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Borges GBFL, Dias CB. Evaluating the Utility of the Surprise Question Among General Physicians for Appropriate Palliative Care Indication in Brazil. Palliat Med Rep 2024; 5:261-268. [PMID: 39044763 PMCID: PMC11262583 DOI: 10.1089/pmr.2024.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 07/25/2024] Open
Abstract
Objectives This study aimed to assess the agreement between established tools, such as the Palliative Performance Scale (PPS) and Brazilian version of the Supportive and Palliative Care Indicators Tool (SPICT-BR), and the subjective assessment of palliative care (PC) need using the Surprise Question (SQ) administered by resident physicians. This assessment was conducted among hospitalized patients, with and without cancer, to determine the efficacy of these tools in indicating the need for PC. Methods A six-month cross-sectional study in 2019 of medical records of patients hospitalized in a single center in IAMSPE-Brazil. The SPICT-BR and PPS were applied to the medical record data, and the SQ was posed to each resident physician. Comparisons for categorical data were made using the chi-square test, with p < 0.05 considered statistically significant. Results Of 203 patients evaluated, 57.6% were male and 81.2% were older adults (≥60 years). The mean age was 67.40 ± 9.72 years. Chronic disease was nonneoplastic in 78.32% of patients, and 56.65% had not been hospitalized in the preceding year. The PPS score was <70% in 69.4% of patients, and 51.2% met at least one SPICT-BR criterion. Among patients with cancer, 40.9% had over two positive SPICT-BR criteria; 97.5% of these patients received NO responses to SQ by residents (p < 0.0001). Similarly, 90.6% of patients with one SPICT-BR criterion received NO responses to SQ, with no significant difference between groups. Conclusion The SQ proved to be a valuable tool for PC indication, particularly when administered by untrained professionals. Consistent with SPICT-BR findings, our study highlights the SQ's role in facilitating early identification of patients in need of PC.
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Gupta A, Burgess R, Drozd M, Gierula J, Witte K, Straw S. The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis. BMJ Support Palliat Care 2024:spcare-2024-004879. [PMID: 38925876 DOI: 10.1136/spcare-2024-004879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The Surprise Question, 'Would you be surprised if this person died within the next year?' is a simple tool that can be used by clinicians to identify people within the last year of life. This review aimed to determine the accuracy of this assessment, across different healthcare settings, specialties, follow-up periods and respondents. METHODS Searches were conducted of Medline, Embase, AMED, PubMed and the Cochrane Central Register of Controlled Trials, from inception until 01 January 2024. Studies were included if they reported original data on the ability of the Surprise Question to predict survival. For each study (including subgroups), sensitivity, specificity, positive and negative predictive values and accuracy were determined. RESULTS Our dataset comprised 56 distinct cohorts, including 68 829 patients. In a pooled analysis, the sensitivity of the Surprise Question was 0.69 ((0.64 to 0.74) I2=97.2%), specificity 0.69 ((0.63 to 0.74) I2=99.7%), positive predictive value 0.40 ((0.35 to 0.45) I2=99.4%), negative predictive value 0.89 ((0.87 to 0.91) I2=99.7%) and accuracy 0.71 ((0.68 to 0.75) I2=99.3%). The prompt performed best in populations with high event rates, shorter timeframes and when posed to more experienced respondents. CONCLUSIONS The Surprise Question demonstrated modest accuracy with considerable heterogeneity across the population to which it was applied and to whom it was posed. Prospective studies should test whether the prompt can facilitate timely access to palliative care services, as originally envisioned. PROSPERO REGISTRATION NUMBER CRD32022298236.
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Affiliation(s)
- Ankit Gupta
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | | | - Michael Drozd
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Klaus Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Jiménez-Puente A, Martín-Escalante MD, Martos-Pérez F, García-Alegría J. Increase in hospital care at the end of life: Retrospective analysis of the last 20 years of life of a cohort of patients. Rev Esp Geriatr Gerontol 2024; 59:101484. [PMID: 38552406 DOI: 10.1016/j.regg.2024.101484] [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: 12/27/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND There is an increasing need for end-of-life care due to society's progressive aging. This study aimed to describe how hospitalizations evolve long-term and in the last months life of a cohort of deceased patients. METHODS The study population were those who died in one year who lived in a district in southern Spain. The number of hospital stays over the previous 20 years and number of contacts with the emergency department, hospitalization, outpatient clinics, and medical day hospital in the last three months of life were determined. The analyses were stratified by age, sex, and pattern of functional decline. RESULTS The study population included 1773 patients (82.5% of all who died in the district). The hospital stays during the last 20 years of life were concentrated in the last five years (66%) and specially in the last six months (32%). Eighty percent had contact with the hospital during their last three months of life. The older group had the minimun of stays over the last 20 years and contacts with the hospital in the last months of life. CONCLUSIONS The majority of hospitalizations occur at the end of life and these admissions represent a significant part of an acute-care hospital's activity. The progressive prolongation of life does not have to go necessarily along with a proportional increase in hospital stays.
