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Xie Z, Ding J, Jiao J, Tang S, Huang C. Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis. BMJ Support Palliat Care 2024; 14:256-268. [PMID: 38154921 PMCID: PMC11347222 DOI: 10.1136/spcare-2023-004465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/19/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The early detection of individuals who require palliative care is essential for the timely initiation of palliative care services. This systematic review and meta-analysis aimed to (1) Identify the screening instruments used by health professionals to promote early identification of patients who may benefit from palliative care; and (2) Assess the psychometric properties and clinical performance of the instruments. METHODS A comprehensive literature search was conducted in PubMed, Embase, CINAHL, Scopus, CNKI and Wanfang from inception to May 2023. We used the COnsensus-based Standards for the Selection of Health Measurement INstruments to assess the methodological quality of the development process for the instruments. The clinical performance of the instruments was assessed by narrative summary or meta-analysis. Subgroup analyses were conducted where necessary. The quality of included studies was assessed using the Newcastle-Ottawa Scale and the Cochrane Collaboration's risk of bias assessment tool. RESULTS We included 31 studies that involved seven instruments. Thirteen studies reported the development and validation process of these instruments and 18 studies related to assessment of clinical performance of these instruments. The content validity of the instruments was doubtful or inadequate because of very low to moderate quality evidence. The pooled sensitivity (Se) ranged from 60.0% to 73.8%, with high heterogeneity (I2 of 88.15% to 99.36%). The pooled specificity (Sp) ranges from 70.4% to 90.2%, with high heterogeneity (I2 of 96.81% to 99.94%). The Supportive and Palliative Care Indicators Tool (SPICT) had better performance in hospitals than in general practice settings (Se=79.8% vs 45.3%, p=0.004; Sp=59.1% vs 97.0%, p=0.000). CONCLUSION The clinical performance of existing instruments in identifying patients with palliative care needs early ranged from poor to reasonable. The SPICT is used most commonly, has better clinical performance than other instruments but performs better in hospital settings than in general practice settings.
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Affiliation(s)
- Zhishan Xie
- Central South University, Changsha, Hunan, China
| | - Jinfeng Ding
- Central South University, Changsha, Hunan, China
| | | | - Siyuan Tang
- Central South University, Changsha, Hunan, China
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Spannella F, Falzetti S, Giulietti F, Sarnari S, Morichi V, Tamburrini P, Gattafoni P, Mannello L, Crippa M, Ferrara L, Sarzani R, Lombrano MR. Prognostic Role of NECPAL CCOMS-ICO Tool on One-Year Mortality in a Hospitalized Older Population. J Palliat Med 2024; 27:367-375. [PMID: 37971772 DOI: 10.1089/jpm.2023.0038] [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: 11/19/2023] Open
Abstract
Background: It is essential to establish both the appropriateness of palliative care (PC) and the prognosis in daily clinical practice to guide decision making in the management of older people with multiple advanced chronic diseases. Objectives: We assessed patients who were appropriate for PC using the NECPAL tool in a hospitalized older population and then we investigated its predictive validity on one-year mortality compared with the multidimensional prognostic index (MPI), a validated geriatric prognostic tool. Design: Prospective cohort study. Setting/Subjects: We enrolled 103 older adults hospitalized for acute medical and surgical conditions in a geriatric hospital in Italy. Measurements: The variables of interest were obtained at baseline through interviews of the ward medical staff and by consulting the computerized medical records. Long-term mortality (one-year) was assessed through the analysis of data acquired from hospital or territorial databases or through telephone contact with caregivers. Results: Mean age was 86.8 ± 7.2 years, with a female prevalence of 54.4%. Prevalence of NECPAL+ patients was 65.1%. MPI low risk: 30.1%; moderate risk: 41.7%; severe risk: 28.2%. Patients deceased during follow-up were 54.4%. NECPAL+ patients were more likely to die, even after adjusting for age, sex, and MPI score (hazard ratio [HR] 2.7, p = 0.020). All the NECPAL categories were associated with one-year mortality. MPI showed a better predictive power than NECPAL (area under the curve [AUC] 0.85 vs. 0.75, p = 0.030). After the exclusion of "Comorbidity: ≥2 concurrent diseases" item from NECPAL, its AUC increased to 0.78 with no statistically significant differences from MPI (p = 0.122). Conclusions: NECPAL is useful to identify the appropriateness of PC in hospitalized older adults, also allowing to predict long-term mortality with a performance similar to that of a validated geriatric prognostic tool.
