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Petchler CM, Singer-Cohen R, Fisher MC, DeGroot L, Gamper MJ, Nelson KE, Peeler A, Koirala B, Morrison M, Abshire Saylor M, Sloan D, Wright R. Palliative Care Research and Clinical Practice Priorities in the United States as Identified by an Interdisciplinary Modified Delphi Approach. J Palliat Med 2024; 27:1135-1145. [PMID: 38726709 DOI: 10.1089/jpm.2023.0664] [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: 09/20/2024] Open
Abstract
Background: Palliative care demands in the United States are growing amid a comparatively small workforce of palliative care clinicians and researchers. Therefore, determining research and clinical practice priorities is essential for streamlining initiatives to advance palliative care science and practice. Objectives: To identify and rank palliative care research and clinical practice priority areas through expert consensus. Design: Using a modified Delphi method, U.S. palliative care experts identified and ranked priority areas in palliative care research and clinical practice. Priorities were thematically grouped and analyzed for topic content and frequency; univariate analysis used the median of each priority item ranking, with a cutoff median of ≤8 indicating >76% agreement for an item's ranking. Results: In total, 27 interdisciplinary pediatric and adult palliative care experts representing 19 different academic institutions and medical centers participated in the preliminary survey and the first Delphi round, and 22 participated in the second Delphi round. The preliminary survey generated 78 initial topics, which were developed into 22 priority areas during the consensus meeting. The top five priorities were (1) access to palliative care, (2) equity in palliative care, (3) adequate financing of palliative care, (4) provision of palliative care in primary care settings, and (5) palliative care workforce challenges. Conclusions: These expert-identified priority areas provide guidance for researchers and practitioners to develop innovative models, policies, and interventions, thereby enriching the quality of life for those requiring palliative care services.
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Affiliation(s)
- Claire M Petchler
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | - Marlena C Fisher
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Lyndsay DeGroot
- Department of General internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mary Jo Gamper
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Katie E Nelson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Binu Koirala
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Megan Morrison
- Department of Geriatrics & Palliative Medicine, Inova Health System Geriatrics & Palliative Medicine, Falls Church, Virginia, USA
| | | | - Danetta Sloan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca Wright
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Ernecoff NC, Anhang Price R, Klein DJ, Haviland AM, Saliba D, Orr N, Gildner J, Gaillot S, Elliott MN. Which medicare advantage enrollees are at highest one-year mortality risk? Arch Gerontol Geriatr 2024; 124:105454. [PMID: 38703702 DOI: 10.1016/j.archger.2024.105454] [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: 02/09/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND While a number of tools exist to predict mortality among older adults, less research has described the characteristics of Medicare Advantage (MA) enrollees at higher risk for 1 year mortality. OBJECTIVES To describe the characteristics of MA enrollees at higher mortality risk using patient survey data. RESEARCH DESIGN Retrospective cohort. SUBJECTS MA enrollees completing the 2019 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. MEASURES Linked demographic, health, and mortality data from a sample of MA enrollees were used to predict 1-year mortality risk and describe enrollee characteristics across levels of predicted mortality risk. RESULTS The mortality model had a 0.80 c-statistic. Mortality risks were skewed: 6 % of enrollees had a ≥ 10 % 1-year mortality risk, while 45 % of enrollees had 1 % to < 5 % 1-year mortality risk. Among the high-risk (≥10 %) group, 47 % were age 85+ versus 12 % among those with mortality risk <5 %. 79 % were in fair or poor self-rated health versus 29 % among those with mortality risk of <5 %. 71 % reported needing urgent care in the prior 6 months versus 40 % among those with a mortality risk of 1 to<5 %. CONCLUSIONS Relatively few older adults enrolled in MA are at high 1-year mortality risk. Nonetheless, MA enrollees over age 85, in fair or poor health, or with recent urgent care needs are far more likely to be in a high mortality risk group.
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Affiliation(s)
- Natalie C Ernecoff
- RAND Corporation, 4570 Fifth Avenue Suite 600, Pittsburgh, PA 15213, United States
| | | | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Amelia M Haviland
- RAND Corporation and Carnegie Mellon University, 4800 Forbes Avenue, Hamburg Hall 2214, Pittsburgh, PA 15213, United States
| | - Debra Saliba
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States; University of California Los Angeles Borun Center, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095, United States; Los Angeles Veterans Administration GRECC, Los Angeles, CA, United States
| | - Nate Orr
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Jennifer Gildner
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244, United States
| | - Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States.
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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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Minato M, Kosaka S, Higuchi M, Ouchi K. Palliative care screening tools in Japan: cross-sectional utility study. BMJ Support Palliat Care 2024:spcare-2023-004761. [PMID: 38395600 DOI: 10.1136/spcare-2023-004761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES In Japan's ageing society, the utility of US-based and UK-based palliative care screening tools in the inpatient setting is unknown. The purpose of this study is to identify the unmet palliative care needs of patients who are admitted to an acute care hospital using the US-based and UK-based screening tools. METHODS This single-centre, cross-sectional study included patients who were admitted to an acute care hospital in Tokyo, Japan, from November 2019 to January 2020. We used the Supportive and Palliative Care Indicator Tool and Palliative Care Screening Tool in the Emergency Department among admitted patients. RESULTS 126 patients (51.6%) were screened positive in total. Among these patients, the main comorbid conditions were dementia/frailty (85.7%) and neurological disease (50.8%). CONCLUSIONS One out of every two internal medicine inpatients at acute care hospitals may have palliative care needs. Given the lack of adequate palliative care workforce in Japan, a modified screening tool to capture the most high-risk patients may be necessary.
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Affiliation(s)
- Mami Minato
- Division of General Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Japan
| | - Shintaro Kosaka
- Division of Internal Medicine, Nerima Hikarigaoka Hospital, Nerima-ku, Tokyo, Japan
| | - Masaya Higuchi
- Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Slotina E, Ditscheid B, Meissner F, Marschall U, Wedding U, Freytag A. A refined ICD-10 diagnoses-based approach for retrospective analysis of potential palliative care need and coverage in claims data of deceased. SAGE Open Med 2024; 12:20503121241269599. [PMID: 39144525 PMCID: PMC11322944 DOI: 10.1177/20503121241269599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/24/2024] [Indexed: 08/16/2024] Open
Abstract
Objectives ICD-10-based approaches often provide the basis for retrospective estimation of potential palliative care need. Applying the ICD-10-based Murtagh et al. classification from 2014 (Murtagh classification), developed using mortality data, to administrative claims data leads to inconsistencies in estimating palliative care need. The aim of the study was to refine the classification for palliative care need estimation in deceased individuals with cancer and non-cancer diagnosis. Methods A retrospective population-based study comparing Murtagh classification to a new ICD-10-based classification (revised by expert opinion) was conducted using outpatient and inpatient claims data, including billing codes for palliative care. Palliative care need was estimated for diagnoses groups and was contrasted with palliative care utilization rates in the last year of life. Our dataset included records of 417,405 individuals who deceased in 2016-2019. Results Out of individuals deceased in 2019 (n = 117,436), 81.4% had at least one diagnosis from the new classification, while 97.0% had at least one diagnosis from the Murtagh classification. Classification revision thus identified fewer individuals as potentially in need of palliative care. Among individuals with cancer, 70.7% (vs. 55.7% via Murtagh classification) received palliative care. In non-cancer subgroups, the utilization rate was considerably lower, with a maximum of 36.7% (vs. 33.7% via Murtagh classification) in 2019. Similar results were observed for the other years. Conclusion Compared to the ICD10-based Murtagh classification, the revised ICD-10-based classification enables more realistic estimations if the cause of death is unavailable and reveals higher rates of palliative care coverage and differences especially in cancer versus non-cancer diseases. German Clinical Trials Register (DRKS00024133).
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Affiliation(s)
- Ekaterina Slotina
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Bianka Ditscheid
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Franziska Meissner
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Ursula Marschall
- Barmer Institute for Health Systems Research, Berlin, Wuppertal, Germany
| | - Ulrich Wedding
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
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Bourmorck D, Pétré B, de Saint-Hubert M, De Brauwer I. Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission. BMC Health Serv Res 2024; 24:773. [PMID: 38956595 PMCID: PMC11218079 DOI: 10.1186/s12913-024-11242-2] [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: 01/24/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Nearly three out of four older people will use the emergency department (ED) during their last year of life. However, most of them do not benefit from palliative care. Providing palliative care is a real challenge for ED clinicians who are trained in acute, life-saving medicine. Our aim is to understand the ED's role in providing palliative care for this population. METHODS We designed a qualitative study based on 1) interviews - conducted with older patients (≥ 75 years) with a palliative profile and their informal caregivers - and 2) focus groups - conducted with ED and primary care nurses and physicians. Palliative profiles were defined by the Supportive and Palliative Indicators tool (SPICT). Qualitative data was collected in French-speaking Belgium between July 2021 and July 2022. We used a constant inductive and comparative analysis. RESULTS Five older patients with a palliative profile, four informal caregivers, 55 primary and ED caregivers participated in this study. A priori, the participants did not perceive any role for the ED in palliative care. In fact, there is widespread discomfort with caring for older patients and providing palliative care. This is explained by multiple areas of tensions. Palliative care is an approach fraught with pitfalls, i.e.: knowledge and know-how gaps, their implementation depends on patients'(co)morbidity profile and professional values, experiences and type of practice. In ED, there are constant tensions between emergency and palliative care requirements, i.e.: performance, clockwork and needs for standardised procedures versus relational care, time and diversity of palliative care projects. However, even though the ED's role in palliative care is not recognised at first sight, we highlighted four roles assumed by ED caregivers: 1) Investigator, 2) Objectifier, 3) Palliative care provider, and 4) Decision-maker on the intensity of care. A common perception among participants was that ED caregivers can assist in the early identification of patients with a palliative profile. CONCLUSIONS Currently, there is widespread discomfort regarding ED caregivers caring for older patients and providing palliative care. Nonetheless, ED caregivers play four roles in palliative care for older patients. In the future, ED caregivers might also perform the role of early identifier.
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Affiliation(s)
- Delphine Bourmorck
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
| | - Benoit Pétré
- Department of Public Health Sciences, Faculty of Medecine, University of Liège, Liège, Belgium
| | - Marie de Saint-Hubert
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- CHU-UCL Namur, Yvoir, Belgium
| | - Isabelle De Brauwer
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Department of Geriatric Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Mahura M, Karle B, Sayers L, Dick-Smith F, Elliott R. Use of the supportive and palliative care indicators tool (SPICT™) for end-of-life discussions: a scoping review. BMC Palliat Care 2024; 23:119. [PMID: 38750464 PMCID: PMC11097449 DOI: 10.1186/s12904-024-01445-z] [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: 08/17/2023] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In order to mitigate the distress associated with life limiting conditions it is essential for all health professionals not just palliative care specialists to identify people with deteriorating health and unmet palliative care needs and to plan care. The SPICT™ tool was designed to assist with this. AIM The aim was to examine the impact of the SPICT™ on advance care planning conversations and the extent of its use in advance care planning for adults with chronic life-limiting illness. METHODS In this scoping review records published between 2010 and 2024 reporting the use of the SPICT™, were included unless the study aim was to evaluate the tool for prognostication purposes. Databases searched were EBSCO Medline, PubMed, EBSCO CINAHL, APA Psych Info, ProQuest One Theses and Dissertations Global. RESULTS From the search results 26 records were reviewed, including two systematic review, two theses and 22 primary research studies. Much of the research was derived from primary care settings. There was evidence that the SPICT™ assists conversations about advance care planning specifically discussion and documentation of advance care directives, resuscitation plans and preferred place of death. The SPICT™ is available in at least eight languages (many versions have been validated) and used in many countries. CONCLUSIONS Use of the SPICT™ appears to assist advance care planning. It has yet to be widely used in acute care settings and has had limited use in countries beyond Europe. There is a need for further research to validate the tool in different languages.