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Affiliation(s)
- Alberto Jiménez-Puente
- Hospital Costa del Sol, Unidad de Evaluación, Marbella, Málaga, Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Marbella, Málaga, Spain; IBIMA Plataforma BIONAND, Marbella, Málaga, Spain.
| | | | | | - Javier García-Alegría
- Hospital Costa del Sol, Área de Medicina Interna, Marbella, Málaga, Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Marbella, Málaga, Spain; IBIMA Plataforma BIONAND, Marbella, Málaga, Spain
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Müller E, Müller MJ, Boehlke C, Schäfer H, Quante M, Becker G. Screening for Palliative Care Need in Oncology: Validation of Patient-Reported Outcome Measures. J Pain Symptom Manage 2024; 67:279-289.e6. [PMID: 38154625 DOI: 10.1016/j.jpainsymman.2023.12.013] [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: 10/25/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
CONTEXT Leading oncology societies recommend monitoring symptoms and support needs through patient-reported outcome measures (PROMs), but their use for assessing specialist palliative care (SPC) need has not yet been explored. Research on SPC integration has focused on staff-assessed screening tools, which are time-consuming. OBJECTIVES This study aimed to assess the diagnostic validity of the Integrated Palliative Outcome Scale (IPOS) and NCCN Distress Thermometer (NCCN DT) in identifying need for SPC in patients with incurable cancer. METHODS In a cross-sectional study, patients with incurable cancer (prognosis <2 years) completed PROMs. In an independent process, the palliative care consultation service (PCCS) assessed the need for SPC in each patient through multiprofessional case review, and this was used as the reference standard. ROC analyses were employed to determine diagnostic validity. RESULTS Of the 208 participants, 71 (34.1 %) were classified as having SPC need by the PCCS. Aiming for a minimum sensitivity of 80%, a cut-off of ≥2 items with high/very high burden in the IPOS resulted in a 90.2% sensitivity (specificity = 50; AUC = 0.791; CI 95%= 0.724-0.858). A cut-off of ≥5 resulted in a sensitivity of 80 % for NCCN DT (specificity = 49.5 %; AUC = 0.687; CI 95% = 0.596-0.777). CONCLUSION PROMs are useful for identifying SPC need in cancer patients. Their implementation might facilitate timely integration of SPC. Future research should focus on an integrated assessment approach with PROMs that combines the requirements of the different specialties to save patient and staff resources.
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Affiliation(s)
- Evelyn Müller
- Department of Palliative Medicine (E.M., M.J.M., G.B.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Josef Müller
- Department of Palliative Medicine (E.M., M.J.M., G.B.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Christopher Boehlke
- Department of Palliative Care (C.B.), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Henning Schäfer
- Department of Radiation Oncology (H.S.), Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ) Heidelberg, Freiburg, Germany
| | - Michael Quante
- Clinic for Internal Medicine II (M.Q.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerhild Becker
- Department of Palliative Medicine (E.M., M.J.M., G.B.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Spannella F, Falzetti S, Giulietti F, Sarnari S, Morichi V, Tamburrini P, Gattafoni P, Mannello L, Crippa M, Ferrara L, Sarzani R, Lombrano MR. Prognostic Role of NECPAL CCOMS-ICO Tool on One-Year Mortality in a Hospitalized Older Population. J Palliat Med 2024; 27:367-375. [PMID: 37971772 DOI: 10.1089/jpm.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: It is essential to establish both the appropriateness of palliative care (PC) and the prognosis in daily clinical practice to guide decision making in the management of older people with multiple advanced chronic diseases. Objectives: We assessed patients who were appropriate for PC using the NECPAL tool in a hospitalized older population and then we investigated its predictive validity on one-year mortality compared with the multidimensional prognostic index (MPI), a validated geriatric prognostic tool. Design: Prospective cohort study. Setting/Subjects: We enrolled 103 older adults hospitalized for acute medical and surgical conditions in a geriatric hospital in Italy. Measurements: The variables of interest were obtained at baseline through interviews of the ward medical staff and by consulting the computerized medical records. Long-term mortality (one-year) was assessed through the analysis of data acquired from hospital or territorial databases or through telephone contact with caregivers. Results: Mean age was 86.8 ± 7.2 years, with a female prevalence of 54.4%. Prevalence of NECPAL+ patients was 65.1%. MPI low risk: 30.1%; moderate risk: 41.7%; severe risk: 28.2%. Patients deceased during follow-up were 54.4%. NECPAL+ patients were more likely to die, even after adjusting for age, sex, and MPI score (hazard ratio [HR] 2.7, p = 0.020). All the NECPAL categories were associated with one-year mortality. MPI showed a better predictive power than NECPAL (area under the curve [AUC] 0.85 vs. 0.75, p = 0.030). After the exclusion of "Comorbidity: ≥2 concurrent diseases" item from NECPAL, its AUC increased to 0.78 with no statistically significant differences from MPI (p = 0.122). Conclusions: NECPAL is useful to identify the appropriateness of PC in hospitalized older adults, also allowing to predict long-term mortality with a performance similar to that of a validated geriatric prognostic tool.