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Affiliation(s)
- Francesco Spannella
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Sara Falzetti
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Federico Giulietti
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
| | - Silvia Sarnari
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Valeria Morichi
- Medical Department, Internal Medicine Unit, IRCCS INRCA, Osimo, Italy
| | | | - Pisana Gattafoni
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
| | | | | | - Letizia Ferrara
- Medical Direction Unit, Risk Manager, IRCCS INRCA, Ancona, Italy
| | - Riccardo Sarzani
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
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Fisher G, Shadmi E, Porat-Packer T, Zisberg A. Identifying patients in need of palliative care: Adaptation of the Necesidades Paliativas CCOMS-ICO© (NECPAL) screening tool for use in Israel. Palliat Support Care 2024; 22:103-109. [PMID: 36285527 DOI: 10.1017/s1478951522001390] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The Necesidades Paliativas CCOMS-ICO© (NECPAL) screening tool was developed to identify patients in need of palliative care and has been used in Israel without formal translation, reliability testing, or validation. Because cultural norms significantly affect subscales such as social vulnerability and health-care delivery, research is needed to comprehensively assess the NECPAL's components, adapt it, and validate it for an Israeli health-care setting. This study linguistically and culturally translated the NECPAL into Hebrew to examine cultural and contextual acceptability for use in the Israeli geriatric health sector. The newly adapted tool was measured for itemized and scale-level content validity, inter-rater reliability (IRR), and construct validity. METHODS The NECPAL was back-translated and its content validated by a 5-member expert panel for clarity and relevance, forming the Israeli-NECPAL (I-NECPAL). Six health-care professionals used the I-NECPAL with 25 post-acute geriatric patients to measure IRR. For construct validity, the known-groups method was used, as there is no "gold standard" method for identifying palliative needs for comparison with the NECPAL. The known groups were 2 fictitious cases, predetermined of palliative need. Thirty health-care professionals, blinded to the predetermined palliative status, used the I-NECPAL to determine whether a patient needs a palliative-centered plan of care. RESULTS The findings point to acceptable content and construct validity as well as IRR of the I-NECPAL for potential inclusion as a tool for identifying geriatric patients in need of palliative care. Content-validity assessment brought linguistic changes and the exclusion of the frailty parameter from the annex of chronic diseases. The kappa-adjusted scale-level content-validity index indicated a high level of content validity (0.96). IRR indicated a high level of agreement (all parameters with an "excellent-good" agreement level). The sensitivity (0.93), specificity (0.17), positive predictive value (0.53), and negative predictive value (0.71) revealed how heavily the scale weighed upon the surprise question. These metrics are improved when removing the surprise question from the instrument. SIGNIFICANCE OF RESULTS Similar to other countries, the Israeli health-care system is regulated by policies that portray the local beliefs and culture as well as evidence-based practice. The decision about when to switch a patient to a palliative-centered plan of care is one such example. It is thus of utmost importance that only locally adapted and vigorously tested screening tools be offered to health-care providers to assist in this decision. The I-NECPAL is the first psychometrically tested palliative needs identification tool for use in the geriatric population in Israel, on both a scale and an itemized level. The results indicate that it can immediately replace the current unvalidated version in use. Further research is needed to determine whether all parts of the scale are relevant for this patient population.
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Affiliation(s)
- Galia Fisher
- The Cheryl Spenser Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Research Department, Shoham Geriatric Medical Center, Pardes Hanna, Israel
| | - Efrat Shadmi
- The Cheryl Spenser Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tammy Porat-Packer
- Research Department, Shoham Geriatric Medical Center, Pardes Hanna, Israel
| | - Anna Zisberg
- The Cheryl Spenser Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Esteban-Burgos AA, Hueso-Montoro C, Mota-Romero E, Montoya-Juarez R, Gomez-Batiste X, Garcia-Caro MP. The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition. BMC Geriatr 2023; 23:715. [PMID: 37924015 PMCID: PMC10623722 DOI: 10.1186/s12877-023-04409-9] [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: 01/19/2023] [Accepted: 10/15/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND It is essential to assess the need for palliative care and the life prognosis of elderly nursing home residents with an advanced chronic condition, and the NECPAL ICO-CCOMS©4.0 prognostic instrument may be adequate for both purposes. The objective of this study was to examine the predictive capacity of NECPAL, the Palliative Prognosis Index, and the PROFUND index in elderly residents with advanced chronic condition with and without dementia, comparing their results at different time points. METHODS This prospective observational study was undertaken in eight nursing homes, following the survival of 146 residents with advanced chronic condition (46.6% with dementia) at 3, 6, 12, and 24 months. The capacity of the three instruments to predict mortality was evaluated by calculating the area under the receiver operating characteristic curve (AUC), with 95% confidence interval, for the global population and separately for residents with and without dementia. RESULTS The mean age of residents was 84.63 years (± 8.989 yrs); 67.8% were female. The highest predictive capacity was found for PROFUND at 3 months (95%CI: 0.526-0.756; p = 0.016), for PROFUND and NECPAL at 12 months (non-significant; AUC > 0.5), and NECPAL at 24 months (close-to-significant (AUC = 0.624; 95% CI: 0.499-0.750; p = 0.053). The highest capacity at 12 months was obtained using PROFUND in residents with dementia (AUC = 0.698; 95%CI: 0.566-0.829; p = 0.003) and NECPAL in residents without dementia (non-significant; AUC = 0.649; 95%CI: 0.432-0.867; p = 0.178). Significant differences in AUC values were observed between PROFUND at 12 (p = 0.017) and 24 (p = 0.028) months. CONCLUSIONS PROFUND offers the most accurate prediction of survival in elderly care home residents with advanced chronic condition overall and in those with dementia, especially over the short term, whereas NECPAL ICO-CCOMS©4.0 appears to be the most useful to predict the long-term survival of residents without dementia. These results support early evaluation of the need for palliative care in elderly care home residents with advanced chronic condition.