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Affiliation(s)
| | | | - Louise Sayers
- Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia
| | | | - Rosalind Elliott
- Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia.
- University of Technology Sydney, Ultimo, Sydney, NSW, Australia.
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Murray SA, Boyd K, Moine S, Kendall M, Macpherson S, Mitchell G, Amblàs-Novellas J. Using illness trajectories to inform person centred, advance care planning. BMJ 2024; 384:e067896. [PMID: 38428953 DOI: 10.1136/bmj-2021-067896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Scott A Murray
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Kirsty Boyd
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Sebastien Moine
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
- Health Education and Practices Laboratory, University of Paris 13, Bobigny, France
| | - Marilyn Kendall
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Stella Macpherson
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
- patient author, UK
| | | | - Jordi Amblàs-Novellas
- Central Catalonia Chronicity Research Group, Faculty of Medicine, University of Vic-Central University of Catalonia, 08500 Vic, Spain
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Bracci EL, Barnett AG, Brown C, Callaway L, Cardona M, Carter HE, Graves N, Hillman K, Lee XJ, McPhail SM, White BP, Willmott L, Harvey G. Process evaluation of a tailored nudge intervention to promote appropriate care and treatment of older patients at the end-of-life. BMC Geriatr 2024; 24:202. [PMID: 38413877 PMCID: PMC10900675 DOI: 10.1186/s12877-024-04818-4] [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: 08/16/2023] [Accepted: 02/16/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Non-beneficial treatment affects a considerable proportion of older people in hospital, and some will choose to decline invasive treatments when they are approaching the end of their life. The Intervention for Appropriate Care and Treatment (InterACT) intervention was a 12-month stepped wedge randomised controlled trial with an embedded process evaluation in three hospitals in Brisbane, Australia. The aim was to increase appropriate care and treatment decisions for older people at the end-of-life, through implementing a nudge intervention in the form of a prospective feedback loop. However, the trial results indicated that the expected practice change did not occur. The process evaluation aimed to assess implementation using the Consolidated Framework for Implementation Research, identify barriers and enablers to implementation and provide insights into the lack of effect of the InterACT intervention. METHODS Qualitative data collection involved 38 semi-structured interviews with participating clinicians, members of the executive advisory groups overseeing the intervention at a site level, clinical auditors, and project leads. Online interviews were conducted at two times: implementation onset and completion. Data were coded to the Consolidated Framework for Implementation Research and deductively analysed. RESULTS Overall, clinicians felt the premise and clinical reasoning behind InterACT were strong and could improve patient management. However, several prominent barriers affected implementation. These related to the potency of the nudge intervention and its integration into routine clinical practice, clinician beliefs and perceived self-efficacy, and wider contextual factors at the health system level. CONCLUSIONS An intervention designed to change clinical practice for patients at or near to end-of-life did not have the intended effect. Future interventions targeting this area of care should consider using multi-component strategies that address the identified barriers to implementation and clinician change of practice. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry (ANZCTR), ACTRN12619000675123p (approved 06/05/2019).
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Affiliation(s)
- Ella L Bracci
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Adrian G Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Christine Brown
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Leonie Callaway
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Health Care, Bond University, Robina, Queensland, Australia
- School of Psychology, University of Queensland, Herston, Queensland, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Duke-NUS Postgraduate Medical School, National University of Singapore, Singapore, Singapore
| | - Kenneth Hillman
- School of Clinical Medicine, UNSW Medicine & Health, Southwest Sydney Clinical Campuses, Discipline of Critical Care, Sydney, NSW, Australia
| | - Xing J Lee
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Ben P White
- Australia Centre for Heath Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lindy Willmott
- Australia Centre for Heath Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gillian Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Leach I, Mayland CR, Turner N, Mitchell S. Understanding patient views and experiences of the IDENTIfication of PALLiative care needs (IDENTI-PALL): a qualitative interview study. Br J Gen Pract 2024; 74:e88-e95. [PMID: 38191566 PMCID: PMC10792441 DOI: 10.3399/bjgp.2023.0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/13/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Palliative care improves quality of life for people with life-threatening illnesses. There are longstanding inequalities in access to palliative care, with many people never identified as having palliative care needs, particularly frail older people, those with non-malignant disease, and people from ethnic minority backgrounds. Little is known about the process of identification of palliative care needs from a patient perspective. AIM To provide new understanding into patient views and experiences of the process of identification of palliative care needs, and to explore the impact of identification on health care, if any, from a patient perspective. DESIGN AND SETTING A qualitative interview study undertaken with patients and family carers in a major UK city. METHOD Semi-structured interviews were carried out with patients (and/or family carers) identified as being on general practice palliative care registers. An inductive thematic analysis was conducted to explore the data. RESULTS Eleven participants were recruited: eight patients and three family carers. The following three interrelated themes were identified: 1) misconceptions about palliative care and unshared prognostic uncertainty hinder the identification of palliative care needs; 2) a compassionate, timely approach is required for identification of palliative care needs, with or without an identification tool; and 3) identification of palliative care needs is beneficial where it leads to proactive holistic care. CONCLUSION A compassionate approach, sharing of prognostic uncertainty, and proactive primary care are key to timely, beneficial identification of palliative care needs. Future policy should ensure that identification is an adaptable, personalised process to meet the individual needs of people with advanced serious illnesses.
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Affiliation(s)
- Isabel Leach
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield
| | - Catriona R Mayland
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield
| | - Nicola Turner
- School of Health Sciences, University of Nottingham, Nottingham
| | - Sarah Mitchell
- Division of Primary Care, Palliative Care and Public Health, University of Leeds, Leeds
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Bouri M, Sakellari E, Krentiris D, Lagiou A. Palliative Care in the Community: The Greek Version of the Supportive and Palliative Care Indicators Tool (SPICT™). J Prim Care Community Health 2024; 15:21501319241245842. [PMID: 38605629 PMCID: PMC11010743 DOI: 10.1177/21501319241245842] [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: 12/28/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION/OBJECTIVES Systematic identification of persons with palliative care needs constitutes a major challenge for promoting palliative care in all levels of the health system, including primary care. The aim of this study was to translate, cross-culturally adapt, and content validate Supportive and Palliative Care Indicators Tool (SPICT) for use in the Greek primary care context. Secondary objectives were to probe the use of SPICT-GR in exemplary case vignettes, to discuss the clarity and comprehensibility of its content as well as the appropriateness, acceptability, and feasibility of the tool within the Greek primary care. METHODS The Greek translation and cross-cultural adaptation of SPICT™ followed World Health Organization recommendations for translation and adaptation of instruments. For this purpose a working group was set up consisting of 2 senior researchers, a primary care professional with postgraduate training in Palliative Medicine and a general practitioner (GP) with special interest in primary palliative care. Three focus groups comprised of health professionals (n = 23) working in primary care settings participated in the pilot testing phase. Participants also completed a questionnaire including rating their perceptions on tool's utility and feasibility as well as on the clarity and relevance of its items. Thematic analysis was used for focus groups discussions on how the tool was perceived and interpreted by health professionals in a Greek healthcare context and descriptive statistics for the quantitative analysis of the questionnaire data. RESULTS The majority assessed the tool as useful (65%), considered its implementation in primary care as feasible (91%) and rated its items as "relevant" or "very relevant" and "clear" or "very clear." Three themes emerged from focus groups discussions: Guiding clinical practice and facilitating collaboration; promoting comprehensive care and awareness for palliative care; applicability in and suitability for primary care. CONCLUSIONS SPICT-GR™ was identified as a practical and applicable tool for primary care, a source of guidance for the comprehensive identification of patients' palliative care needs, promoting awareness on palliative care and facilitating a shared language among health care professionals.
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Affiliation(s)
| | | | - Dimitrios Krentiris
- Health Center of Salamina, 2nd Regional Health Authority of Piraeus and the Aegean, Greece
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van der Stap L, de Heij AH, van der Heide A, Reyners AK, van der Linden YM. Clinical decision support system to optimise symptom management in palliative medicine: focus group study. BMJ Support Palliat Care 2023; 13:e397-e407. [PMID: 34272271 DOI: 10.1136/bmjspcare-2021-002940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/27/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Suboptimal symptom control in patients with life-limiting illnesses is a major issue. A clinical decision support system (CDSS) that combines a patient-reported symptom assessment scale (SAS) and guideline-based individualised recommendations has the potential to improve symptom management. However, lacking end-user acceptance often prevents CDSS use in daily practice.We aimed to evaluate the acceptability and feasibility of a palliative care CDSS according to its targeted end-users. METHODS Six focus groups with different groups of stakeholders were conducted: (1) patient representatives; (2) community nurses; (3) hospital nurses; (4) general practitioners; (5) hospital physicians and (6) palliative care specialists. Audiotapes were transcribed verbatim and thematically analysed. RESULTS Fifty-one stakeholders (6-12 per focus group) participated. Six themes were discussed: effect, validity, continuity, practical usability, implementation and additional features. All participants expected a CDSS to improve symptom management, for example, by reminding clinicians of blind spots and prompting patient participation. They feared interference with professional autonomy of physicians, doubted the validity of using a patient-reported SAS as CDSS input and thought lacking care continuity would complicate CDSS use. Clinicians needed clear criteria for when to use the CDSS (eg, life-limiting illness, timing in illness trajectory). Participants preferred a patient-coordinated system but were simultaneously concerned patients may be unwilling or unable to fill out an SAS. CONCLUSIONS A palliative care CDSS was considered useful for improving symptom management. To develop a feasible system, barriers for successful implementation must be addressed including concerns about using a patient-reported SAS, lacking care continuity and unclear indications for use.
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Affiliation(s)
- Lotte van der Stap
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert H de Heij
- Center of Expertise for Palliative Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anna Kl Reyners
- Center of Expertise for Palliative Care/Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvette M van der Linden
- Center of Expertise in Palliative Care/Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
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13
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Bischoff KE, Vanegas G, O'Riordan DL, Sumser B, Long J, Lin J, Berkey AR, Kobayashi E, Zapata C, Rabow MW, Pantilat SZ. A Systematic Approach to Assessing and Addressing Palliative Care Needs in an Outpatient Population. J Pain Symptom Manage 2023; 66:270-280.e8. [PMID: 37380147 DOI: 10.1016/j.jpainsymman.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
CONTEXT/OBJECTIVES A critical frontier for palliative medicine is to develop systems to routinely and equitably address the palliative care (PC) needs of seriously ill populations. METHODS An automated screen identified Medicare primary care patients who had serious illness based on diagnosis codes and utilization patterns. A stepped-wedge design was used to evaluate a six-month intervention through which a healthcare navigator assessed these seriously ill patients and their care partners for PC needs in the domains of 1) physical symptoms, 2) emotional distress, 3) practical concerns, and 4) advance care planning (ACP) via telephone surveys. Identified needs were addressed with tailored PC interventions. RESULTS A total of 292/2175 (13.4%) patients screened positive for serious illness. A total of 145 completed an intervention phase; 83 completed a control phase. Severe physical symptoms were identified in 27.6%, emotional distress in 57.2%, practical concerns in 37.2%, and ACP needs in 56.6%. Twenty-five intervention patients (17.2%) were referred to specialty PC compared to six control patients (7.2%). Prevalence of ACP notes increased 45.5%-71.7% (p = 0.001) during the intervention and remained stable during the control phase. Quality of life remained stable during the intervention and declined 7.4/10-6.5/10 (P =0.04) during the control phase. CONCLUSION Through an innovative program, patients with serious illness were identified from a primary care population, assessed for PC needs, and offered specific services to meet those needs. While some patients were appropriate for specialty PC, even more needs were addressed without specialty PC. The program resulted in increased ACP and preserved quality of life.