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Affiliation(s)
- Francesco Spannella
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Sara Falzetti
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Federico Giulietti
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
| | - Silvia Sarnari
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Valeria Morichi
- Medical Department, Internal Medicine Unit, IRCCS INRCA, Osimo, Italy
| | | | - Pisana Gattafoni
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
| | | | | | - Letizia Ferrara
- Medical Direction Unit, Risk Manager, IRCCS INRCA, Ancona, Italy
| | - Riccardo Sarzani
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
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Hoffman MR, Slivinski A, Shen Y, Watts DD, Wyse RJ, Garland JM, Fakhry SM. Would you be surprised? Prospective multicenter study of the Surprise Question as a screening tool to predict mortality in trauma patients. J Trauma Acute Care Surg 2024; 96:35-43. [PMID: 37858301 DOI: 10.1097/ta.0000000000004151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND The Surprise Question (SQ) ("Would I be surprised if the patient died within the next year?") is a validated tool used to identify patients with limited life expectancy. Because it may have potential to expedite palliative care interventions per American College of Surgeons Trauma Quality Improvement Program Palliative Care Best Practices Guidelines, we sought to determine if trauma team members could use the SQ to accurately predict 1-year mortality in trauma patients. METHODS A multicenter, prospective, cohort study collected data (August 2020 to February 2021) on trauma team members' responses to the SQ at 24 hours from admission. One-year mortality was obtained via social security death index records. Positive/negative predictive values and accuracy were calculated overall, by provider role and by patient age. RESULTS Ten Level I/II centers enrolled 1,172 patients (87.9% blunt). The median age was 57 years (interquartile range, 36-74 years), and the median Injury Severity Score was 10 (interquartile range, 5-14 years). Overall 1-year mortality was 13.3%. Positive predictive value was low (30.5%) regardless of role. Mortality prediction minimally improved as age increased (positive predictive value highest between 65 and 74 years old, 34.5%) but consistently trended to overprediction of death, even in younger patients. CONCLUSION Trauma team members' ability to forecast 1-year mortality using the SQ at 24 hours appears limited perhaps because of overestimation of injury effects, preinjury conditions, and/or team bias. This has implications for the Trauma Quality Improvement Program Guidelines and suggests that more research is needed to determine the optimal time to screen trauma patients with the SQ. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Melissa Red Hoffman
- From the Department of Surgery (M.R.H.), Trauma Services (A.S.), Mission Hospital, Asheville, North Carolina; and Center for Trauma and Acute Care Surgery Research (Y.S., D.D.W., R.J.W., J.M.G., S.M.F.), HCA Healthcare, Clinical Services Group, Nashville, Tennessee
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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 2023:spcare-2023-004465. [PMID: 38154921 DOI: 10.1136/spcare-2023-004465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Müller E, Müller MJ, Seibel K, Boehlke C, Schäfer H, Klein C, Heckel M, Simon ST, Becker G. Interrater agreement of multi-professional case review as reference standard for specialist palliative care need: a mixed-methods study. BMC Palliat Care 2023; 22:181. [PMID: 37974104 PMCID: PMC10652431 DOI: 10.1186/s12904-023-01281-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND A wide variety of screening tools for the need for specialist palliative care (SPC) have been proposed for the use in oncology. However, as there is no established reference standard for SPC need to compare their results with, their sensitivity and specificity have not yet been determined. The aim of the study was to explore whether SPC need assessment by means of multi-professional case review has sufficient interrater agreement to be employed as a reference standard. METHODS Comprehensive case descriptions were prepared for 20 inpatients with advanced oncologic disease at the University Hospital Freiburg (Germany). All cases were presented to the palliative care teams of three different hospitals in independent, multi-professional case review sessions. The teams assessed whether patients had support needs in nine categories and subsequently concluded SPC need (yes / no). Interrater agreement regarding SPC need was determined by calculating Fleiss' Kappa. RESULTS In 17 out of 20 cases the three teams agreed regarding their appraisal of SPC need (substantial interrater agreement: Fleiss' Kappa κ = 0.80 (95% CI: 0.55-1.0; p < 0.001)). The number of support needs was significantly lower for patients who all teams agreed had no SPC need than for those with agreed SPC need. CONCLUSIONS The proposed expert case review process shows sufficient reliability to be used as a reference standard. Key elements of the case review process (e.g. clear definition of SPC need, standardized review of the patients' support needs) and possible modifications to simplify the process are discussed. TRIAL REGISTRATION German Clinical Trials Register, DRKS00021686, registered 17.12.2020.