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Affiliation(s)
- Ana Alejandra Esteban-Burgos
- Departamento de Enfermería, Universidad de Jaén, Jaén, Spain
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain
| | - César Hueso-Montoro
- Departamento de Enfermería, Universidad de Jaén, Jaén, Spain
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
| | - Emilio Mota-Romero
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Centro de Salud Salvador Caballero. Distrito Sanitario Granada-Metropolitano. Servicio Andaluz de Salud, Granada, Spain
- Departamento de Enfermería, Universidad de Granada, Granada, Spain
| | - Rafael Montoya-Juarez
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain.
- Departamento de Enfermería, Universidad de Granada, Granada, Spain.
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain.
| | - Xavier Gomez-Batiste
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - María Paz Garcia-Caro
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Departamento de Enfermería, Universidad de Granada, Granada, Spain
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain
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Julià-Móra JM, Blanco-Mavillard I, Prieto-Alomar A, Márquez-Villaverde E, Terrassa-Solé M, Leiva-Santos JP, Rodríguez-Calero MÁ. Analysis of palliative care needs in hospitalized patients. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:261-268. [PMID: 37419323 DOI: 10.1016/j.enfcle.2023.06.001] [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: 02/15/2021] [Accepted: 04/16/2023] [Indexed: 07/09/2023]
Abstract
AIM To determine the prevalence of palliative care needs in patients in an acute care hospital and to analyze the profile of these patients. DESIGN We conducted a prospective cross-sectional study in an acute care hospital, in April 2018. The study population consisted of all patients over 18 years of age admitted to hospital wards and intensive care units. Variables were collected on a single day by six micro-teams using the NECPAL CCOMS-ICO© instrument. The descriptive analysis, on patient mortality and length of stay, was performed at a one-month follow-up. RESULTS We assessed 153 patients, of whom 65 (42.5%) were female, with a mean age of 68.17±17.03 years. A total of 45 patients (29.4%) were found to be SQ+, of which 42 were NECPAL+ (27.5%), with a mean age of 76.64±12.70 years. According to the disease indicators, 33.35% had cancer, 28.6% had heart disease, and 19% had COPD, resulting in a ratio of 1:3 between patients with cancer and non-cancer disease. Half of the inpatients in need of palliative care were in the Internal Medicine Unit. CONCLUSIONS Almost 28% of patients were identified as NECPAL+, most of them not identified as under palliative care in clinical records. Greater awareness and knowledge from healthcare professionals would facilitate the early identification of these patients and avoid overlooking palliative care needs.
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Affiliation(s)
- Joana Maria Julià-Móra
- Equipo de Soporte de Cuidados Paliativos, Hospital de Manacor, Manacor, Spain; Grupo de investigación en Cuidados, Cronicidad y Evidencias en Salud (CurES), Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Ian Blanco-Mavillard
- Unidad de Calidad, Docencia e Investigación, Hospital de Manacor, Manacor, Spain.
