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Haupt EC, Sharma I, Nguyen HQ. Symptom Burden and Survival in Patients Receiving Outpatient and Home-Based Palliative Care. J Palliat Med 2023; 26:843-848. [PMID: 36917220 DOI: 10.1089/jpm.2022.0267] [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] [Indexed: 03/15/2023] Open
Abstract
Background: Symptom burden assessment with the Edmonton Symptom Assessment System (ESAS) has been widely studied among patients in outpatient palliative care (OPC), but fewer reports in home-based palliative care (HBPC), and none has assessed the prognostic value of ESAS scores in HBPC. Methods: This retrospective cohort study compares symptom burden and its prognostic value in adult patients receiving OPC and HBPC services between January 1, 2019, and June 30, 2021. Results: Patients completed the ESAS at the first OPC consultation (n = 4086) and at admission to HBPC (n = 4087). OPC patients were younger, more likely to have cancer, less likely to have had a recent hospitalization, and had higher adjusted median ESAS scores (28.1 vs. 22.9) compared with HBPC patients (all p < 0.001). ESAS was prognostic of survival in both settings (Hazard ratio 1.18-1.64, p < 0.01). Conclusion: Symptom burden is an independent prognosticator of survival in HBPC and OPC in this community-based setting.
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Affiliation(s)
- Eric C Haupt
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Ishita Sharma
- Department of Geriatric, Palliative Medicine and Continuing Care, Kaiser-Downey Medical Center, Downey, California, USA
| | - Huong Q Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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2
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Reinke LF, Sullivan DR, Slatore C, Dransfield MT, Ruedebusch S, Smith P, Rise PJ, Tartaglione EV, Vig EK, Au DH. A Randomized Trial of a Nurse-Led Palliative Care Intervention for Patients with Newly Diagnosed Lung Cancer. J Palliat Med 2022; 25:1668-1676. [PMID: 35649214 DOI: 10.1089/jpm.2022.0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Specialist palliative care improves quality of life (QOL), symptom burden, and may prolong survival among patients with advanced lung cancer. Previous trials focused on advanced disease, and less is known about patients across a broad range of stages. Objective: We sought to assess the effect of a nurse-led telephone-based primary palliative care intervention that focused on patients across a broad range of stages. Design, Setting, and Participants: We conducted a multisite randomized controlled trial in the United States involving patients diagnosed within two months with any stage or histology of lung cancer to compare the effects of a telephone-based palliative care intervention delivered by registered nurses trained in primary palliative care versus usual care. Main Outcomes and Measures: The primary outcome was the Functional Assessment of Cancer Therapy-Lung Scale Total Outcome Index (FACT-L TOI), which measures QOL and symptoms. We estimated having 80% power to detect a 5-point change from baseline to three months. Secondary outcome was a change in satisfaction of care, measured by the FAMCARE-P13. Results: A total of 151 patients were enrolled over 30 months. Patients were, on average, male (98%), age 70 years, White (85%), and 36% diagnosed with stage I-II, and 64% had stage III-IV. In comparison to usual care, patients in the nurse-led intervention did not report improvement in QOL from baseline to three months follow-up or demonstrate differences in treatment effect by site or cancer stage: FACT-L TOI 1.03 (95% confidence interval [CI]: -3.98 to 6.04). Satisfaction with care did not significantly improve: 0.66 (95% CI: -2.01 to 3.33). Conclusions: Among patients with newly diagnosed lung cancer, a nurse-led, primary palliative care intervention did not significantly improve QOL, symptom burden, or satisfaction of care. In contrast to several clinical trials demonstrating the effectiveness of delivering specialty palliative care with disease-modifying treatments on QOL among patients with advanced lung cancer, this intervention did not significantly improve QOL among patients with any stage lung cancer. Future research should identify which specific components of primary palliative care improve outcomes for patients newly diagnosed with lung cancer.