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Affiliation(s)
- Evelyn Müller
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany.
| | - Michael Josef Müller
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
| | - Katharina Seibel
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
| | - Christopher Boehlke
- Department of Palliative Care, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Henning Schäfer
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
| | - Carsten Klein
- Department of Palliative Medicine, University Hospital Erlangen-EMN, Comprehensive Cancer Center CCC Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine, University Hospital Erlangen-EMN, Comprehensive Cancer Center CCC Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Steffen T Simon
- Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), University Hospital of Cologne, Faculty of Medicine and University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - Gerhild Becker
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
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Esteban-Burgos AA, Hueso-Montoro C, Mota-Romero E, Montoya-Juarez R, Gomez-Batiste X, Garcia-Caro MP. The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition. BMC Geriatr 2023; 23:715. [PMID: 37924015 PMCID: PMC10623722 DOI: 10.1186/s12877-023-04409-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/15/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND It is essential to assess the need for palliative care and the life prognosis of elderly nursing home residents with an advanced chronic condition, and the NECPAL ICO-CCOMS©4.0 prognostic instrument may be adequate for both purposes. The objective of this study was to examine the predictive capacity of NECPAL, the Palliative Prognosis Index, and the PROFUND index in elderly residents with advanced chronic condition with and without dementia, comparing their results at different time points. METHODS This prospective observational study was undertaken in eight nursing homes, following the survival of 146 residents with advanced chronic condition (46.6% with dementia) at 3, 6, 12, and 24 months. The capacity of the three instruments to predict mortality was evaluated by calculating the area under the receiver operating characteristic curve (AUC), with 95% confidence interval, for the global population and separately for residents with and without dementia. RESULTS The mean age of residents was 84.63 years (± 8.989 yrs); 67.8% were female. The highest predictive capacity was found for PROFUND at 3 months (95%CI: 0.526-0.756; p = 0.016), for PROFUND and NECPAL at 12 months (non-significant; AUC > 0.5), and NECPAL at 24 months (close-to-significant (AUC = 0.624; 95% CI: 0.499-0.750; p = 0.053). The highest capacity at 12 months was obtained using PROFUND in residents with dementia (AUC = 0.698; 95%CI: 0.566-0.829; p = 0.003) and NECPAL in residents without dementia (non-significant; AUC = 0.649; 95%CI: 0.432-0.867; p = 0.178). Significant differences in AUC values were observed between PROFUND at 12 (p = 0.017) and 24 (p = 0.028) months. CONCLUSIONS PROFUND offers the most accurate prediction of survival in elderly care home residents with advanced chronic condition overall and in those with dementia, especially over the short term, whereas NECPAL ICO-CCOMS©4.0 appears to be the most useful to predict the long-term survival of residents without dementia. These results support early evaluation of the need for palliative care in elderly care home residents with advanced chronic condition.
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Affiliation(s)
- Ana Alejandra Esteban-Burgos
- Departamento de Enfermería, Universidad de Jaén, Jaén, Spain
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain
| | - César Hueso-Montoro
- Departamento de Enfermería, Universidad de Jaén, Jaén, Spain
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
| | - Emilio Mota-Romero
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Centro de Salud Salvador Caballero. Distrito Sanitario Granada-Metropolitano. Servicio Andaluz de Salud, Granada, Spain
- Departamento de Enfermería, Universidad de Granada, Granada, Spain
| | - Rafael Montoya-Juarez
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain.
- Departamento de Enfermería, Universidad de Granada, Granada, Spain.
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain.