| | | | | | | | | | - Miguel Ángel Rodríguez-Calero
- Departamento de Calidad, Hospital Torrecárdenas, Almería, Spain; Departamento de Enfermería y Fisioterapia, Universidad de las Islas Baleares, Palma, Spain; Grupo de investigación en Cuidados, Cronicidad y Evidencias en Salud (CurES), Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
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Caro-Martínez E, Abad-Collado S, Escrivá-Cerrudo B, García-Almarza S, García-Ródenas MDM, Gómez-Merino E, Serrano-Mateo MI, Ramos-Rincón JM. Nosocomial COVID-19 Infection in a Long-Term Hospital in Spain: Retrospective Observational Study. Medicina (B Aires) 2022; 58:medicina58050566. [PMID: 35629983 PMCID: PMC9143631 DOI: 10.3390/medicina58050566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/16/2022] [Accepted: 04/17/2022] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives. The aim of this study is to compare clinical and epidemiological characteristics and outcomes in patients with versus without nosocomial COVID-19 after exposure to SARS-CoV-2 and to analyze the risk factors for severe outcomes of COVID-19 in a long-term hospital in Spain. Materials and methods. This retrospective, single-center observational study included all inpatients in a long-term hospital during a COVID-19 outbreak from 21 January to 15 March 2021. Results. Of 108 admitted patients, 65 (60.2%) were diagnosed with nosocomial COVID-19 disease (n = 34 women (52.3%), median age 77 years). In the univariable analysis, risk factors associated with nosocomial COVID-19 were dementia (OR 4.98 95% CI 1.58–15.75), dyspnea (OR 5.34 95% CI 1.69–16.82), asthenia (OR 5.10, 95% CI 1.40–18.60) and NECesidades PALiativas (NECPAL) (OR 1.28 95% CI 1.10–1.48). In the multivariable analysis, risk factors independently associated with nosocomial COVID-19 infection were dyspnea (aOR 7.39; 95% CI 1.27–43.11) and NECPAL (aOR 1.25; 95% CI 1.03–1.52). Of the 65 patients diagnosed with nosocomial COVID-19, 29 (44.6%) died, compared to 7/43 (16.2%) non-infected patients (OR 4.14, 95% CI 1.61–10.67). Factors associated with mortality in nosocomial COVID-19 were confusion (aOR 3.83; 95% CI 1.03–14.27) and dyspnea (aOR 7.47; 95% CI 1.87–29.82). The NECPAL tool played an important predictive role in both nosocomial COVID-19 infection and mortality (aOR 1.19, 95% CI: 1.00–1.41). Conclusions. In a long-term hospital, nosocomial COVID-19 main clinical characteristics associated with infection were dyspnea and NECPAL. Mortality was higher in the group with nosocomial COVID-19; risk factors were confusion and dyspnea. The NECPAL tool may help to predict progression and death in COVID-19.
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Affiliation(s)
- Elena Caro-Martínez
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;
- Internal Medicine Department, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain; (S.A.-C.); (B.E.-C.); (E.G.-M.); (M.-I.S.-M.)
- Correspondence:
| | - Susana Abad-Collado
- Internal Medicine Department, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain; (S.A.-C.); (B.E.-C.); (E.G.-M.); (M.-I.S.-M.)
| | - Blanca Escrivá-Cerrudo
- Internal Medicine Department, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain; (S.A.-C.); (B.E.-C.); (E.G.-M.); (M.-I.S.-M.)
| | - Shaila García-Almarza
- Geriatric Unit, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain;
| | | | - Elena Gómez-Merino
- Internal Medicine Department, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain; (S.A.-C.); (B.E.-C.); (E.G.-M.); (M.-I.S.-M.)
| | - María-Isabel Serrano-Mateo
- Internal Medicine Department, Sant Vicent del Raspeig Hospital, San Vicente del Raspeig, 03690 Alicante, Spain; (S.A.-C.); (B.E.-C.); (E.G.-M.); (M.-I.S.-M.)