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Affiliation(s)
- Kara E Bischoff
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA.
| | - Gabriela Vanegas
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - David L O'Riordan
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Bridget Sumser
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Judy Long
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Jessica Lin
- University Medical Partners (J.L.), Stanford Healthcare, Stanford, California, USA
| | - Ann R Berkey
- The Berkey Group (A.R.B.), San Francisco, California, USA
| | - Edward Kobayashi
- Department of Family and Community Medicine (E.K.), University of California, San Francisco, San Francisco, California, USA
| | - Carly Zapata
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Michael W Rabow
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
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Serra S, Spampinato MD, Riccardi A, Guarino M, Fabbri A, Orsi L, De Iaco F. Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach. J Clin Med 2023; 12:4357. [PMID: 37445392 DOI: 10.3390/jcm12134357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation.
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Affiliation(s)
- Sossio Serra
- Emergency Department, Maurizio Bufalini Hospital, 47521 Cesena, Italy
| | | | | | - Mario Guarino
- UOC MEU Ospedale CTO-AORN dei Colli Napoli, 80131 Napoli, Italy
| | - Andrea Fabbri
- Emergency Department, AUSL Romagna, Presidio Ospedaliero Morgagni-Pierantoni, 47121 Forlì, Italy
| | - Luciano Orsi
- Palliative Care Physician and Scientific Director of "Rivista Italiane di Cure Palliative", 26013 Crema, Italy
| | - Fabio De Iaco
- Struttura Complessa di Medicina di Emergenza Urgenza Ospedale Maria Vittoria, ASL Città di Torino, 10144 Torino, Italy
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Bourmorck D, de Saint-Hubert M, Desmedt M, Piers R, Flament J, De Brauwer I. SPICT as a predictive tool for risk of 1-year health degradation and death in older patients admitted to the emergency department: a bicentric cohort study in Belgium. BMC Palliat Care 2023; 22:79. [PMID: 37355577 DOI: 10.1186/s12904-023-01201-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 06/20/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Older patients are increasingly showing multi-comorbidities, including advanced chronic diseases. When admitted to the emergency department (ED), the decision to pursue life-prolonging treatments or to initiate a palliative care approach is a challenge for clinicians. We test for the first time the diagnostic accuracy of the Supportive and Palliative Care Indicators Tool (SPICT) in the ED to identify older patients at risk of deteriorating and dying, and timely address palliative care needs. METHODS We conducted a prospective bicentric cohort study on 352 older patients (≥ 75 years) admitted to two EDs in Belgium between December 2019 and March 2020 and between August and November 2020. SPICT (French version, 2019) variables were collected during the patients' admission to the ED, along with socio-demographic, medical and functional data. The palliative profile was defined as a positive SPICT assessment. Survival, symptoms and health degradation (≥ 1 point in ADL Katz score or institutionalisation and death) were followed at 12 months by phone. Main accuracy measures were sensitivity, specificity and likelihood ratios (LR) as well as cox regression, survival analysis using the Kaplan Meier method, and ordinal regression. RESULTS Out of 352 patients included in the study (mean age 83 ± 5.5 years, 43% male), 167 patients (47%) had a positive SPICT profile. At one year follow up, SPICT positive patients presented significantly more health degradation (72%) compared with SPICT negative patients (35%, p < 0.001). SPICT positivity was correlated with 1-year health degradation (OR 4.9; p < 0.001). The sensitivity and specificity of SPICT to predict health degradation were 0.65 (95%CI, 0.57-0.73) and 0.72 (95%CI, 0.64-0.80) respectively, with a negative LR of 0.48 (95%CI, 0.38-0.60) and a positive LR of 2.37 (1.78-3.16). The survival time was shorter in SPICT positive patients than in SPICT negative ones (p < 0.001), the former having a higher 1-year mortality rate (HR = 4.21; p < 0.001). CONCLUSIONS SPICT successfully identifies older patients at high risk of health degradation and death. It can support emergency clinicians to identify older patients with a palliative profile and subsequently initiate a palliative care approach with a discussion on goals of care.
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Affiliation(s)
- Delphine Bourmorck
- Institut de Recherche Santé et Société, Université catholique de Louvain (UCLouvain), Clos Chapelle-aux-Champs, 30, Bruxelles, 1200, Belgium.
| | - Marie de Saint-Hubert
- Institut de Recherche Santé et Société, Université catholique de Louvain (UCLouvain), Clos Chapelle-aux-Champs, 30, Bruxelles, 1200, Belgium
- Centre Hospitalier Universitaire - UCL - Namur, Avenue Gaston Thérasse 1, Yvoir, 5530, Belgium
| | - Marianne Desmedt
- Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, Bruxelles, 1200, Belgium
| | - Ruth Piers
- Department of Geriatrics, Ghent University Hospital, C. Heymanslaan 10, Ghent, Gent, 9000, Belgium
| | - Julien Flament
- Centre Hospitalier Universitaire - UCL - Namur, Avenue Gaston Thérasse 1, Yvoir, 5530, Belgium
| | - Isabelle De Brauwer
- Institut de Recherche Santé et Société, Université catholique de Louvain (UCLouvain), Clos Chapelle-aux-Champs, 30, Bruxelles, 1200, Belgium
- Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, Bruxelles, 1200, Belgium
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16
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Cole CS, Roydhouse J, Fink RM, Ozkaynak M, Carpenter JG, Plys E, Wan S, Levy CR. Identifying Nursing Home Residents with Unmet Palliative Care Needs: A Systematic Review of Screening Tool Measurement Properties. J Am Med Dir Assoc 2023; 24:619-628.e3. [PMID: 37030323 PMCID: PMC10156164 DOI: 10.1016/j.jamda.2023.02.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVES Despite common use of palliative care screening tools in other settings, the performance of these tools in the nursing home has not been well established; therefore, the purpose of this review is to (1) identify palliative care screening tools validated for nursing home residents and (2) critically appraise, compare, and summarize the quality of measurement properties. DESIGN Systematic review of measurement properties consistent with Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. SETTINGS AND PARTICIPANTS Embase (Ovid), MEDLINE (PubMed), CINAHL (EBSCO), and PsycINFO (Ovid) were searched from inception to May 2022. Studies that (1) reported the development or evaluation of a palliative care screening tool and (2) sampled older adults living in a nursing home were included. METHODS Two reviewers independently screened, selected, extracted data, and assessed risk of bias. RESULTS We identified only 1 palliative care screening tool meeting COSMIN criteria, the NECesidades Paliativas (NEC-PAL, equivalent to palliative needs in English), but evidence for use with nursing home residents was of low quality. The NEC-PAL lacked robust testing of measurement properties such as reliability, sensitivity, and specificity in the nursing home setting. Construct validity through hypothesis testing was adequate but only reported in 1 study. Consequently, there is insufficient evidence to guide practice. Broadening the criteria further, this review reports on 3 additional palliative care screening tools identified during the search and screening process but which were excluded during full-text review for various reasons. CONCLUSION AND IMPLICATIONS Given the unique care environment of nursing homes, we recommend future studies to validate available tools and develop new instruments specifically designed for nursing home use. In the meantime, we recommend that clinicians consider the evidence presented here and choose a screening instrument that best meets their needs.
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Affiliation(s)
- Connie S Cole
- University of Colorado School of Medicine, Aurora, CO, USA.
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Regina M Fink
- University of Colorado School of Medicine, Aurora, CO, USA; University of Colorado College of Nursing, Aurora, CO, USA
| | | | | | - Evan Plys
- Massachusetts General Hospital, Boston, MA, USA
| | - Shaowei Wan
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Cari R Levy
- University of Colorado School of Medicine, Aurora, CO, USA
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17
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Blanes-Selva V, Asensio-Cuesta S, Doñate-Martínez A, Pereira Mesquita F, García-Gómez JM. User-centred design of a clinical decision support system for palliative care: Insights from healthcare professionals. Digit Health 2023; 9:20552076221150735. [PMID: 36644661 PMCID: PMC9837281 DOI: 10.1177/20552076221150735] [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: 06/30/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
Objective Although clinical decision support systems (CDSS) have many benefits for clinical practice, they also have several barriers to their acceptance by professionals. Our objective in this study was to design and validate The Aleph palliative care (PC) CDSS through a user-centred method, considering the predictions of the artificial intelligence (AI) core, usability and user experience (UX). Methods We performed two rounds of individual evaluation sessions with potential users. Each session included a model evaluation, a task test and a usability and UX assessment. Results The machine learning (ML) predictive models outperformed the participants in the three predictive tasks. System Usability Scale (SUS) reported 62.7 ± 14.1 and 65 ± 26.2 on a 100-point rating scale for both rounds, respectively, while User Experience Questionnaire - Short Version (UEQ-S) scores were 1.42 and 1.5 on the -3 to 3 scale. Conclusions The think-aloud method and including the UX dimension helped us to identify most of the workflow implementation issues. The system has good UX hedonic qualities; participants were interested in the tool and responded positively to it. Performance regarding usability was modest but acceptable.
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Affiliation(s)
- Vicent Blanes-Selva
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain,Vicent Blanes-Selva, Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, 46022, Spain.