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Affiliation(s)
- Lynn F Reinke
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA
| | - Donald R Sullivan
- Department of Veterans Affairs, Portland Health Care System, Health Services R&D, Portland, Oregon, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Christopher Slatore
- Department of Veterans Affairs, Portland Health Care System, Health Services R&D, Portland, Oregon, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Mark T Dransfield
- Department of Veterans Affairs, Division of Pulmonary and Critical Care Medicine, Birmingham VA Medical Center, Birmingham, Alabama, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Susan Ruedebusch
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA
| | - Patti Smith
- Department of Veterans Affairs, Division of Pulmonary and Critical Care Medicine, Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Peter J Rise
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA
| | - Erica V Tartaglione
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA
| | - Elizabeth K Vig
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA.,Geriatric and Palliative Care Medicine Division, School of Medicine, University of Washington, Seattle, Washington, USA
| | - David H Au
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA.,Pulmonary and Critical Care Medicine Division, School of Medicine, University of Washington, Seattle, Washington, USA
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Measuring effectiveness in community-based palliative care programs: A systematic review. Soc Sci Med 2022; 296:114731. [DOI: 10.1016/j.socscimed.2022.114731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/19/2021] [Accepted: 01/14/2022] [Indexed: 01/11/2023]
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Ferrell BR, Chung V, Koczywas M, Smith TJ. Dissemination and Implementation of Palliative Care in Oncology. J Clin Oncol 2020; 38:995-1001. [PMID: 32023151 PMCID: PMC7082157 DOI: 10.1200/jco.18.01766] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 12/24/2022] Open
Abstract
Palliative care began in academic centers with specialty consultation services, and its value to patients, families, and health systems has been evident. The demand for palliative care to be integrated throughout the cancer trajectory, combined with a limited palliative care workforce, means that new models of care are needed. This review discusses evidence regarding the need for integration of palliative care into routine oncology care and describes best practices recognized for dissemination of palliative care. The available evidence suggests that palliative care be widely adopted by clinicians in all oncology settings to benefit patients with cancer and their families. Efforts are needed to adapt and integrate palliative care into community practice. Limitations of these models are discussed, as are future directions to continue implementation efforts. The benefits of palliative care can only be realized through effective dissemination of these principles of care, with more primary palliative care delivered by oncology clinicians.
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Affiliation(s)
| | | | | | - Thomas J. Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, MD
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5
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The Perceived Facilitators and Challenges of Translating a Lung Cancer Palliative Care Intervention Into Community-Based Settings. J Hosp Palliat Nurs 2019; 20:407-415. [PMID: 30063635 DOI: 10.1097/njh.0000000000000470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite significant progress in implementing palliative care interventions for patients with cancer, few intervention studies seek health care clinicians' input before implementation of these into the community. The purpose of this study was to explore palliative care and oncology clinicians' perspectives on the perceived facilitators and challenges in meeting the quality-of-life needs of patients with lung cancer and family caregivers in community-based settings. The Reach Effectiveness Adoption Implementation Maintenance model for implementation research was used as a framework. This was a multisite qualitative study using focus group and key informant interviews. Nineteen clinicians addressed useful practices and challenges in the following areas: (a) early palliative care, (b) interdisciplinary care planning, (c) symptom management, (d) addressing psychological and social needs, and (e) providing culturally respectful care, including spiritual care. In preparation for the intervention, specific education needs and organizational challenges were revealed. Challenges included timing and staffing constraints, the need for clinician education on palliative care services to increase organizational buy-in, and education in providing spiritual support for patients and family caregivers. This research allowed investigators to understand perceptions of clinicians as they prepared to integrate palliative care in their settings. Hospice and palliative care nurses can be instrumental in implementing palliative care into community practice.
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Reiser V, Rosenzweig M, Welsh A, Ren D, Usher B. The Support, Education, and Advocacy (SEA) Program of Care for Women With Metastatic Breast Cancer: A Nurse-Led Palliative Care Demonstration Program. Am J Hosp Palliat Care 2019; 36:864-870. [PMID: 30974954 DOI: 10.1177/1049909119839696] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Women with metastatic breast cancer (MBC) experience unique symptom management and psychosocial needs due to aggressive, yet palliative treatment with a progressive, chronic illness. OBJECTIVE This article describes the effect of a quality improvement project for coordination of supportive care in MBC. Program evaluations included referral rates for supportive services, patient-reported outcomes of symptom distress, generalized anxiety, and overall well-being. DESIGN An interdisciplinary Support, Education and Advocacy Program (MBC-SEA) was developed. The 1-hour, weekly, patient review included collaborative assessments to determine needs for social service, psychological counseling, and palliative care. A prospective pre- and postexperimental cohort design with convenience sampling was used. Analysis was conducted with paired t test analysis of pre- and postimplementation outcomes. SETTING/PARTICIPANTS Program outcomes of 118 women with MBC visiting an urban outpatient breast cancer clinic during September 2016 to November 2016 (pre) and January 2017 to March 2017 (post) were evaluated. MEASUREMENTS Referral rates to social work and palliative care, symptom, anxiety, and overall well-being scores. RESULTS Following program implementation, referrals to palliative care and social work supportive services increased significantly including patient-reported outcomes symptom distress scores mean difference 1.4 (95% confidence interval [CI]: 0.4306-2.6428), P = .004; generalized anxiety scores mean difference 1.5 (95% CI: 0.5406-2.5781), P = .003; and overall well-being mean difference of -0.7 (95% CI: -1.3498 to -0.0570), P = .03. CONCLUSIONS Purposeful nurse-led assessment for social service and palliative care needs increases referrals with improvement in patient-reported outcomes.