| | - Jose-Manuel Ramos-Rincón
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;
- Internal Medicine Department, Alicante General University Hospital, 03010 Alicante, Spain
- Clinical Medicine Department, Miguel Hernández University, 03550 Elche, Spain
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Tripodoro VA, Llanos V, Daud ML, Muñoz P, Del Mar E, Tranier R, Sandjian S, Lellis SD, Días JM, Saurí A, De Simone GG, Gómez-Batiste X. Palliative and prognostic approach in cancer patients identified in the multicentre NECesidades PALiativas 2 study in Argentina. Ecancermedicalscience 2022; 15:1316. [PMID: 35047067 PMCID: PMC8723739 DOI: 10.3332/ecancer.2021.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Early identification of palliative needs has proven benefits in quality of life, survival and decision-making. The NECesidades PALiativas (NECPAL) Centro Coordinador Organización Mundial de la Salud - Instituto Catalán de Oncología (CCOMS-ICO©) tool combines the physician’s insight with objective disease progression parameters and advanced chronic conditions. Some parameters have been independently associated with mortality risk in different populations. According to the concept of the ‘prognostic approach’ as a companion of the ‘palliative approach’, predictive models that identify individuals at high mortality risk are needed. Objective We aimed to identify prognostic factors of mortality in cancer in our cultural context. Method We assessed cancer patients with palliative needs until death using this validated predictive tool at three hospitals in Buenos Aires City. This multifactorial, quantitative and qualitative non-dichotomous assessment process combines subjective perception (the surprise question: Would you be surprised if this patient dies in the next year?) with other parameters, including the request (and need) for palliative care (PC), the assessment of disease severity, geriatric syndromes, psychosocial factors and comorbidities, as well as the use of healthcare resources. Results 2,104 cancer patients were identified, 681 were NECPAL+ (32.3%). During a 2-year follow-up period, 422 NECPAL+ patients died (61.9%). The mean overall survival was 8 months. A multivariate model was constructed with significant indicators in univariate analysis. The best predictors of mortality were: nutritional decline (p < 0.000), functional decline (p < 0.000), palliative performance scale (PPS) ≤ 50 (p < 0.000), persistent symptoms (p < 0.002), functional dependence (p < 0.000), poor treatment response (p < 0.000), primary cancer diagnosis (p = 0.024) and condition (in/outpatients) (p < 0.000). Only three variables remained as survival predictors: low response to treatment (p < 0.001), PPS ≤ 50 (p < 0.000) and condition (in/outpatients) (p < 0.000). Conclusion This prospective model aimed to improve cancer survival prediction and timely PC referral in Argentinian hospitals.
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Affiliation(s)
- Vilma Adriana Tripodoro
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Av Combatientes de Malvinas 3150, C1427 ARN, Buenos Aires, Argentina.,Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina.,https://orcid.org/0000-0003-2328-6032
| | - Victoria Llanos
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Av Combatientes de Malvinas 3150, C1427 ARN, Buenos Aires, Argentina.,Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - María Laura Daud
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - Pilar Muñoz
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - Eden Del Mar
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Av Combatientes de Malvinas 3150, C1427 ARN, Buenos Aires, Argentina
| | - Romina Tranier
- Instituto de Oncología Ángel Roffo, Universidad de Buenos Aires, Av San Martín 5481 (1417), Ciudad de Buenos Aires, Argentina
| | - Sol Sandjian
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - Silvina De Lellis
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - Juan Manuel Días
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - Alvaro Saurí
- Instituto de Oncología Ángel Roffo, Universidad de Buenos Aires, Av San Martín 5481 (1417), Ciudad de Buenos Aires, Argentina
| | - Gustavo Gabriel De Simone
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina.,Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Av Caseros 2061 (1264), Ciudad de Buenos Aires, Argentina
| | - Xavier Gómez-Batiste
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya, C Miquel Martí i Pol 1, 08500 Vic, Catalonia, Spain
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Ferré C, Canelles S, Daniel X, Rubio O, Esteban F, Pobo A. Detection of frailty and palliative needs from discharged critical care patients in collaboration with primary care. Med Intensiva 2021; 46:101-103. [PMID: 34863667 DOI: 10.1016/j.medine.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/04/2020] [Accepted: 11/29/2020] [Indexed: 10/19/2022]
Affiliation(s)
- C Ferré
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain
| | - S Canelles
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain
| | - X Daniel
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain
| | - O Rubio
- Unidad de Cuidados Intensivos, Hospital Sant Joan de Déu, Fundació Althaia Xarxa Universitària, Manresa, Barcelona, Spain
| | - F Esteban
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain
| | - A Pobo
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain.
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Esteban-Burgos AA, Lozano-Terrón MJ, Puente-Fernandez D, Hueso-Montoro C, Montoya-Juárez R, García-Caro MP. A New Approach to the Identification of Palliative Care Needs and Advanced Chronic Patients among Nursing Home Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063171. [PMID: 33808567 PMCID: PMC8003433 DOI: 10.3390/ijerph18063171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 01/05/2023]
Abstract
Background: Proper planning of Palliative Care in nursing homes requires advanced knowledge of the care needs that residents show. The aim of the study was to evaluate Palliative Needs and other conditions such as fragility, complexity, and prognosis and also to suggest new indicators for the establishment of the resident’s advanced chronic condition. Methods: Cross-sectional study conducted in 149 nursing homes Complex Chronic residents evaluated by trained professionals. Palliative Care Needs, assessed by the NECPAL ICO-CCOMS© tool, and fragility, case and palliative complexity and prognosis were evaluate through a comprehensive assessment. Descriptive analyses and association measures were performed setting the statistical significance at 0.05. Results: More than 50% of the residents had positive Surprise Question and other Palliative Needs and were classified as Advanced Chronic Patients. Distress and/or Severe Adaptative Disorder was the most frequent need shown by the residents and significant differences in levels of frailty and other characteristics, were found between the Positive and the Negative Surprise Question Groups. Statistically significant correlations were also found between aspects of both groups. Conclusions: Nursing homes residents show Palliative Needs regardless of the response to the Surprise Question of the NECPAL tool. Other characteristics such as presence of an intermediate level of frailty are suggested as a new perspective to identify advanced chronic patients among nursing homes residents.