| | - Sabina Asensio-Cuesta
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain
| | | | - Felipe Pereira Mesquita
- Divisão de Hematologia, departamento de Clínica Médica, da Universidade Federal de Juiz de Fora, Minas Gerais, Brasil
| | - Juan M. García-Gómez
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain
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Seow H, Bainbridge D, Stajduhar K, Marshall D, Howard M, Brouwers M, Barwich D, Burge F, Kelley ML. Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program. Am J Hosp Palliat Care 2022:10499091221134709. [PMID: 36269212 DOI: 10.1177/10499091221134709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Primary care providers play an important role in providing early palliative care, however they often lack practical supports to operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to help primary care providers offer an early palliative approach to care. The CAPACITI pilot program consisted of 10 facilitated, monthly training sessions, covering identification and assessment, communication, and engaging caregivers and specialists. We present the findings of an evaluation of the pilot program. Method: We conducted a single cohort study of primary care providers who participated in CAPACITI. Study outcomes were the change in the percentage of caseload reported as requiring palliative care and improved confidence in competencies measured on a 20-item, study-created survey. Pre and post survey data were analyzed using paired t-tests. Results: Twenty-two teams representing 127 care providers (including 36 physicians and 28 Nurse Practitioners) completed CAPACITI. Paired comparisons showed a moderate improvement in confidence across the competencies covered (.6 to 1.3 mean improvement across items using seven-point scales, all P < .05). Pre-CAPACITI, clinician prescribers (N = 32) identified a mean of 1.2% of their caseload requiring a palliative approach to care, which increased to 1.6% post-program (P = .02). Said differently, the total group of paired clinician prescribers identified 338 patients as requiring palliative care in their caseloads at baseline vs 482 patients following the intervention, for an overall increase of 144 patients in their collective caseloads. Conclusion: CAPACITI improved self-assessed palliative care identification and provider confidence in core competencies. The program demonstrated potential for building palliative care capacity in primary care teams.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Kelli Stajduhar
- Department of School of Nursing and Institute on Aging and Lifelong Health, 8205University of Victoria, Victoria, BC, Canada
| | - Denise Marshall
- Department of Health Sciences, 62703McMaster University, Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, 152996McMaster University, Hamilton, ON, Canada
| | - Melissa Brouwers
- School of Epidemiology and Public Health, 177403University of Ottawa, Ottawa, ON, Canada
| | - Doris Barwich
- 12358The University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Department of Family Medicine, 152980Dalhousie University, Halifax, NS, Canada
| | - Mary Lou Kelley
- School of Social Work, 157782Lakehead University, Thunder Bay, ON, Canada
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Yuyama EK, Lima NKDC, Ferrioli E, Dos Santos AFJ, Amorim RS, Moriguti JC. Palliative Care in Advanced Alzheimer's Disease Dementia: Evaluation of the Answers Given by Caregivers and Physicians to the Accuracy of Surprise Question, as a Prognostic Tool. Am J Hosp Palliat Care 2022:10499091221121328. [PMID: 35961638 DOI: 10.1177/10499091221121328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Alzheimer's disease (AD) dementia is the sixth leading cause of death in the United States. The surprise question (SQ) "Would you be surprised if this patient were to die within the next 12 months?" was used to identify death-risk patients, who could benefit from palliative care. Objective: To examine the prognostic accuracy of the SQ by physicians and caregivers in outpatients with AD dementia. Methods: This is a longitudinal and prospective study involving 101 patients along 1 year, applying the SAS 9.2 software and adopting a .05 P-value to assess the variables that influenced answers to the accuracy of SQ using the chi-square test. Results: 27 patients (26.7%) died during the follow-up. When caregivers answered the SQ, it presented a 51.8% sensitivity (CI 31.9 - 71.3), a 66.7% negative predictive value (20.7 - 63.6), a 56.2% specificity (CI 29.8 - 80.2), and a 40.9% positive predictive value of (CI 43.0 - 85.4) with a 53.4% accuracy (CI 38.5 - 68.4). When physicians answered, the SQ had an 88.8% sensitivity (CI 70.8 - 97.6), a 40% negative predictive value (CI 5.2 - 85.3), a 12.5% specificity (CI 1.5 - 38.3), a 63.1% positive predictive value (CI 45.9 - 78.1) with a 60.4% accuracy (CI 45.8 - 75). Conclusion: SQ remains a good tool with high sensitivity for the identification of patients with advanced AD dementia when presented to the attending physician for planning palliative advanced care with accuracy of 60.4% and caregivers' accuracy of 53.4%.
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Affiliation(s)
- Erika Kiyomi Yuyama
- Ribeirão Preto Medical School of the University of São Paulo [USP], Ribeirão Preto, Brazil
| | | | - Eduardo Ferrioli
- Ribeirão Preto Medical School of the University of São Paulo [USP], Ribeirão Preto, Brazil
| | | | | | - Julio Cesar Moriguti
- Ribeirão Preto Medical School of the University of São Paulo [USP], Ribeirão Preto, Brazil
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Oishi A, Hamano J, Boyd K, Murray S. Translation and Cross-Cultural Adaptation of the Supportive and Palliative Care Indicators Tool into Japanese: A Preliminary Report. Palliat Med Rep 2022; 3:1-5. [PMID: 36059910 PMCID: PMC9438437 DOI: 10.1089/pmr.2021.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Methods: Results: Conclusion:
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Affiliation(s)
- Ai Oishi
- Primary Care Research Unit, Graduate School of Health Data Science, Yokohama City University, Yokohama, Japan
- Address correspondence to: Ai Oishi, MD, MSc, PhD, Primary Care Research Unit, Graduate School of Health Data Science, Yokohama City University, 22-2 Seto, Kanazawa-ku, Yokohama 236-0027, Japan,
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kirsty Boyd
- Primary Palliative Care Research Group, User Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Scott Murray
- Primary Palliative Care Research Group, User Institute, University of Edinburgh, Edinburgh, United Kingdom
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21
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Mitchell S, Leach I, Turner N, Mayland CR. Understanding patient views and experiences of the IDENTIfication of PALLiative care needs (IDENTI-Pall): a qualitative interview study protocol. BMJ Open 2022; 12:e062500. [PMID: 35697465 PMCID: PMC9196159 DOI: 10.1136/bmjopen-2022-062500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION More people are living with multimorbidity, defined as two or more long-term physical or mental health conditions. Multimorbidity is associated with poor quality of life and high treatment burden. Palliative care identification tools have been developed for use in primary care to seek out patients who could benefit from a palliative approach to their care. There has been little evaluative research on such tools; patient perspectives on the process of identifying their palliative care needs is a significant gap. The aim of this research is to provide new understanding into patient perspectives of the experience of having their palliative care needs identified, and the impact on their healthcare. METHODS AND ANALYSIS This qualitative study will employ semistructured interviews to elicit the views of participants. We will purposively sample 10-12 adults with advanced serious illness who have been identified by their primary care team as having palliative care needs, and/or are receiving care from specialist palliative care services. A family member or carer may be included in an interview at the participant's request. A descriptive, thematic analysis will be carried out using the data analysis software NVivo. ETHICS AND DISSEMINATION Ethical approval has been granted by the North of Scotland Research Ethics Committee. Study findings will be disseminated in peer-reviewed journals and through conference presentations. Other activities include the development of patient-centred outcomes for clinical practice and policy in relation to the use of palliative care identification tools. TRIAL REGISTRATION NUMBER National Institute for Health Research (NIHR) Clinical Studies Portfolio, UK Clinical Research Network (UKCRN) Study number 51296.
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Affiliation(s)
- Sarah Mitchell
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Isabel Leach
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Nicola Turner
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - C R Mayland
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
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22
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Atreya S, Datta S, Salins N. Public Health Perspective of Primary Palliative Care: A Review through the Lenses of General Practitioners. Indian J Palliat Care 2022; 28:229-235. [PMID: 36072244 PMCID: PMC9443115 DOI: 10.25259/ijpc_9_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/30/2022] [Indexed: 11/04/2022] Open
Abstract
The rising trend of chronic life-threatening illnesses is accompanied by an exponential increase in serious health-related suffering. Palliative care is known to ameliorate physical and psychosocial suffering and restore quality of life. However, the contemporary challenges of palliative care delivery, such as changing demographics, social isolation, inequity in service delivery, and professionalisation of dying, have prompted many to adopt a public health approach to palliative care delivery. A more decentralised approach in which palliative care is integrated into primary care will ensure that the care is available locally to those who need it and at a cost that they can afford. General practitioners (GPs) play a pivotal role in providing primary palliative care in the community. They ensure that care is provided in alignment with patients’ and their families’ wishes along the trajectory of the life-threatening illness and at the patient’s preferred place. GPs use an interdisciplinary approach by collaborating with specialist palliative care teams and other healthcare professionals. However, they face challenges in providing end-of-life care in the community, which include identification of patients in need of palliative care, interpersonal communication, addressing patients’ and caregivers’ needs, clarity in roles and responsibilities between GPs and specialist palliative care teams, coordination of service with specialists and lack of confidence in providing palliative care in view of deficiencies in knowledge and skills in palliative care. Multiple training formats and learning styles for GPs in end-of-life care have been explored across studies. The research has yielded mixed results in terms of physician performance and patient outcomes. This calls for more research on GPs’ views on end-of-life care learning preferences, as this might inform policy and practice and facilitate future training programs in end-of-life care.
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Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psycho-oncology, Tata Medical Center, Kolkata, India,
| | - Soumitra Datta
- Department of Palliative Care and Psycho-oncology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
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23
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Tros W, van der Steen JT, Liefers J, Akkermans R, Schers H, Numans ME, van Peet PG, Groenewoud AS. General practitioners' evaluations of optimal timing to initiate advance care planning for patients with cancer, organ failure, or multimorbidity: A health records survey study. Palliat Med 2022; 36:510-518. [PMID: 34965754 PMCID: PMC8972953 DOI: 10.1177/02692163211068692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Appropriate timing to initiate advance care planning is difficult, especially for individuals with non-malignant disease in community settings. AIM To identify the optimal moment for, and reasons to initiate advance care planning in different illness trajectories. DESIGN AND METHODS A health records survey study; health records were presented to 83 GPs with request to indicate and substantiate what they considered optimal advance care planning timing within the 2 years before death. We used quantitative and qualitative analyses. SETTING AND PATIENTS We selected and anonymized 90 health records of patients who died with cancer, organ failure or multimorbidity, from a regional primary care registration database in the Netherlands. RESULTS The median optimal advance care planning timing according to the GPs was 228 days before death (interquartile range 392). This moment was closer to death for cancer (87.5 days before death, IQR 302) than for organ failure (266 days before death, IQR 401) and multimorbidity (290 days before death, IQR 389) (p < 0.001). The most frequently mentioned reason for cancer was "receiving a diagnosis" (21.5%), for organ failure it was "after a period of illness" (14.7%), and for multimorbidity it was "age" and "patients" expressed wishes or reflections' (both 12.0%). CONCLUSION The optimal advance care planning timing and reasons to initiate advance care planning indicated by GPs differ between patients with cancer and other illnesses, and they also differ between GPs. This suggests that "the" optimal timing for ACP should be seen as a "window of opportunity" for the different disease trajectories.
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Affiliation(s)
- Willemijn Tros
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janine Liefers
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Petra G van Peet
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - A Stef Groenewoud
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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24
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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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25
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Owusuaa C, Dijkland SA, Nieboer D, van der Heide A, van der Rijt CCD. Predictors of Mortality in Patients with Advanced Cancer-A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:328. [PMID: 35053493 PMCID: PMC8774229 DOI: 10.3390/cancers14020328] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
To timely initiate advance care planning in patients with advanced cancer, physicians should identify patients with limited life expectancy. We aimed to identify predictors of mortality. To identify the relevant literature, we searched Embase, MEDLINE, Cochrane Central, Web of Science, and PubMed databases between January 2000-April 2020. Identified studies were assessed on risk-of-bias with a modified QUIPS tool. The main outcomes were predictors and prediction models of mortality within a period of 3-24 months. We included predictors that were studied in ≥2 cancer types in a meta-analysis using a fixed or random-effects model and summarized the discriminative ability of models. We included 68 studies (ranging from 42 to 66,112 patients), of which 24 were low risk-of-bias, and 39 were included in the meta-analysis. Using a fixed-effects model, the predictors of mortality were: the surprise question, performance status, cognitive impairment, (sub)cutaneous metastases, body mass index, comorbidity, serum albumin, and hemoglobin. Using a random-effects model, predictors were: disease stage IV (hazard ratio [HR] 7.58; 95% confidence interval [CI] 4.00-14.36), lung cancer (HR 2.51; 95% CI 1.24-5.06), ECOG performance status 1+ (HR 2.03; 95% CI 1.44-2.86) and 2+ (HR 4.06; 95% CI 2.36-6.98), age (HR 1.20; 95% CI 1.05-1.38), male sex (HR 1.24; 95% CI 1.14-1.36), and Charlson comorbidity score 3+ (HR 1.60; 95% CI 1.11-2.32). Thirteen studies reported on prediction models consisting of different sets of predictors with mostly moderate discriminative ability. To conclude, we identified reasonably accurate non-tumor specific predictors of mortality. Those predictors could guide in developing a more accurate prediction model and in selecting patients for advance care planning.
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Affiliation(s)
- Catherine Owusuaa
- Department of Medical Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands;
| | - Simone A. Dijkland
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (S.A.D.); (D.N.); (A.v.d.H.)
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (S.A.D.); (D.N.); (A.v.d.H.)