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Affiliation(s)
- Victoria Reiser
- 1 University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | | | - Ann Welsh
- 2 Magee Women's Hospital of UPMC, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Dianxu Ren
- 3 Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Barbara Usher
- 3 Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Siler S, Mamier I, Winslow BW, Ferrell BR. Interprofessional Perspectives on Providing Spiritual Care for Patients With Lung Cancer in Outpatient Settings. Oncol Nurs Forum 2019; 46:49-58. [PMID: 30547964 PMCID: PMC7008957 DOI: 10.1188/19.onf.49-58] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore palliative care and oncology clinicians' perspectives on current challenges and facilitating factors in meeting the spiritual needs of patients with lung cancer and family caregivers. This study was conducted in preparation for a community-based lung cancer palliative care intervention. PARTICIPANTS & SETTING 19 oncology and palliative care clinicians in three outpatient Kaiser Permanente sites in southern California. METHODOLOGIC APPROACH This multisite qualitative study used focus group and key informant interviews. Data were analyzed using content analysis methodology, and a team approach was used to validate findings. FINDINGS Clinicians described facilitating factors (interprofessional team support, assessment of spiritual needs, clinician-provided spiritual support, and provision of culturally respectful spiritual care) and challenges (related to providing culturally respectful spiritual care by respecting the patients' spiritual and cultural beliefs in an open way and in advocating for the patients' wishes) they encountered when addressing patient and caregiver spiritual needs. IMPLICATIONS FOR NURSING This study demonstrated the need to provide nurses with practical tools, education, and a supportive environment to address patients' and family caregivers' spiritual concerns.
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Nguyen HQ, Ruel N, Macias M, Borneman T, Alian M, Becher M, Lee K, Ferrell B. Translation and Evaluation of a Lung Cancer, Palliative Care Intervention for Community Practice. J Pain Symptom Manage 2018; 56:709-718. [PMID: 30076966 PMCID: PMC6248339 DOI: 10.1016/j.jpainsymman.2018.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 01/03/2023]
Abstract
CONTEXT A notable gap in the evidence base for palliative care (PC) for cancer is that most trials were conducted in specialized centers with limited translation and further evaluation in "real-world" settings. Health systems are desperate for guidance on effective, scalable models. OBJECTIVES The objective of this study was to determine the effects of a nurse-led PC intervention for patients with non-small-cell lung cancer and their family caregivers (FCGs) in a community-based setting. METHODS Two-group, sequential, quasi-experimental design with Phase 1 (usual care [UC]) followed by Phase 2 (intervention) was conducted at three Kaiser Permanente Southern California sites. Participants included patients with Stage 2-4 non-small-cell lung cancer and their FCG. Standard measures of quality of life (QOL) included Functional Assessment of Cancer Therapy-Lung, Functional Assessment of Chronic Illness Therapy-Spirituality Subscale, City of Hope Family QOL; other outcomes were distress, health care utilization, caregiver preparedness, and burden. RESULTS Patients in the intervention cohort had significant improvements in three (physical, emotional, and functional well-being) of the five QOL domains at one month that were sustained through three month compared to UC (P < 0.01). Caregivers in the intervention cohort had improvements in physical (P = 0.04) and spiritual well-being (P = 0.03) and preparedness (P = 0.04) compared to UC. There were no differences in distress or health care utilization between cohorts. CONCLUSION Our findings suggest that a research-based PC intervention can be successfully adapted to community settings to achieve similar, if not better, QOL outcomes for patients and FCGs compared to UC. Nonetheless, additional modifications to ensure consistent referrals to PC and streamlining routine assessments and patient/FCG education are needed to sustain and disseminate the PC intervention.
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Affiliation(s)
- Huong Q Nguyen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California.
| | - Nora Ruel
- City of Hope Medical Center, Duarte, California
| | - Mayra Macias
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | | | - Melissa Alian
- Riverside Medical Center, Kaiser Permanente Southern California, Riverside, California
| | - Mark Becher
- Fontana Medical Center, Kaiser Permanente Southern California, Fontana, California
| | - Kathy Lee
- Anaheim and Irvine Medical Centers, Kaiser Permanente Southern California, Anaheim, California
| | - Betty Ferrell
- Nursing Research & Education, City of Hope Medical Center, Duarte, California
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Narsavage GL, Chen YJ, Korn B, Elk R. The potential of palliative care for patients with respiratory diseases. Breathe (Sheff) 2017; 13:278-289. [PMID: 29209422 PMCID: PMC5709801 DOI: 10.1183/20734735.014217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians. Early palliative care can relieve suffering and provide support for people with respiratory diseaseshttp://ow.ly/z0Hd30jpsb4
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Affiliation(s)
- Georgia L Narsavage
- Dept of Nursing, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Yea-Jyh Chen
- Kent State University - College of Nursing, Kent, OH, USA
| | - Bettina Korn
- End-of-Life Care Programme, St. James's Hospital, Dublin, Ireland
| | - Ronit Elk
- University of South Carolina - College of Nursing, Columbia, SC, USA
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