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Affiliation(s)
- Ana A. Esteban-Burgos
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Doctoral Programme in Clinical Medicine and Public Health, University of Granada, 18012 Granada, Spain
| | | | - Daniel Puente-Fernandez
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Doctoral Programme in Clinical Medicine and Public Health, University of Granada, 18012 Granada, Spain
- Correspondence:
| | - César Hueso-Montoro
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
| | - Rafael Montoya-Juárez
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
| | - María P. García-Caro
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
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10
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Troncoso J, Morales-Meyer T, Villarroel L, Turrillas P, Rodríguez-Nuñez A. [Adaptation and validation in Chile of the patient identification instrument needing palliative care: NECPAL-CCOMS-ICO 3.1©]. Aten Primaria 2021; 53:101994. [PMID: 33740612 PMCID: PMC7985705 DOI: 10.1016/j.aprim.2021.101994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/29/2020] [Accepted: 11/18/2020] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Adapt and validate the NECPAL instrument in Chile. DESIGN Prospective, longitudinal, analytical study for validation of the instrument in 5 stages: cultural adaptation, content validation, pilot test, application, and statistical analysis. PLACE Four primary care centers of the South East Metropolitan Health Service, in Santiago, Chile. PARTICIPANTS Primary health care physicians and nurses for cultural adaptation and application, and palliative care experts for content validation. MAIN MEASUREMENTS Cultural adaptation was carried out through cognitive interviews. Content validity was measured using Delphi method and the Lawshe content validity ratio (CVR) was obtained. In the pilot test, we measured stability (test-retest), inter judge harmony and application time in 14 chronic advanced patients (CAP). The test was applied to this same group, calculating the sample according to Nunally's recommendation. RESULTS A sample of 118 CAP was obtained. The CVR was 0.75 and the average testing time was 6.7 min (SD = 4.01). The test-retest obtained a Kappa test concordance index between 0.632 and 1.0; and the interjudge harmony agreement between 0.192 and 0.692. The surprise question (PS) was positive in 20.3% of the sample. The main conditions associated with the disease-specific severity item, were fragility (23.7%), chronic heart disease (21.2%) and chronic lung disease (12.7%). The demand group and specific severity indicators obtained a greater predictive capacity of PS+, with an area under the curve of 0.808 (95% CI: 0.697-0.918). CONCLUSIONS NECPAL is feasible to be used in Chile, has adequate psychometric properties and will allow early detection of patients in need of palliative care.
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Affiliation(s)
- Jonathan Troncoso
- Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Región Metropolitana, Chile
| | - Tina Morales-Meyer
- Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Región Metropolitana, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Región Metropolitana, Chile
| | - Pamela Turrillas
- Cátedra de Cuidados Paliativos, Universidad de Vic y Central de Catalunya, Barcelona, Barcelona, España
| | - Alfredo Rodríguez-Nuñez
- Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Región Metropolitana, Chile.