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (S.A.D.); (D.N.); (A.v.d.H.)
| | - Carin C. D. van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands;
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26
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White N, Oostendorp LJ, Vickerstaff V, Gerlach C, Engels Y, Maessen M, Tomlinson C, Wens J, Leysen B, Biasco G, Zambrano S, Eychmüller S, Avgerinou C, Chattat R, Ottoboni G, Veldhoven C, Stone P. An online international comparison of palliative care identification in primary care using the Surprise Question. Palliat Med 2022; 36:142-151. [PMID: 34596445 PMCID: PMC8796152 DOI: 10.1177/02692163211048340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Surprise Question ('Would I be surprised if this patient died within 12 months?') identifies patients in the last year of life. It is unclear if 'surprised' means the same for each clinician, and whether their responses are internally consistent. AIM To determine the consistency with which the Surprise Question is used. DESIGN A cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries ('vignettes'). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]-100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently 'no') and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213. SETTING/PARTICIPANTS Registered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes. RESULTS Participants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries (p = 0.002). There was also a difference in threshold levels depending on age of clinician, for every yearly increase, participants had a higher threshold. There was no difference in inconsistency between countries (p = 0.53). CONCLUSIONS There is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted.
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Affiliation(s)
- Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Linda Jm Oostendorp
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Christina Gerlach
- Palliative Care Unit, Department of Oncology, Hematology and BMT, and Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Interdisciplinary Palliative Care Unit, Department of Hematology, Oncology, and Pneumology, University Medical Center, Mainz, Germany
| | - Yvonne Engels
- Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maud Maessen
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christopher Tomlinson
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Johan Wens
- Department Family Medicine and Population Health (FamPop), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Bert Leysen
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Guido Biasco
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna & Academy of the Sciences of Palliative Medicine, Bologna, Italy
| | - Sofia Zambrano
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Eychmüller
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Christina Avgerinou
- Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Carel Veldhoven
- Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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27
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Teike Lüthi F, MacDonald I, Rosselet Amoussou J, Bernard M, Borasio GD, Ramelet AS. Instruments for the identification of patients in need of palliative care in the hospital setting: a systematic review of measurement properties. JBI Evid Synth 2021; 20:761-787. [PMID: 34812189 DOI: 10.11124/jbies-20-00555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to provide a comprehensive overview of the measurement properties of the available instruments used by clinicians for identifying adults in need of general or specialized palliative care in hospital settings. INTRODUCTION Identification of patients in need of palliative care has been recognized as an area where many health care professionals need guidance. Differentiating between patients who require general palliative care and patients with more complex conditions who need specialized palliative care is particularly challenging. INCLUSION CRITERIA We included development and validation studies that reported on measurement properties (eg, content validity, reliability, or responsiveness) of instruments used by clinicians for identifying adult patients (>18 years and older) in need of palliative care in hospital settings. METHODS Studies published until March 2020 were searched in four databases: Embase.com, Medline Ovid, PubMed, and CINAHL EBSCO. Unpublished studies were searched in Google Scholar, government websites, hospice websites, the Library Network of Western Switzerland, and WorldCat. The search was not restricted by language; however, only studies published in English or French were eligible for inclusion. The title and abstracts of the studies were screened by two independent reviewers against the inclusion criteria. Full-text studies were reviewed for inclusion by two independent reviewers. The quality of the measurement properties of all included studies were assessed independently by two reviewers according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS Out of the 23 instruments identified, four instruments were included, as reported in six studies: the Center to Advance Palliative Care (CAPC) criteria, the Necesidades Paliativas (NECPAL), the Palliative Care Screening Tool (PCST), and the Supportive and Palliative Care Indicators Tool (SPICT). The overall psychometric quality of all four instruments was insufficient according to the COSMIN criteria, with the main deficit being poor construct description during development. CONCLUSIONS For the early identification of patients needing palliative care in hospital settings, there is poor quality and incomplete evidence according to the COSMIN criteria for the four available instruments. This review highlights the need for further development of the construct being measured. This may be done by conducting additional studies on these instruments or by developing a new instrument for the identification of patients in need of palliative care that addresses the current gaps in construct and structural validity. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020150074.
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Affiliation(s)
- Fabienne Teike Lüthi
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Switzerland Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland Psychiatry Library, Education and Research Department, Lausanne University Hospital and University of Lausanne, Site de Cery, Prilly, Switzerland Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence
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28
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Birgisdóttir D, Duarte A, Dahlman A, Sallerfors B, Rasmussen BH, Fürst CJ. A novel care guide for personalised palliative care - a national initiative for improved quality of care. BMC Palliat Care 2021; 20:176. [PMID: 34763677 PMCID: PMC8582140 DOI: 10.1186/s12904-021-00874-4] [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: 05/04/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Even when palliative care is an integrated part of the healthcare system, the quality is still substandard for many patients and often initiated too late. There is a lack of structured guidelines for identifying and caring for patients; in particular for those with early palliative care needs. A care guide can act as a compass for best practice and support the care of patients throughout their palliative trajectory. Such a guide should both meet the needs of health care professionals and patients and families, facilitating discussion around end-of-life decision-making and enabling them to plan for the remaining time in life. The aim of this article is to describe the development and pilot testing of a novel Swedish palliative care guide. Methods The Swedish Palliative Care Guide (S-PCG) was developed according to the Medical Research Council framework and based on national and international guidelines for good palliative care. An interdisciplinary national advisory committee of over 90 health care professionals together with patient, family and public representatives were engaged in the process. The feasibility was tested in three pilot studies in different care settings. Results After extensive multi-unit and interprofessional testing and evaluation, the S-PCG contains three parts that can be used independently to identify, assess, address, follow up, and document the individual symptoms and care-needs throughout the whole palliative care trajectory. The S-PCG can provide a comprehensive overview and shared understanding of the patients’ needs and possibilities for ensuring optimal quality of life, the family included. Conclusions Based on broad professional cooperation, patients and family participation and clinical testing, the S-PCG provides unique interprofessional guidance for assessment and holistic care of patients with palliative care needs, promotes support to the family, and when properly used supports high-quality personalised palliative care throughout the palliative trajectory. Future steps for the S-PCG, entails scientific evaluation of the clinical impact and effect of S-PCG in different care settings – including implementation, patient and family outcomes, and experiences of patient, family and personnel. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00874-4.
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Affiliation(s)
- Dröfn Birgisdóttir
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden. .,The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.
| | - Anette Duarte
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Anna Dahlman
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden
| | - Bengt Sallerfors
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden
| | - Birgit H Rasmussen
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Faculty of Medicine, Department for Healthcare Sciences, Institute for Palliative Care, Lund University, Lund, Sweden
| | - Carl Johan Fürst
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden.,The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
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29
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Lüthi FT, Bernard M, Gamondi C, Ramelet AS, Borasio GD. ID-PALL: An Instrument to Help You Identify Patients in Need of Palliative Care. PRAXIS 2021; 110:839-844. [PMID: 34814722 DOI: 10.1024/1661-8157/a003788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Palliative care is frequently associated with the end of life and cancer. However, other patients may need palliative care, and this need may be present earlier in the disease trajectory. It is therefore essential to identify at the right time patients who need palliative care and to distinguish between those in need of general palliative care and those for whom a referral to specialists is required. ID-PALL has been developed as an instrument to support professionals in this identification and to discuss a suitable palliative care project, in order to maintain the best quality of life for patients and their relatives. Recommendations for clinical practice are also proposed to guide professionals after the identification phase.
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Affiliation(s)
- Fabienne Teike Lüthi
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - Mathieu Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne
| | - Claudia Gamondi
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne
- Palliative and Supportive Care Service, Istituto Oncologico della Svizzera Italiana, Bellinzona
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Lausanne
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne
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30
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Ngwenya N, Crang C, Farquhar M, Rintoul RC, Mahadeva R, Calvert LD, Murray SA, Barclay S. Communicating uncertainty: contrasting the communication experiences of patients with advanced COPD and incurable lung cancer. Fam Pract 2021; 38:637-643. [PMID: 33871548 PMCID: PMC8604275 DOI: 10.1093/fampra/cmab024] [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: 11/13/2022] Open
Abstract
BACKGROUND Due to the uncertain disease trajectory and variable rate of progression in chronic obstructive pulmonary disease (COPD), health care professionals (HCPs) are challenged in explaining what the future may hold for patients compared to those with lung cancer (LC). Support and communication of timely information can significantly improve health outcomes. OBJECTIVE This study sought to identify factors that impact communication and support and recommend ways to improve patients' understanding of living with life-threatening illness. METHODS Semi-structured interviews with patients with LC (n = 22) and advanced COPD (n = 18), their informal carers (21 LC and 18 COPD) and HCPs (n = 51). Patients were recruited from primary and secondary care in the East of England, UK, during 2010-12. RESULTS Directness and clarity characterized communication in LC, whereas uncertainty and limited explanations predominated in COPD. Discussions on how the disease might impact on decisions and preferences to be made in the future were less common in COPD. Information for LC patients was mainly from hospital clinicians and any information for COPD patients mainly from primary care clinicians. CONCLUSIONS The experience of COPD patients could be improved by professionals soon after diagnosis explaining to them the typical pattern of decline in COPD, highlighting the inherent uncertainties about when exacerbations and death may occur. This conversation should lead to planning for the different challenges that the patient and informal carer recognize as most important to them. This contrasts with the 'breaking bad news' conversation that oncologists are highly trained to deliver.
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Affiliation(s)
- Nothando Ngwenya
- Social Science and Research Ethics Department, Africa Health Research Institute, KwaZulu-Natal, South Africa.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Clare Crang
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Robert C Rintoul
- Department of Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Department of Oncology, University of Cambridge, UK
| | - Ravi Mahadeva
- Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lori D Calvert
- North West Anglia Hospitals NHS Foundation Trust, Cambridgeshire, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, University of Edinburgh, Edinburgh, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Teike Lüthi F, Bernard M, Vanderlinden K, Ballabeni P, Gamondi C, Ramelet AS, Borasio GD. Measurement Properties of ID-PALL, A New Instrument for the Identification of Patients With General and Specialized Palliative Care Needs. J Pain Symptom Manage 2021; 62:e75-e84. [PMID: 33781917 DOI: 10.1016/j.jpainsymman.2021.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/07/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022]
Abstract
CONTEXT To improve access to palliative care, identification of patients in need of general or specialized palliative care is necessary. To our knowledge, no available identification instrument makes this distinction. ID-PALL is a screening instrument developed to differentiate between these patient groups. OBJECTIVE To assess the structural and criterion validity and the inter-rater agreement of ID-PALL. METHODS In this multicenter, prospective, cross-sectional study, nurses and physicians assessed medical patients hospitalized for 2 to 5 days in two tertiary hospitals in Switzerland using ID-PALL. For the criterion validity, these assessments were compared to a clinical gold standard evaluation performed by palliative care specialists. Structural validity, internal consistency and inter-rater agreement were assessed. RESULTS 2232 patients were assessed between January and December 2018, 97% by nurses and 50% by physicians. The variances for ID-PALL G and S are explained by two factors, the first one explaining most of the variance in both cases. For ID-PALL G, sensitivity ranged between 0.80 and 0.87 and specificity between 0.56 and 0.59. ID-PALL S sensitivity ranged between 0.82 and 0.94, and specificity between 0.35 and 0.64. A cut-off value of 1 delivered the optimal values for patient identification. Cronbach's alpha was 0.78 for ID-PALL G and 0.67 for ID-PALL S. The agreement rate between nurses and physicians was 71.5% for ID-PALL G and 64.6% for ID-PALL S. CONCLUSION ID-PALL is a promising screening instrument allowing the early identification of patients in need of general or specialized palliative care. It can be used by nurses and physicians without a specialized palliative care training. Further testing of the finalized clinical version appears warranted.
