Looking Back, Moving Forward: A Retrospective Review of Care Trends in an Academic Palliative and Supportive Care Program from 2004 to 2016

Palliative care needs of the cancer patients receiving active therapy

PURPOSE

To identify cancer patients' palliative care needs with problem burden, problem intensity, and felt needs related to these problems while receiving cancer treatment.

METHODS

This is a descriptive survey study conducted at a tertiary hospital with no palliative care services in Istanbul, Turkey, from September 2019 to February 2020. Data were collected using the Patient Information Form and the Three Levels of Needs Questionnaire (3LNQ). Descriptive statistics (frequency and percentage) were used to present data.

RESULTS

The mean age of patients was 60.2 ± 13.0, and the mean duration since the diagnosis was 11.6 ± 21.4 months. Of the patients, 40.4% were diagnosed with gastrointestinal (GI) cancer, and 34.4% had stage 4 cancer. Patients mostly received help for their pain (85.7%), lack of appetite (64.8%), and nausea (73/7%). The most frequent unmet needs were problems with concentration (70%), worrying (68%), difficulties with sex life (63.6%), problems with being limited in work and daily activities (61.4%), and being depressed (58.5%) among patients who reported to have these symptoms.

CONCLUSION

This study shows that patients with cancer require supportive and palliative care along with medical treatment for cancer and its treatment-induced physical and psychological symptoms. The study results have the potential to guide the development of palliative care services, especially for outpatient oncology settings in countries where palliative care services mostly focus on the end-of-life care. Further studies are also needed to focus on interventions to meet cancer patients' palliative care needs during the medical cancer treatment process with tailored palliative care delivery models.

Creating Effective Models for Delivering Palliative Care in Advanced Liver Disease

Purpose of Review

The current healthcare system is not fully equipped to provide comprehensive support for patients with advanced liver disease (ALD) and their caregivers resulting in concomitant suffering and reduced quality of life (QoL). Integration of palliative care (PC) within routine care has demonstrated benefits in improving symptoms and QoL and reducing healthcare utilization for other serious illnesses but has been underutilized or delayed for ALD care. The purpose of this article is to outline the domains and benefits of PC and discuss the misconceptions and barriers for PC integration, and healthcare delivery models supporting PC integration within ALD care.

Recent Findings

PC has eight key domains related to physical and mental health, goals for future care, and care of the caregivers. PC offers benefits to improve health outcomes and patient satisfaction and reduce healthcare utilization. To date there have been successful models of PC that are primarily hospital- or community-based; successful models have been PC specialist- or primary/generalist-led.

Summary

Concurrent PC within oncology has formed the basis for most evidence-based guidelines. PC integration within ALD care is still in its infancy. While amassing evidence in ALD, hepatology organizations can promote consensus-based integrated PC models that can guide research and practice efforts to increase supportive care for these patients in need and their family caregivers.

Referral Practices of Cardiologists to Specialist Palliative Care in Canada

BACKGROUND

Patients with heart failure have palliative care needs that can be effectively addressed by specialist palliative care (SPC). Despite this, SPC utilization by this patient population is low, suggesting barriers to SPC referral. We sought to determine the referral practices of cardiologists to SPC.

METHODS

Cardiologists across Canada were invited to participate in a survey about their referral practices to SPC. Associations between referral practices and demographic, professional, and attitudinal factors were analyzed using multiple and logistic regression.

RESULTS

The response rate was 51% (551 of 1082). Between 35.1% and 64.2% of respondents were unaware of referral criteria to local SPC services. Of the respondents, 29% delayed SPC referral because of prognostic uncertainty, and 46.8% believed that SPC prioritizes patients with cancer. In actual practice, nearly three-fourths of cardiologists referred late. Referral frequency was associated with greater availability of SPC services for patients with nonmalignant diseases (P = 0.008), a higher number of palliative care settings accepting patients receiving continuous infusions or pursuing acute care management (P < 0.001), satisfaction with services (P < 0.001), and less equation of palliative care with end-of-life care (P < 0.001). Early timing of referral was associated with greater availability of SPC services for patients with nonmalignant diseases and less equation of palliative care with end-of-life care.

CONCLUSIONS

The findings suggest that barriers to timely SPC referral include an insufficiency of services for patients with nonmalignant diseases especially in the outpatient setting, the perception that SPC services do not accept patients receiving cardiology-specific treatments, and a misperception about the identity of palliative care.