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11
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Turrillas P, Peñafiel J, Tebé C, Amblàs-Novellas J, Gómez-Batiste X. NECPAL prognostic tool: a palliative medicine retrospective cohort study. BMJ Support Palliat Care 2021:bmjspcare-2020-002567. [PMID: 33593868 DOI: 10.1136/bmjspcare-2020-002567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To develop and validate a prognostic model to assess mortality risk at 24 months in patients with advanced chronic conditions. METHODS Retrospective design based on a previous population cohort study with 789 adults who were identified with the surprise question and NECPAL tool from primary and intermediate care centres, nursing homes and one acute hospital of Spain. A Cox regression model was used to derive a mortality predictive model based on patients' age and six previously selected NECPAL prognostic factors (palliative care need identified by healthcare professionals, functional decline, nutritional decline, multimorbidity, use of resources, disease-specific criteria of severity/progression). Patients were split into derivation/validation cohorts, and four steps were followed: descriptive analysis, predictors' assessment, model estimation and model assessment. RESULTS All predictive variables were independently associated with increased risk of mortality at 24 months. Performance model including age was good; discrimination power by area under the curve (AUC) was 0.72/0.67 in the derivation/validation cohorts, and correlation between expected and observed (E/O) mortality ratio was 0.74/0.70. The model showed similar performance across settings (AUC 0.65-0.74, E/O 1.00-1.01), the best performance in oncological patients (AUC 0.78, E/O 0.76) and the worst in dementia patients (AUC 0.58, E/O 0.85). Based on the number of factors affected, three prognostic stages with significant differences and a median survival of 38, 17.2 and 3.6 months (p<0.001) were defined. CONCLUSION The NECPAL prognostic tool is accurate and eventually useful at the clinical practice. Stratification in risk groups may enable early intervention and enhance policy-making and service planning.
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Affiliation(s)
- Pamela Turrillas
- The 'Qualy' Observatory, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain
| | - Judith Peñafiel
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Biostatistics Unit, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebé
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Biostatistics Unit, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Amblàs-Novellas
- The 'Qualy' Observatory, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - Xavier Gómez-Batiste
- The 'Qualy' Observatory, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
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12
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Ferré C, Canelles S, Daniel X, Rubio O, Esteban F, Pobo A. Detection of frailty and palliative needs from discharged critical care patients in collaboration with primary care. Med Intensiva 2021; 46:S0210-5691(20)30397-1. [PMID: 33531189 DOI: 10.1016/j.medin.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/04/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022]
Affiliation(s)
- C Ferré
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, España
| | - S Canelles
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, España
| | - X Daniel
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, España
| | - O Rubio
- Unidad de Cuidados Intensivos, Hospital Sant Joan de Déu, Fundació Althaia Xarxa Universitària, Manresa, Barcelona, España
| | - F Esteban
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, España
| | - A Pobo
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, España.
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13
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Withdrawing noninvasive ventilation at end-of-life care: is there a right time? Curr Opin Support Palliat Care 2020; 13:344-350. [PMID: 31599816 DOI: 10.1097/spc.0000000000000471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is the 'when' and 'how' of the matter of withdrawing noninvasive ventilation (NIV) at end-of-life (EoL) setting, having in mind the implications for patients, families and healthcare team. RECENT FINDINGS Several recent publications raised the place and potential applications of NIV at EoL setting. However, there are no clear guidelines about when and how to withdraw NIV in these patients. Continuing NIV in a failing clinical condition may unnecessarily prolong the dying process. This is particularly relevant as frequently, EoL discussions are started only when patients are in severe distress, and they have little time to discuss their preferences and decisions. SUMMARY Better advanced chronic disease and EoL condition definitions, as well as identification of possible scenarios, should help to decision-making and find the appropriate time to initiate, withhold and withdraw NIV. This review emphasized the relevance of an integrated approach across illness' trajectories and key transitions of patients who will need EoL care and such sustaining support measure.
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14
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Gómez-Batiste X, Turrillas P, Tebé C, Calsina-Berna A, Amblàs-Novellas J. NECPAL tool prognostication in advanced chronic illness: a rapid review and expert consensus. BMJ Support Palliat Care 2020; 12:e10-e20. [PMID: 32241958 DOI: 10.1136/bmjspcare-2019-002126] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/24/2020] [Accepted: 03/11/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop a proposal for a 2-year mortality prognostic approach for patients with advanced chronic conditions based on the palliative care need (PCN) items of the NECesidades PALiativas (NECPAL) CCOMS-ICO V.3.1 2017 tool. METHODS A phase 1 study using three components based on the NECPAL items: (1) a rapid review of systematic reviews (SRs) on prognostic factors of mortality in patients with advanced chronic diseases and PCNs; (2) a clinician and statistician experts' consensus based on the Delphi technique on the selection of mortality prognostic factors; and (3) a panel meeting to discuss the findings of components (1) and (2). RESULTS Twenty SRs were included in a rapid review, and 50% were considered of moderate quality. Despite methodological issues, nutritional and functional decline, severe and refractory dyspnoea, multimorbidity, use of resources and specific disease indicators were found to be potentially prognostic variables for mortality across four clinical groups and end-of-life (EoL) trajectories: cancer, dementia and neurologic diseases, chronic organ failure and frailty. Experts' consensus added 'needs' identified by health professionals. However, clinicians were less able to discriminate which NECPAL items were more reliable for a 'general' model. A retrospective cohort study was designed to evaluate this proposal in phase 2. CONCLUSIONS We identified several parameters with prognostic value and linked them to the tool's utility to timely identify PCNs of patients with advanced chronic conditions in all settings of care. Initial results show this is a clinical and feasible tool, that will help with clinical pragmatic decision-making and to define services.