| | - Xavier Gomez-Batiste
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - María Paz Garcia-Caro
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Departamento de Enfermería, Universidad de Granada, Granada, Spain
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain
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Vitorino JV, Duarte BV, Laranjeira C. When to initiate early palliative care? Challenges faced by healthcare providers. Front Med (Lausanne) 2023; 10:1220370. [PMID: 37849489 PMCID: PMC10577203 DOI: 10.3389/fmed.2023.1220370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Joel Vieira Vitorino
- School of Health Sciences, Polytechnic of Leiria, Morro do Lena, Alto do Vieiro, Leiria, Portugal
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal
| | - Beatriz Veiga Duarte
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Morro do Lena, Alto do Vieiro, Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
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Herrera-Abián M, Castañeda-Vozmediano R, Antón-Rodríguez C, Palacios-Ceña D, González-Morales LM, Pfang B, Noguera A. The caregiver's perspective on end-of-life inpatient palliative care: a qualitative study. Ann Med 2023; 55:2260400. [PMID: 37738527 PMCID: PMC10519265 DOI: 10.1080/07853890.2023.2260400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Understanding patient and caregiver experience is key to providing person-centered care. The palliative care approach includes holistic assessment and whole-person care at the end of life, that also involves the patient's family and loved ones. The aim of this study was to describe the way that family caregivers experienced patients' deaths during their loved ones' last hospital admission, comparing inpatient palliative care (PCU) and non-palliative care (Non-PCU) units. METHODS A qualitative case study approach was implemented. Family caregivers of terminally ill patients admitted to the Infanta Elena Hospital (Madrid, Spain) between 2016 and 2018 were included using purposeful sampling. Eligible caregivers were first-degree relatives or spouses present during the patient's last hospital admission. Data were collected via in-depth interviews and researchers' field notes. Semi-structured interviews with a question guide were used. A thematic inductive analysis was performed. The group of caregivers of patients admitted to the PCU unit and the group of caregivers of patients admitted to Non-PCU were analyzed separately, through a matrix. RESULTS In total 24 caregivers (12 from the PCU and 12 from Non-PCU units) were included. Two main themes were identified: caregivers' perception of scientific and technical appropriateness of care, and perception of person-centred care. Scientific appropriateness of care was subdivided into two categories: diagnostic tests and treatment, and symptom control. Perception of person-centred care was subdivided as: communication, emotional support, and facilitating the farewell process. Caregivers of patients admitted to a PCU unit described their experience of end-of-life care as positive, while their Non-PCU unit counterparts described largely negative experiences. CONCLUSIONS PCU provides a person-centered approach to care at the end of life, optimizing treatment for patients with advanced disease, ensuring effective communication, establishing a satisfactory professional relationship with both patients and their loved ones, and facilitating the farewell process for family caregivers.
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Affiliation(s)
- María Herrera-Abián
- Palliative Care Unit, Infanta Elena University Hospital, Valdemoro, Madrid, Spain
| | | | | | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine, and Rehabilitation; Humanities and Qualitative Research in Health Science Research Group, Rey Juan Carlos University (Hum&QRinHS), Alcorcón, Spain
| | | | - Bernadette Pfang
- Clinical and Organizational Innovation Unit (UICO), Madrid, Spain
- Healthcare Research Institute, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Antonio Noguera
- Palliative Care Unit, Infanta Elena University Hospital, Valdemoro, Madrid, Spain
- Palliative Care, Fundación Jiménez Díaz University Hospital, Madrid, Spain
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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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13
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Chu C, Engels Y, Suh SY, Kim SH, White N. Should the Surprise Question be Used as a Prognostic Tool for People With Life-limiting Illnesses? J Pain Symptom Manage 2023; 66:e437-e441. [PMID: 37207786 DOI: 10.1016/j.jpainsymman.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023]
Abstract
The surprise question screening tool ("Would I be surprised if this person died within the next 12 months?") was initially developed to identify possible palliative care needs. One controversial topic regarding the surprise question is whether it should be used as a prognostic tool (predicting survival) for patients with life-limiting illnesses. In this "Controversies in Palliative Care" article, three groups of expert clinicians independently answered this question. All experts provide an overview of current literature, practical advice, and opportunities for future research. All experts reported on the inconsistency of the prognostic capabilities of the surprise question. Two of the three expert groups felt that the surprise question should not be used as a prognostic tool due to these inconsistencies. The third expert group felt that the surprise question should be used as a prognostic tool, particularly for shorter time frames. The experts all highlighted that the original rationale for the surprise question was to trigger a further conversation about future treatment and a potential shift in the focus of the care, identifying patients who many benefit from specialist palliative care or advance care planning; however, many clinicians find this discussion a difficult one to initiate. The experts agreed that the benefit of the surprise question comes from its simplicity: a one-question tool that requires no specific information about the patient's condition. More research is needed to better support the application of this tool in routine practice, particularly in noncancer populations.
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Affiliation(s)
- Christina Chu
- Marie Curie Palliative Care Research Department (C.C.), UCL, London. UK
| | - Yvonne Engels
- Radbound University Medical Center (Y.E.), Nijmegen, The Netherlands
| | - Sang-Yeon Suh
- Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea; Department of Medicine (S.Y.S.), School of Medicine, Dongguk University, Seoul, Republic of Korea
| | - Sun-Hyun Kim
- Department of Family Medicine (S.H.K.), School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon Metropolitan City, Incheon, Republic of Korea
| | - Nicola White
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry (N.W.), University College London, London, UK.
