the patient had died. Frequencies (the number of professionals) and cross tabs (for support) were calculated. Results The number of healthcare professionals involved was appropriate according to the vast majority (91%) of informal care givers. Support was provided by all three professionals, but a small proportion (14%) of informal care givers did not receive sufficient information on possibilities of care and support from any of the care providers. Discussion Reluctance to involve a case manager is unnecessary, as long as the role of each professional is explained to patients and informal care givers. At all times, support should be offered to the informal care givers as well as to the patient. Added value of the case manager is found in offering specific knowledge of palliative care.
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Affiliation(s)
| | - Anneke L Francke
- VU University Medical Center, the Netherlands
- NIVEL Netherlands Institute for Health Services Research
| | - Luc Deliens
- Vrije Universiteit Brussel and Ghent University, Belgium
| | | | - Kris C Vissers
- Radboud University Nijmegen Medical Centre, the Netherlands
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