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Affiliation(s)
- Xavier Gómez-Batiste
- The 'Qualy' Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, Barcelona, Spain .,Chair of Palliative Care, Faculty of Medicine, University of Vic ‒ Central University of Catalonia, Vic, Barcelona, Spain
| | - Pamela Turrillas
- The 'Qualy' Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, Barcelona, Spain.,Chair of Palliative Care, Faculty of Medicine, University of Vic ‒ Central University of Catalonia, Vic, Barcelona, Spain
| | - Cristian Tebé
- Department of Statistics, Biomedical Research Institute of Bellvitge (IDIBELL), Barcelona, Spain
| | - Agnès Calsina-Berna
- The 'Qualy' Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, Barcelona, Spain.,Chair of Palliative Care, Faculty of Medicine, University of Vic ‒ Central University of Catalonia, Vic, Barcelona, Spain
| | - Jordi Amblàs-Novellas
- Chair of Palliative Care, Faculty of Medicine, University of Vic ‒ Central University of Catalonia, Vic, Barcelona, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia, Vic, Barcelona, Spain
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15
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Gómez-Batiste X, Lasmarías C, Amblàs J, Costa X, Ela S, Mir S, Calsina-Berna A, Espaulella J, Santaugènia S, Pujol R, Geli MG, Calle C. Chair ICO/UVIC-UCC of palliative care at the University of Vic - Central University of Catalonia: an innovative multidisciplinary model of education, research and knowledge transfer. BMJ Support Palliat Care 2018; 9:e33. [PMID: 30518526 DOI: 10.1136/bmjspcare-2018-001656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/26/2018] [Accepted: 10/31/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Generation and dissemination of knowledge is a relevant challenge of palliative care (PC). The Chair Catalan Institute of Oncology (ICO)/University of Vic (UVIC) of Palliative Care (CPC) was founded in 2012, as a joint project of the ICO and the University of Vic/Central of Catalonia to promote the development of PC with public health and community-oriented vision and academic perspectives. The initiative brought together professionals from a wide range of disciplines (PC, geriatrics, oncology, primary care and policy) and became the first chair of PC in Spain. We describe the experience of the CPC at its fifth year of implementation. METHODS Data collection from annual reports, publications, training and research activities. RESULTS Results for period 2012-2017 are classified into three main blocks: (1) Programme: (a) The advanced chronic care model (Palliative needs (NECPAL)); (b) the psychosocial and spiritual domains of care (Psychosocial needs (PSICPAL)); (c) advance care planning and shared decision making (Advance care planning (PDAPAL)); and (d) the compassive communities projects (Society involvement (SOCPAL)). (2) Education and training activities: (a) The master of PC, 13 editions and 550 professionals trained; (b) postgraduate course on psychosocial care, 4 editions and 140 professionals trained; and (c) workshops on specific topics, pregraduate training and online activities with a remarkable impact on the Spanish-speaking community. (3) Knowledge-transfer activities and research projects: (a) Development of 20 PhDs projects; and (b) 59 articles and 6 books published. CONCLUSION Being the first initiative of chair in PC in Spain, the CPC has provided a framework of multidisciplinary areas that have generated innovative experiences and projects in PC.
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Affiliation(s)
- Xavier Gómez-Batiste
- Chair in Palliative Care, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain .,The Qualy Observatory-WHO Collaborating Centre for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, Barcelona, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Cristina Lasmarías
- Chair in Palliative Care, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.,The Qualy Observatory-WHO Collaborating Centre for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, Barcelona, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Jordi Amblàs
- Chair in Palliative Care, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Xavier Costa
- Chair in Palliative Care, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.,Primary Care Team Torelló (Barcelona), Barcelona, Spain
| | - Sara Ela
- Chair in Palliative Care, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.,The Qualy Observatory-WHO Collaborating Centre for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, Barcelona, Spain
| | - Sarah Mir
- Chair in Palliative Care, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Agnès Calsina-Berna
- Chair in Palliative Care, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.,Comprehensive Support Unit, Catalan Institute of Oncology, Badalona, Spain
| | - Joan Espaulella
- Chair in Palliative Care, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Sebastià Santaugènia
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.,National Strategy of Integrated and Chronic Care, Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Ramon Pujol
- Chair in Palliative Care, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Marina Geli Geli
- Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
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