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Suratako S, Matchim Y. Palliative care programmes for people with conditions other than cancer in Thailand: a literature review. Int J Palliat Nurs 2023; 29:374-384. [PMID: 37620144 DOI: 10.12968/ijpn.2023.29.8.374] [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: 08/26/2023]
Abstract
BACKGROUND Thailand has few studies on palliative care programmes for people with conditions other than cancer. OBJECTIVE The objective of this review was to investigate and discuss existing studies of palliative care programmes for non-cancer patients in Thailand. METHODS A literature review was conducted using CINAHL, PubMed, Scopus, Science Direct and Google Scholar to find research conducted from 2000 to 2020. The search found 29 articles, eight of which met the inclusion criteria. RESULTS The eight articles included in this review were focused on four end-stage renal disease (ESRD) programmes, two congestive heart failure (CHF) programmes, one chronic obstructive pulmonary disease (COPD) programme and one stroke programme. CONCLUSIONS There have been few studies of existing palliative care programmes for non-cancer patients in Thailand. These programmes were developed for persons with ESRD, CHF, COPD and stroke, whereas none were available for people with dementia. More palliative care programmes are needed for non-cancer patients.
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Affiliation(s)
| | - Yaowarat Matchim
- Associate Professor, Faculty of Nursing, Thammasat University, Thailand
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Ishii Y, Ito N, Matsumura Y, Aoyama M, Kohara I, Murai K, Takeuchi K, Yokoyama T, Miyashita M, Miyashita M. Validity and reliability of the Integrated Palliative Care Outcome Scale for non-cancer patients. Geriatr Gerontol Int 2023. [PMID: 37246235 DOI: 10.1111/ggi.14603] [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: 02/23/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
AIM This study assessed the validity and reliability of the Integrated Palliative Care Outcome Scale for non-cancer patients. METHODS We recruited 223 non-cancer patients receiving palliative care and their healthcare providers (222) across two home care facilities and two hospitals for a cross-sectional study. We assessed the construct validity and known-group validity of the Integrated Palliative Care Outcome Scale. The weighted kappa and interclass correlation coefficients were assessed to ascertain reliability. RESULTS The scale scores were significantly higher for the 'non-stable' group (worsening condition group) measured in the palliative care phase than for the 'stable' group (P < 0.001). Regarding validity, Spearman's correlations between similar items on the Integrated Palliative Care Outcome Scale and Edmonton Symptom Assessment System ranged from 0.61 to 0.94. Regarding reliability, the weighted kappa coefficients ranged from 0.53 to 0.81 for patients and from 0.58 to 0.90 for healthcare providers. For inter-rater reliability between patients and healthcare providers, the weighted kappa coefficients for each item ranged from 0.03 to 0.42. CONCLUSION This study confirmed the validity and reliability of the Integrated Palliative Care Outcome Scale for non-cancer patients requiring palliative care. However, the inter-rater reliability indicates poor agreement between the assessments of patients and healthcare providers. This highlights the discrepancies between both their assessments and the importance of the patient's assessment. Geriatr Gerontol Int 2023; ••: ••-••.
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Affiliation(s)
- Yoko Ishii
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
- Jichi Medical University School of Nursing, Tochigi, Japan
| | - Nao Ito
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
- Iwate Medical University School of Nursing, Iwate, Japan
| | - Yuko Matsumura
- Department of Nursing, Kyoto City Hospital, Kyoto, Japan
| | - Maho Aoyama
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Izumi Kohara
- Jichi Medical University School of Nursing, Tochigi, Japan
| | | | | | - Takako Yokoyama
- Multifunctional Small Nursing Care Home "Aisanchi", Tochigi, Japan
| | - Masako Miyashita
- Tohoku Bunka Gakuen University, Faculty of Health and Welfare Department of Nursing, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
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16
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Haranis M, Lampkin N, Roche-Green A, Burgher Seaman J, Fennimore L. Development and Implementation of a Real-Time Inpatient Palliative Care Screening Process to Promote Earlier Palliative Care Referrals. J Hosp Palliat Nurs 2023; 25:97-104. [PMID: 36727695 DOI: 10.1097/njh.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite the previous development of criteria for palliative screening tools, there remains a lack of validated and practical screening processes for the general hospitalized patient population for everyday clinical use. This quality improvement project's aim was to implement a practical institution-based adult inpatient palliative care screening tool embedded into the electronic medical record with an automated alert process to assist in identifying patients earlier within hospital admission. The project used a preimplementation and postimplementation design and followed the Plan-Do-Study-Act process to measure the effectiveness of the tool and alert process in decreasing time from admission to palliative care referral and impact on referring patterns. During the project period, 1851 palliative care referrals were completed, and minimal difference (0.6%) was noted in the average time from admission to referral preimplementation and postimplementation ( P = .939). There was a 3.7% increase in referrals postimplementation and a shift in referring service patterns ( P = .321). Although the expected outcome of earlier palliative referrals during admissions was not met, the development and implementation of the tool and alert process is a step toward the creation of a standard practical tool for the general hospitalized patient population.
