Can Studies on Early Palliative Care Be Harmful to Patient Well Being?

Palliative care facilitates the preparedness of caregivers for thoracic cancer patients

OBJECTIVE

Palliative care improves outcomes for patients with thoracic cancer; however, limited evidence exists for the benefits of this approach for caregivers. This study aimed to advance understanding of the experiences of palliative care described by bereaved caregivers.

METHODS

Fifteen adult caregivers completed semi-structured interviews following prior participation in a randomised controlled trial of early referral to palliative care versus discretionary referral to palliative care. Interviews explored caregiver experiences of palliative care delivery. Interview transcripts were thematically analysed.

RESULTS

Four related themes about the experiences of palliative care were identified, each of which required sufficient time between palliative care first contact and death: 'relationship building'; 'clear communication and information'; 'access to practical support'; and 'access to psychosocial support'. The core category underpinning these themes was palliative care facilitates caregiver preparedness. Caregivers noted that palliative care played a critical role in preparing them for the future and described a sense of practical and emotional 'relief' associated with the support services made available to them.

CONCLUSION

Our findings emphasise that palliative care can have a positive impact on caregivers' preparedness for providing the care needed by thoracic cancer patients and that this can improve the experiences of both caregivers and patients.

[Palliative care medical consultation in a hematology department. Feedback and critical reflection on a year of practice]

INTRODUCTION

Patients with hematological malignancies have less access to palliative care than other cancer patients, and benefit from it later in the course of their disease, though symptom burden is just as heavy.

METHODS

We created a specialized outpatient palliative care consultation in the hematology department to improve the quality of patient management and enhance cooperation with hematologists.

RESULTS

We found that though patient characteristics and survival were extremely variable, they all had in common a need for symptom management and care coordination. As a result of the consultation, hematology teams called upon a specialized palliative care multidisciplinary team more often to meet patients hospitalized within their departments, and more patients with hematological malignancies hemopathies were hospitalized in palliative care units.

DISCUSSION

We describe the benefits that can be anticipated when collaboration increases between hematology and palliative care, including early on in the course of disease. It is now up to policy-makers to establish priorities regarding the allocation of health resources, in particular regarding end-of-life. This requires identifying patient needs, optimizing patient access to specialized palliative care, and improving the pertinence of palliative care interventions as they cannot be generalized.