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Affiliation(s)
- Fabienne Teike Lüthi
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne (F.T.L., M.B., K.V., C.G., G.D.B.), Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital (F.T.L., P.B., A.S.R.), Lausanne, Switzerland.
| | - Mathieu Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne (F.T.L., M.B., K.V., C.G., G.D.B.), Lausanne, Switzerland
| | - Katia Vanderlinden
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne (F.T.L., M.B., K.V., C.G., G.D.B.), Lausanne, Switzerland
| | - Pierluigi Ballabeni
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital (F.T.L., P.B., A.S.R.), Lausanne, Switzerland; Centre for Primary Care and Public Health (Unisanté), University of Lausanne (P.B.), Lausanne, Switzerland
| | - Claudia Gamondi
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne (F.T.L., M.B., K.V., C.G., G.D.B.), Lausanne, Switzerland; Palliative and Supportive Care Service, Oncology Institute of Southern Switzerland (C.G.), Ticino, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital (F.T.L., P.B., A.S.R.), Lausanne, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne (F.T.L., M.B., K.V., C.G., G.D.B.), Lausanne, Switzerland
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Reliability and validity of the Arabic translation of the palliative performance scale. Palliat Support Care 2021; 18:575-579. [PMID: 31699174 DOI: 10.1017/s1478951519000889] [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] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to translate the Palliative Performance Scale (PPSv2) into Arabic and to test the reliability and validity of the PPS Arabic translation (PPS-Arabic). METHOD The PPSv2 was translated into Modern Standard Arabic using a forward-backward method. Inter-rater and intra-rater reliabilities were tested in a pilot study that included 20 patients. The validation study included 150 cancer patients. Patients were divided according to their treatment plan into three groups (in-remission, palliative chemotherapy, and best supportive care) to perform hypothesis-testing construct validity. Validity was further evaluated by correlating PPS-Arabic with the Karnofsky Performance Scale (KPS), the Eastern Cooperative Oncology Group (ECOG) scale, and Physical Functioning (PF2) and Role Functioning (RF2) scales of the European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30). RESULTS The intraclass correlation coefficients for the intra-rater and inter-rater reliability were 0.935 (95% CI: 0.88-0.965; p < 0.001) and 0.965 (95% CI: 0.934-0.981; p < 0.001), respectively. The PPS-Arabic internal consistency Cronbach's alpha was 0.986. The average PPS-Arabic score differed significantly (p < 0.001) between the three groups of patients being 89 for in-remission, 58 for palliative chemotherapy, and 38 for best supportive care. The PPS-Arabic score correlated significantly (p < 0.001) with the KPS, ECOG performance scale, and the EORTC QLQ-C30 PF2 and RF2 scales. CONCLUSION The PPS-Arabic is a reliable and valid tool for the assessment of performance status of cancer patients.
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Oğuz G, Şenel G, Koçak N, Karaca Ş. The Turkish Validity and Reliability Study of Palliative Performance Scale. Asia Pac J Oncol Nurs 2021; 8:413-418. [PMID: 34159234 PMCID: PMC8186388 DOI: 10.4103/apjon.apjon-2111] [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: 02/02/2021] [Accepted: 03/31/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The Palliative Performance Scale version 2 (PPSv2) is a useful tool designed to assess the performance status of palliative care patients. The aim of this study was to translate the PPSv2 into Turkish and to test the validity and reliability of Turkish PPSv2 (PPS-TR) in cancer patients receiving palliative care. METHODS The translation of PPSv2 into Turkish was implemented using a forward-back forward procedure. The patients were allocated from inpatient palliative care unit, consultations from oncology services, palliative care polyclinic, and consultations from emergency unit. The inter-rater and intra-rater reliabilities were tested in a pilot study with 51 patients. The cross-sectional study consisted of 280 patients. The relationship between PPS-TR, Katz Index of Independence in Activities of Daily Living (Katz ADL), and Karnofsky Performance Scale (KPS) was also measured. Construct validity was assessed by observing the test capacity across patient groups based on the place of care. RESULTS Intraclass correlation coefficients (ICCs) at Time 1 and Time 2 were 0.982 (95% confidence interval [CI]: 0.972-0.989) and 0.991 (95% CI: 0.986-0.995). ICCs of intra-rater agreements were at least 0.956 (95% CI: 0.909-0.977) for three raters. KPS, Katz ADL, and PPS-TR scores of outpatients were significantly higher than those of inpatients and emergency. There was a perfect correlation between PPS-TR and KPS, while the correlation of PPS-TR with Katz ADL was almost perfect. CONCLUSIONS The PPS-TR is a reliable and valid tool for assessment of performance status of cancer patients receiving palliative care.
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Affiliation(s)
- Gonca Oğuz
- Department of Anesthesiology, Palliative Care Unit,University of Health Sciences, Dr AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Gülçin Şenel
- Department of Anesthesiology, Palliative Care Unit,University of Health Sciences, Dr AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Nesteren Koçak
- Department of Anesthesiology, Palliative Care Unit,University of Health Sciences, Dr AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Şerife Karaca
- Department of Anesthesiology, Palliative Care Unit,University of Health Sciences, Dr AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Teike Lüthi F, Mabire C, Rosselet Amoussou J, Bernard M, Borasio GD, Ramelet AS. Instruments for the identification of patients in need of palliative care: protocol for a systematic review of measurement properties. JBI Evid Synth 2021; 18:1144-1153. [PMID: 32813369 DOI: 10.11124/jbisrir-d-19-00146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to provide a comprehensive overview of the psychometric properties of available clinician-reported instruments developed to identify patients in need of general and specialized palliative care in acute care settings. INTRODUCTION Identification of patients in need of palliative care has been recognized as an area where many health care professionals need guidance. Differentiating between patients who require general palliative care and patients with more complex conditions who need specialized palliative care is particularly challenging. To our knowledge, no dedicated instruments are available to date to assist health care professionals to make this identification. INCLUSION CRITERIA Included studies will report on i) instruments aiming to identify patients in need of palliative care, ii) adult patients in need of palliative care in acute-care settings, iii) clinician-reported outcome measures, or iv) the development process or one or more of its measurement properties. Studies conducted in intensive care units, emergency departments, or nursing homes will be excluded. METHODS We will search for studies published in English and French in a variety of sources, including Embase, Medline Ovid SP, PubMed, CINAHL EBSCO, Google Scholar, government websites, and hospice websites. All citations will be screened and selected by two independent reviewers. Data extraction, quality assessment, and syntheses of included studies will be performed according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020150074.
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Affiliation(s)
- Fabienne Teike Lüthi
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Lausanne University Hospital, Lausanne, Switzerland
| | - Cédric Mabire
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence
| | - Joëlle Rosselet Amoussou
- Psychiatry Library, Education and Research Department, Lausanne University Hospital and University of Lausanne, Site de Cery, Prilly, Switzerland
| | | | | | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence
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Pocock L, Morris R, French L, Purdy S. Underutilisation of EPaCCS (Electronic Palliative Care Coordination Systems) in end-of life-care: a cross-sectional study. BMJ Support Palliat Care 2021:bmjspcare-2020-002798. [PMID: 33837112 DOI: 10.1136/bmjspcare-2020-002798] [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: 11/11/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To support greater personalisation of end-of-life care, Electronic Palliative Care Coordination Systems (EPaCCS) have been implemented across England. Here, we describe patient factors associated with dying with an EPaCCS record and explore the association between having an EPaCCS record with cause and place of death. METHOD This is a cross-sectional study using routinely collected data. Data were extracted from primary care records in 20 of 86 general practices within one Clinical Commissioning Group in England. All deaths (n=1723) recorded between 22 February 2018 and 21 February 2019 were included to determine whether the deceased patient had an EPaCCS record at the time of death, a range of demographic factors, place of death and cause of death. RESULTS Only 18% of the sample died with an EPaCCS record, and people who died of a non-cancer cause were less likely to have an EPaCCS record than those who died of cancer (OR=0.41; 95% CI 0.31 to 0.55). Adjusting for patient demographic factors and cause of death, having an EPaCCS record was strongly associated with dying in the community (OR=5.10; 95% CI 3.70 to 7.03). CONCLUSIONS A small proportion of this sample died with an EPaCCS record, despite evidence of an association with dying in the community.
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Affiliation(s)
- Lucy Pocock
- Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK
| | - Richard Morris
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Lydia French
- Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK
| | - Sarah Purdy
- Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK
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Goni-Fuste B, Crespo I, Monforte-Royo C, Porta-Sales J, Balaguer A, Pergolizzi D. What defines the comprehensive assessment of needs in palliative care? An integrative systematic review. Palliat Med 2021; 35:651-669. [PMID: 33648403 DOI: 10.1177/0269216321996985] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The comprehensive assessment of needs in palliative care identifies where patients most want attention to guide clinical decisions that tailor care provision from their first encounters. AIM To define how and what needs are identified by the comprehensive assessment of needs in the original peer-reviewed articles in the field of palliative care. DESIGN An integrative systematic review as outlined by Whittemore and Knafl. Quality appraisal performed using the Mixed Methods Appraisal Tool. DATA SOURCES PubMed, CINAHL, PsycINFO, Web of Science databases searched through May 2019 and updated in July 2020. RESULTS Forty-nine articles met inclusion criteria for original articles in English or Spanish reporting comprehensive assessment of needs of adult patients receiving palliative care. The majority (41/49) of studies were moderate to high quality. Two themes were identified: (1) How a comprehensive assessment of needs should be carried out in palliative care, which reflected a preference to develop structured tools for assessment; (2) What needs of patients should be assessed in the comprehensive assessment of needs in palliative care, which conveyed a trend to assess beyond core domains - physical, psychological, social, spiritual - with information and practical most prevalent, but with substantial variation in specifying and classifying needs into domains. CONCLUSIONS The assessment of needs in palliative care is comprehensive but lacks consensus on the needs and domains that should be assessed by the palliative care team. Future studies should better define what needs can be standardized into the assessment to improve process of care and patient satisfaction.
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Affiliation(s)
- Blanca Goni-Fuste
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Monforte-Royo
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Josep Porta-Sales
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain.,Institut Català d'Oncologia Girona, Girona, Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain.,Universitat Internacional de Catalunya, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
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Gallagher E, Carter-Ramirez D, Boese K, Winemaker S, MacLennan A, Hansen N, Hafid A, Howard M. Frequency of providing a palliative approach to care in family practice: a chart review and perceptions of healthcare practitioners in Canada. BMC FAMILY PRACTICE 2021; 22:58. [PMID: 33773579 PMCID: PMC8005234 DOI: 10.1186/s12875-021-01400-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/23/2021] [Indexed: 12/01/2022]
Abstract
Background Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate clinicians’ perceptions of the results. Methods We conducted a descriptive study of deceased patients in an interprofessional team family practice. We integrated conceptual models of a palliative approach to create a chart review tool to capture a palliative approach in the last year of life and assessed a global rating of whether a palliative approach was provided. Clinicians completed a questionnaire before learning the results and after, on perceptions of how often they believed a palliative approach was provided by the team. Results Among 79 patients (mean age at death 73 years, 54% female) cancer and cardiac diseases were the top conditions responsible for death. One-quarter of patients were assessed as having received a palliative approach. 53% of decedents had a documented discussion about goals of care, 41% had nurse involvement, and 15.2% had a discussion about caregiver well-being. These indicators had the greatest discrimination between a palliative approach or not. Agreement that elements of a palliative approach were provided decreased significantly on the clinician questionnaire from before to after viewing the results. Conclusions This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01400-4.