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17
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Teixeira J, Luz P, Quita R, Dias D, Freire E. Palliative care referral identification: the NECPAL CCOMS-ICO tool. BMJ Support Palliat Care 2023:spcare-2023-004174. [PMID: 36854614 DOI: 10.1136/spcare-2023-004174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Júlio Teixeira
- Medical Oncology, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Paulo Luz
- Medical Oncology, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Ricardo Quita
- Respiratory Medicine, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - David Dias
- Medical Oncology, Centro Hospitalar Cova da Beira EPE, Covilha, Portugal
| | - Elga Freire
- Palliative Care Unit, Department of Internal Medicine, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
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18
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Cimino V, Chisari CG, Toscano S, Patti F. Palliative care in multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:129-138. [PMID: 36599504 DOI: 10.1016/b978-0-12-824535-4.00009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Main target in palliative care (PC) is burden care of patients and their families, with the aim to reduce suffering through the management of symptoms, rehabilitation, psychosocial issues, and spiritual well-being, using a multidisciplinary approach. Multiple sclerosis (MS) is a chronic disease which induces physical and psychosocial symptoms, with a significant impact on the quality of life. As a consequence, despite advances in research in disease-modifying drugs, MS remains a life-limiting disease with symptoms negatively impacting the lives of MS patients and their families. PC has been developed for end-of-life treatment in oncology, being little used in MS. Specific issues in MS, like pain due to spasticity, requires a different approach respect to cancer pain management. Moreover, it is difficult to anticipate life expectancy in people with severe MS, who often need palliative care for a long extended period. PC teams are trained to keep open full and competent lines of communication about symptoms and disease progression, advanced care planning, and end-of-life issues and wishes. Many studies investigated the effects of home-based PC in advanced MS, showing weak evidences about the efficacy of PC versus usual care in MS. However, current evidence does not support or refute the routine use of PC interventions for people with MS.
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Affiliation(s)
- Vincenzo Cimino
- Rehabilitation Division, Centro Neurolesi "Bonino Pulejo", IRCSS, Messina, Italy
| | - Clara Grazia Chisari
- Department G.F. Ingrassia, Section of Neuroscience, University of Catania, Catania, Italy
| | - Simona Toscano
- Department G.F. Ingrassia, Section of Neuroscience, University of Catania, Catania, Italy
| | - Francesco Patti
- Department G.F. Ingrassia, Section of Neuroscience, University of Catania, Catania, Italy.
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Velepucha-Iniguez J, Bonilla Sierra P, Bruera E. Barriers to Palliative Care Access in Patients With Intellectual Disability: A Scoping Review. J Pain Symptom Manage 2022; 64:e347-e356. [PMID: 35995282 DOI: 10.1016/j.jpainsymman.2022.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/12/2022] [Accepted: 08/11/2022] [Indexed: 01/04/2023]
Abstract
UNLABELLED There is limited knowledge about inequalities regarding palliative care access among patients with intellectual disability. The present scoping review aimed to identify the existing barriers that limit access to palliative care (PC) in patients with intellectual disability. METHODS We conducted a literature review on publications since 2014 from three databases (MEDLINE, Biomed Central, and Elsevier Scopus), along with hand searches in scientific journals. The review included peer-reviewed studies written in English and Spanish language with quantitative and qualitative study designs. The participants were patients with intellectual disability and health professionals who had worked with them or had experience in palliative care. RESULTS 22 studies met the selection criteria. The barriers identified were under referral to palliative care, reduced access, communication, and limited knowledge and experience by health professionals. CONCLUSION Patients with intellectual disability do not get referred to PC frequently. Health professionals and caregivers do not recognize when it is necessary to make a referral, and they need to improve their communication abilities. Also, health care workers need more training in PC, pain management, anticipation of death, and use of opioids. More research and education on the palliative care needs and care for patients with intellectual disabilities is needed.
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Affiliation(s)
- Josselyn Velepucha-Iniguez
- Department of Health Sciences (J.V.I., P.B.S.), Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador.
| | - Patricia Bonilla Sierra
- Department of Health Sciences (J.V.I., P.B.S.), Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine (E.B.), The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Advanced Adrenocortical Carcinoma: From Symptoms Control to Palliative Care. Cancers (Basel) 2022; 14:cancers14235901. [PMID: 36497381 PMCID: PMC9739560 DOI: 10.3390/cancers14235901] [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: 10/30/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 12/02/2022] Open
Abstract
The prognosis of patients with advanced adrenocortical carcinoma (ACC) is often poor: in the case of metastatic disease, five-year survival is reduced. Advanced disease is not a non-curable disease and, in referral centers, the multidisciplinary approach is the standard of care: if a shared decision regarding several treatments is available, including the correct timing for the performance of each one, overall survival is increased. However, many patients with advanced ACC experience severe psychological and physical symptoms secondary to the disease and the cancer treatments. These symptoms, combined with existential issues, debase the quality of the remaining life. Recent strong evidence from cancer research supports the early integration of palliative care principles and skills into the advanced cancer patient's trajectory, even when asymptomatic. A patient with ACC risks quickly suffering from symptoms/effects alongside the disease; therefore, early palliative care, in some cases concurrent with oncological treatment (simultaneous care), is suggested. The aims of this paper are to review current, advanced ACC approaches, highlight appropriate forms of ACC symptom management and suggest when and how palliative care can be incorporated into the ACC standard of care.