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Affiliation(s)
- Erin Gallagher
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.,Division of Palliative Care, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Daniel Carter-Ramirez
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.,Division of Palliative Care, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Kaitlyn Boese
- Division of Palliative Care, Department of Medicine, University of Ottawa, 451 Smyth, Road Ottawa, Ottawa, ON, K1H 8M5, Canada.,Department of Palliative Care, Bruyere Continuing Care, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
| | - Samantha Winemaker
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.,Division of Palliative Care, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Amanda MacLennan
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.,Division of Palliative Care, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Nicolle Hansen
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Abe Hafid
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
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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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Ermers DJM, Kuip EJM, Veldhoven CMM, Schers HJ, Perry M, Bronkhorst EM, Vissers KCP, Engels Y. Timely identification of patients in need of palliative care using the Double Surprise Question: A prospective study on outpatients with cancer. Palliat Med 2021; 35:592-602. [PMID: 33423610 PMCID: PMC7975860 DOI: 10.1177/0269216320986720] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Surprise Question ("Would I be surprised if this patient were to die within the next 12 months?") is widely used to identify palliative patients, though with low predictive value. To improve timely identification of palliative care needs, we propose an additional Surprise Question ("Would I be surprised if this patient is still alive after 12 months?") if the original Surprise Question is answered with "no." The combination of the two questions is called the Double Surprise Question. AIM To examine the prognostic accuracy of the Double Surprise Question in outpatients with cancer. DESIGN A prospective study. PARTICIPANTS Twelve medical oncologists completed the Double Surprise Question for 379 patients. RESULTS In group 1 (original Surprise Question "yes": surprised if dead) 92.1% (176/191) of the patients were still alive after 1 year, in group 2a (original and additional Surprise Question "no": not surprised if dead and not surprised if alive) 60.0% (63/105), and in group 2b (original Surprise Question "no," additional Surprise Question "yes": surprised if alive) 26.5% (22/83) (p < 0.0001). The positive predictive value increased by using the Double Surprise Question; 74% (61/83) vs 55% (103/188). Anticipatory palliative care provision and Advance Care Planning items were most often documented in group 2b. CONCLUSIONS The Double Surprise Question is a promising tool to more accurately identify outpatients with cancer at risk of dying within 1 year, and therefore, those in need of palliative care. Studies should reveal whether the implementation of the Double Surprise Question leads to more timely palliative care.
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Affiliation(s)
- Daisy JM Ermers
- Department of Anesthesiology, Pain and
Palliative Medicine, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Evelien JM Kuip
- Department of Anesthesiology, Pain and
Palliative Medicine, Radboud University Medical Center, Nijmegen, The
Netherlands
- Department of Medical Oncology, Radboud
University Medical Center, Nijmegen, The Netherlands
| | - CMM Veldhoven
- Department of Anesthesiology, Pain and
Palliative Medicine, Radboud University Medical Center, Nijmegen, The
Netherlands
- General Practice Berg en Dal, Berg en
Dal, The Netherlands
| | - Henk J Schers
- Department of Primary and Community
Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Primary and Community
Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Geriatrics, Radboud
University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Health Evidence, Radboud
University Medical Center, Nijmegen, The Netherlands
| | - Kris CP Vissers
- Department of Anesthesiology, Pain and
Palliative Medicine, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and
Palliative Medicine, Radboud University Medical Center, Nijmegen, The
Netherlands
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Ament SMC, Couwenberg IME, Boyne JJJ, Kleijnen J, Stoffers HEJH, van den Beuken MHJ, Engels Y, Bellersen L, Janssen DJA. Tools to help healthcare professionals recognize palliative care needs in patients with advanced heart failure: A systematic review. Palliat Med 2021; 35:45-58. [PMID: 33054670 PMCID: PMC7797617 DOI: 10.1177/0269216320963941] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The delivery of palliative care interventions is not widely integrated in chronic heart failure care as the recognition of palliative care needs is perceived as difficult. Tools may facilitate healthcare professionals to identify patients with palliative care needs in advanced chronic heart failure. AIM To identify tools to help healthcare professionals recognize palliative care needs in patients with advanced chronic heart failure. DESIGN This systematic review was registered in the PROSPERO database (CRD42019131896). Evidence of tools' development, evaluation, feasibility, and implementation was sought and described. DATA SOURCES Electronic searches to identify references of tools published until June 2019 were conducted in MEDLINE, CINAHL, and EMBASE. Hand-searching of references and citations was undertaken. Based on the identified tools, a second electronic search until September 2019 was performed to check whether all evidence about these tools in the context of chronic heart failure was included. RESULTS Nineteen studies described a total of seven tools. The tools varied in purpose, intended user and properties. The tools have been validated to a limited extent in the context of chronic heart failure and palliative care. Different health care professionals applied the tools in various settings at different moments of the care process. Guidance and instruction about how to apply the tool revealed to be relevant but may be not enough for uptake. Spiritual care needs were perceived as difficult to assess. CONCLUSION Seven tools were identified which showed different and limited levels of validity in the context of palliative care and chronic heart failure.
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Affiliation(s)
- Stephanie MC Ament
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Inge ME Couwenberg
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Josiane JJ Boyne
- Department of Patient and Care, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Jos Kleijnen
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Kleijnen Systematic Reviews Ltd, York, UK
| | - Henri EJH Stoffers
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Marieke HJ van den Beuken
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Daisy JA Janssen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Research and Education, Ciro, Horn, The Netherlands
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Andriastuti M, Halim PG, Kusrini E, Bangun M. Correlation of Pediatric Palliative Screening Scale and Quality of Life in Pediatric Cancer Patients. Indian J Palliat Care 2020; 26:338-341. [PMID: 33311876 PMCID: PMC7725190 DOI: 10.4103/ijpc.ijpc_197_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 05/14/2020] [Indexed: 11/04/2022] Open
Abstract
Context Palliative care in children is used to be only intended for those in near end-of-life phase. Ideally, palliative intervention should be given since the first time of cancer diagnosis. Palliative care is introduced from the beginning of the treatment by acknowledging that it helps to ensure an ongoing focus on the quality of life (QOL) so that children still can enjoy their life. Several approaches have been used to identify children with the need of palliative care. Aims The aim was to describe the use of Paediatric Palliative Screening Scale (PaPaS Scale) and its depiction to the QOL of children with malignancies. Settings and Design A cross-sectional study was conducted in sixty children age 2-18 years with malignancies, who were consulted to the palliative team. Subjects and Methods Sixty participants were recruited randomly during the study. PaPaS Scale and QOL (using PedsQL™ cancer module 3.0) were assessed at the same time. Cutoff points of 67 for parent-proxy report and 68.9 for self-report were used, those who have scores <67 and <68.9 were grouped as low QOL group. PaPaS scale was divided into three groups: (1) no palliative care needs (score 10-14), (2) considered palliative care (15-24), and (3) need for palliative (≥25). Statistical Analysis Differences between palliative score and QOL were analyzed using Chi-square and Fisher test. Results Children who have lower QOL based on parent-proxy report (<67) included 25 children; they consist of 16 children (64%) with score 10-14, four children (16%) with score 15-24, and five children (20%) with score ≥25. Children with higher QOL (16 children) consist of ten children (62.5%) with score 10-14, four children (25%) scores 15-24, and two children (12.5%) with score ≥25. In the self-report, children with low QOL (eight children) consist of four children (50%) with score 10-14, four children (50%) with score 15-24, and no children with score ≥ 25. Children with higher QOL (11 children) consist of eight children (72.2%) with score 10-14, two children (18.2%) with scores 15-24, and one child (9.1%) with score ≥25. Statistical analysis showed no correlation between PaPaS score and QOL of children with malignancies in parent-proxy report (P = 0.89) and self-report (P = 0.37). Conclusions This study showed that children with malignancies already had lower QOL despite the low PaPaS scale they had. The results of this study support the provision of early palliative intervention, starting with a small proportion of intervention to improve the QOL of cancer child.
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Affiliation(s)
- Murti Andriastuti
- Department of Child Health, Faculty of Medicine Indonesia University, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Pricilia Gunawan Halim
- Department of Child Health, Faculty of Medicine Indonesia University, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Eny Kusrini
- Pediatric Nurse, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Meidiana Bangun
- Pediatric Nurse, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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42
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Enguidanos S, Rahman A, Fields T, Mack W, Brumley R, Rabow M, Mert M. Challenges in Using Insurance Claims Data to Identify Palliative Care Patients for a Research Trial. J Pain Symptom Manage 2020; 60:1012-1018. [PMID: 32592736 DOI: 10.1016/j.jpainsymman.2020.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Little is known about strategies for enrolling patients in home-based palliative care programs despite the need to conduct effectiveness studies of this emerging industry. PURPOSE We used medical claims data from Accountable Care Organizations in California to identify patients for a randomized controlled trial of home-based palliative care. We report outcomes from this strategy and the implications for future research. RESULTS Claims data identified 1357 patients. Research assistants could not reach 986 patients (72.7%), usually because the phone calls went unanswered (38.5%) and many patients' phone numbers were missing or incorrect (16.3%). Of 371 patients reached, 163 opted out. Of 208 patients screened, 177 were ineligible for the trial. Just 10 patients were enrolled. RECOMMENDATIONS Our findings suggest that medical claims data may not be useful for engaging patients potentially eligible for palliative care research trials. We recommend that alternative identification and recruitment strategies be considered.
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Affiliation(s)
- Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Anna Rahman
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA.
| | - Torrie Fields
- Blue Shield of California, San Francisco, California, USA; VotiveHealth, San Luis Obispo, California, USA
| | - Wendy Mack
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Richard Brumley
- Reliance Hospice and Palliative Care, Costa Mesa, California, USA
| | - Michael Rabow
- University of California, San Francisco, California, USA
| | - Melissa Mert
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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43
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Lewis ET, Mahimbo A, Linhart C, Williamson M, Morgan M, Hammill K, Hall J, Cardona M. General practitioners' perceptions on the feasibility and acceptability of implementing a risk prediction checklist to support their end-of-life discussions in routine care: a qualitative study. Fam Pract 2020; 37:703-710. [PMID: 32297645 DOI: 10.1093/fampra/cmaa036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND General practitioners' (GPs) play a central role in facilitating end-of-life discussions with older patients nearing the end-of-life. However, prognostic uncertainty of time to death is one important barrier to initiation of these discussions. OBJECTIVE To explore GPs' perceptions of the feasibility and acceptability of a risk prediction checklist to identify older patients in their last 12 months of life and describe perceived barriers and facilitators for implementing end-of-life planning. METHODS Qualitative, semi-structured interviews were conducted with 15 GPs practising in metropolitan locations in New South Wales and Queensland between May and June 2019. Data were analysed thematically. RESULTS Eight themes emerged: accessibility and implementation of the checklist, uncertainty around checklist's accuracy and usefulness, time of the checklist, checklist as a potential prompt for end-of-life conversations, end-of-life conversations not an easy topic, end-of-life conversation requires time and effort, uncertainty in identifying end-of-life patients and limited community literacy on end-of-life. Most participants welcomed a risk prediction checklist in routine practice if assured of its accuracy in identifying which patients were nearing end-of-life. CONCLUSIONS Most participating GPs saw the value in risk assessment and end-of-life planning. Many emphasized the need for appropriate support, tools and funding for prognostic screening and end-of-life planning for this to become routine in general practice. Well validated risk prediction tools are needed to increase clinician confidence in identifying risk of death to support end-of-life care planning.
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Affiliation(s)
- Ebony T Lewis
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Abela Mahimbo
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, Australia
| | - Christine Linhart
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Margaret Williamson
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.,Centre for Primary Health Care & Equity, University of New South Wales, Sydney, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Kathrine Hammill
- School of Science & Health, Western Sydney University, Sydney, Australia
| | - John Hall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Magnolia Cardona
- Gold Coast University Hospital, Gold Coast, Australia.,Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
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44
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Hill L, Prager Geller T, Baruah R, Beattie JM, Boyne J, de Stoutz N, Di Stolfo G, Lambrinou E, Skibelund AK, Uchmanowicz I, Rutten FH, Čelutkienė J, Piepoli MF, Jankowska EA, Chioncel O, Ben Gal T, Seferovic PM, Ruschitzka F, Coats AJS, Strömberg A, Jaarsma T. Integration of a palliative approach into heart failure care: a European Society of Cardiology Heart Failure Association position paper. Eur J Heart Fail 2020; 22:2327-2339. [PMID: 32892431 DOI: 10.1002/ejhf.1994] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022] Open
Abstract
The Heart Failure Association of the European Society of Cardiology has published a previous position paper and various guidelines over the past decade recognizing the value of palliative care for those affected by this burdensome condition. Integrating palliative care into evidence-based heart failure management remains challenging for many professionals, as it includes the identification of palliative care needs, symptom control, adjustment of drug and device therapy, advance care planning, family and informal caregiver support, and trying to ensure a 'good death'. This new position paper aims to provide day-to-day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory. The specific components of palliative care for symptom alleviation, spiritual and psychosocial support, and the appropriate modification of guideline-directed treatment protocols, including drug deprescription and device deactivation, are described for the chronic, crisis and terminal phases of heart failure.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Tal Prager Geller
- Palliative Care Ward at Dorot Health Centre, Heart Failure Unit at Rabin Medical Center, Netanya, Israel
| | - Resham Baruah
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - James M Beattie
- Cicely Saunders Institute, King's College London, London, UK
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | | | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Massimo Francesco Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy.,University of Parma, Parma, Italy
| | - Ewa A Jankowska
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.,University of Medicine Carol Davila, Bucharest, Romania
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre Serbia, Medical School Belgrade, Belgrade, Serbia
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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45
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ElMokhallalati Y, Bradley SH, Chapman E, Ziegler L, Murtagh FE, Johnson MJ, Bennett MI. Identification of patients with potential palliative care needs: A systematic review of screening tools in primary care. Palliat Med 2020; 34:989-1005. [PMID: 32507025 PMCID: PMC7388141 DOI: 10.1177/0269216320929552] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite increasing evidence of the benefits of early access to palliative care, many patients do not receive palliative care in a timely manner. A systematic approach in primary care can facilitate earlier identification of patients with potential palliative care needs and prompt further assessment. AIM To identify existing screening tools for identification of patients with advanced progressive diseases who are likely to have palliative care needs in primary healthcare and evaluate their accuracy. DESIGN Systematic review (PROSPERO registration number CRD42019111568). DATA SOURCES Cochrane, MEDLINE, Embase and CINAHL were searched from inception to March 2019. RESULTS From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs. The tools are based on a wide range of general and disease-specific indicators. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential palliative care needs with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99%. CONCLUSION The ability of current screening tools to identify patients with advanced progressive diseases who are likely to have palliative care needs in primary care is limited. Further research is needed to identify standardised screening processes that are based not only on predicting mortality and deterioration but also on anticipating the palliative care needs and predicting the rate and course of functional decline. This would prompt a comprehensive assessment to identify and meet their needs on time.
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Affiliation(s)
- Yousuf ElMokhallalati
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Stephen H Bradley
- Academic Unit of Primary Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
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46
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Robinson J, Frey R, Boyd M, McLeod H, Meehan B, Gott M. InterRAI assessments: opportunities to recognise need for and implementation of palliative care interventions in the last year of life? Australas J Ageing 2020; 40:e22-e28. [PMID: 33739596 DOI: 10.1111/ajag.12840] [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: 01/16/2020] [Revised: 06/21/2020] [Accepted: 07/06/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To explore how interRAI assessments could be used to identify opportunities to integrate palliative care into a plan of care. METHODS A population-based, cross-sectional design using unique identifiers to link deaths with a national interRAI database. Data were analysed using logistic regression models and chi-square tests. RESULTS A total of 4869 people died over a 12-month period in one district health board area; 50.9% (n = 2478) received one or more interRAI assessments in the year before death. Diagnosis impacted on the type and timing of interRAI assessments and the recognition of end-stage disease. CONCLUSION People in the last year of life experience frequent interRAI assessments. There are opportunities to identify people who might benefit from a palliative care approach. Future research is needed to understand how interRAI assessors can be supported in the application of assessment items related to palliative care.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Heather McLeod
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Brigette Meehan
- Technical Advisory Services Limited (TAS), interRAI New Zealand, Wellington, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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47
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Remawi BN, Gadoud A, Murphy IMJ, Preston N. Palliative care needs-assessment and measurement tools used in patients with heart failure: a systematic mixed-studies review with narrative synthesis. Heart Fail Rev 2020; 26:137-155. [PMID: 32748015 PMCID: PMC7769784 DOI: 10.1007/s10741-020-10011-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patients with heart failure have comparable illness burden and palliative care needs to those with cancer. However, few of them are offered timely palliative care. One main barrier is the difficulty in identifying those who require palliative care. Several palliative care needs-assessment/measurement tools were used to help identify these patients and assess/measure their needs, but it is not known which one is the most appropriate for this population. This review aimed to identify the most appropriate palliative care needs-assessment/measurement tools for patients with heart failure. Cochrane Library, MEDLINE Complete, AMED, PsycINFO, CINAHL Complete, EMBASE, EThOS, websites of the identified tools, and references and citations of the included studies were searched from inception to 25 June 2020. Studies were included if they evaluated palliative care needs-assessment/measurement tools for heart failure populations in terms of development, psychometrics, or palliative care patient/needs identification. Twenty-seven papers were included regarding nineteen studies, most of which were quantitative and observational. Six tools were identified and compared according to their content and context of use, development, psychometrics, and clinical applications in identifying patients with palliative care needs. Despite limited evidence, the Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF) is the most appropriate palliative care needs-assessment tool for use in heart failure populations. It covers most of the patient needs and has the best psychometric properties and evidence of identification ability and appropriateness. Psychometric testing of the tools in patients with heart failure and evaluating the tools to identify those with palliative care needs require more investigation.
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Affiliation(s)
- Bader Nael Remawi
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Amy Gadoud
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.,International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
| | - Iain Malcolm James Murphy
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.,Trinity Hospice and Palliative Care Services, Low Moor Road, Blackpool, FY2 0BG, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
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48
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Casale G, Magnani C, Fanelli R, Surdo L, Goletti M, Boyd K, D'Angelo D, Mastroianni C. Supportive and palliative care indicators tool (SPICT™): content validity, feasibility and pre-test of the Italian version. BMC Palliat Care 2020; 19:79. [PMID: 32505197 PMCID: PMC7276086 DOI: 10.1186/s12904-020-00584-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Difficulties in identifying patients at risk of clinical deterioration or death represent one of the main barriers to Palliative Care (PC) development in the community. Currently, no specific Italian tools aimed at identifying patients with PC needs are available. Of the different European tools available, the SPICT™ can be used easily in any kind of setting and does not include the Surprise Question. The purpose of the study was to translate, cross-culturally adapt and pre-test the Italian version of the SPICT™. Methods The Beaton recommendations for the cross-cultural adaptation of instruments were followed. Content validity was assessed using the Lynn method. A sample of Italian General Practitioners (GPs) assessed the SPICT-IT™ for feasibility and tested it. Results During the cross-cultural adaptation, some issues regarding semantic, experiential, idiomatic and conceptual equivalences were raised and resolved. The Scale-Content Validity Index/Ave was 0.86. Of the 907 GPs included in the sample, 71 (7.8%) agreed to test the SPICT-IT™ and to assess its feasibility. The participants provided care for 73,526 people in the community. Of these people, 1.7% (N = 1303) were identified as being in need of PC according to the SPICT-IT™. Sixty-six (93.0%) GPs stated they would use the SPICT-IT™ in their daily clinical practice. Conclusions The SPICT-IT™ demonstrated acceptable content validity. The percentage of patients identified through the SPICT-IT™ was comparable to findings from literature. The next phase of this project will investigate the impact of a proactive training programme aimed at supporting GPs in identifying patients with PC needs and delivering appropriate Primary Palliative Care (PPC).
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Affiliation(s)
- Giuseppe Casale
- Antea Associazione, Piazza Santa Maria della Pietà, 5, Pad XXII, 00135, Rome, Italy
| | - Caterina Magnani
- Antea Associazione, Piazza Santa Maria della Pietà, 5, Pad XXII, 00135, Rome, Italy.,Roma 1 Local Health Authority, Borgo Santo Spirito, 3, 00193, Rome, Italy
| | - Renato Fanelli
- Primary Care Medical Center, Via Frà Albenzio, 10, 00136, Rome, Italy
| | - Laura Surdo
- Antea Associazione, Piazza Santa Maria della Pietà, 5, Pad XXII, 00135, Rome, Italy.
| | - Mauro Goletti
- Roma 1 Local Health Authority, Borgo Santo Spirito, 3, 00193, Rome, Italy
| | - Kirsty Boyd
- Primary Palliative Care Group, The University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Daniela D'Angelo
- Research, National Institute of Health, Via Giano della Bella, 34, 00162, Rome, Italy
| | - Chiara Mastroianni
- Antea Associazione, Piazza Santa Maria della Pietà, 5, Pad XXII, 00135, Rome, Italy
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Kamal AH, Bowman B, Ritchie CS. Identifying Palliative Care Champions to Promote High-Quality Care to Those with Serious Illness. J Am Geriatr Soc 2020; 67:S461-S467. [PMID: 31074852 DOI: 10.1111/jgs.15799] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/10/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
Abstract
Leading medical authorities advocate for routine integration of palliative care for all major causes of death in the United States. With rapid growth and acceptance, the field of palliative care is tasked with addressing a compelling question of its time: "Who will deliver timely, evidence-based palliative care to all who should benefit?" The current number of palliative care specialists will not suffice to meet the needs of persons with serious illness. In 2010, initial estimates quantified the shortage at 6000 to 18 000 additional palliative care physicians needed to fully staff existing programs. Unfortunately, the predicted number of specialty physicians in 2030 will likely not be larger than the workforce in existence today. These findings result in a physician-to-serious-illness-person ratio of about 1:28 000 in 2030.1 To address the workforce shortage, stronger alignment is needed between intensity of patient needs and provision of palliative care services. Such an alignment better harnesses the talents of those in a position to deliver core palliative care services (such as discussing goals of care with patients or managing their symptoms) while engaging palliative care specialists to address more complex issues. We introduce the concept of "Palliative Care Champions," who sit at the nexus between specialty palliative care and the larger clinical workforce. Acknowledging that the needs of most patients can be met by clinicians who have received basic palliative care training, and that specialty palliative care is not always available for those with more complex needs, there exists an important opportunity for those with additional interest to scale training and quality improvement to fill this void. J Am Geriatr Soc 67:S461-S467, 2019.
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Affiliation(s)
- Arif H Kamal
- Duke Cancer Institute and Duke Fuqua School of Business, Durham, North Carolina
| | - Brynn Bowman
- Center to Advance Palliative Care, New York, New York
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50
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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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