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Abian MH, Antón Rodríguez C, Noguera A. End of Life Cost Savings in the Palliative Care Unit Compared to Other Services. J Pain Symptom Manage 2022; 64:495-503. [PMID: 35842179 DOI: 10.1016/j.jpainsymman.2022.06.016] [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: 03/27/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Hospital deaths carry a significant healthcare cost that has been confirmed to be lower when palliative care units (PCUs) are available. OBJECTIVES To compare the last admission hospital health care cost of dying in a first-level hospital between the PCU and the rest of the hospital services. METHODS A retrospective, comparative, observational study evaluating costs from the payer perspective on treatments and diagnostic-therapeutic tests performed on patients who die in first-level hospital, comparing whether they were treated by the PCU or another unit (Non-PCU). Patients with a mortality risk >2 were included according to the Severity of Illness Index (SOI) and Risk of Mortality (MOR). All cost express in €, median per patient and interquartile range (IQR). RESULTS From 1,833 patients who died, 1,389 were included, 442 (31.1%) treated by PCU and 928 (68.9%) Non-PCU. Statistical differences were found for the last admission total cost (€262.8 (€470.1) for PCU versus €515.3 (€980.48) in Non-PCU), daily total cost (€74.27 (€127.4) vs €115.8 (€142.4) Non-PCU). Savings were maintained when the sample was broken down by diagnosis-related group (DRG) and a multivariate analysis was performed to determine how the different patients baseline characteristics between PCU and Non-PCU patients influenced the results obtained. CONCLUSIONS Data from this study show that cost is significantly lower when the patients are treated by a PCU during their last hospital stay when they pass away.
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Affiliation(s)
- María Herrera Abian
- Palliative Care Chief, Hospital Universitario Infanta Elena (M.H.A.), Valdemoro, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria (M.H.A.), Madrid, España
| | - Cristina Antón Rodríguez
- Palliative Care Chief, Hospital Universitario Fundación Jiménez Díaz (C.A.R., A.N.), Madrid, España; Unidad de Apoyo a la Investigación, Facultad de Medicina (C.A.R.), Universidad Francisco de Vitoria, Madrid, España.
| | - Antonio Noguera
- Palliative Care Chief, Hospital Universitario Fundación Jiménez Díaz (C.A.R., A.N.), Madrid, España
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22
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Ferro-Uriguen A, Beobide-Telleria I, Gil-Goikouria J, Peña-Labour PT, Díaz-Vila A, Herasme-Grullón AT, Echevarría-Orella E, Seco-Calvo J. Application of a person-centered prescription model improves pharmacotherapeutic indicators and reduces costs associated with pharmacological treatment in hospitalized older patients at the end of life. Front Public Health 2022; 10:994819. [PMID: 36262221 PMCID: PMC9574095 DOI: 10.3389/fpubh.2022.994819] [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: 07/15/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023] Open
Abstract
Objective This study sought to investigate whether applying an adapted person-centered prescription (PCP) model reduces the total regular medications in older people admitted in a subacute hospital at the end of life (EOL), improving pharmacotherapeutic indicators and reducing the expense associated with pharmacological treatment. Design Randomized controlled trial. The trial was registered with ClinicalTrials.gov (NCT05454644). Setting A subacute hospital in Basque Country, Spain. Subjects Adults ≥65 years (n = 114) who were admitted to a geriatric convalescence unit and required palliative care. Intervention The adapted PCP model consisted of a systematic four-step process conducted by geriatricians and clinical pharmacists. Relative to the original model, this adapted model entails a protocol for the tools and assessments to be conducted on people identified as being at the EOL. Measurements After applying the adapted PCP model, the mean change in the number of regular drugs, STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with limited life expectancy) criteria, drug burden index (DBI), drug-drug interactions, medication regimen complexity index (MRCI) and 28-days medication cost of chronic prescriptions between admission and discharge was analyzed. All patients were followed for 3 months after hospital discharge to measure the intervention's effectiveness over time on pharmacotherapeutic variables and the cost of chronic medical prescriptions. Results The number of regular prescribed medications at baseline was 9.0 ± 3.2 in the intervention group and 8.2 ± 3.5 in the control group. The mean change in the number of regular prescriptions at discharge was -1.74 in the intervention group and -0.07 in the control group (mean difference = 1.67 ± 0.57; p = 0.007). Applying a PCP model reduced all measured criteria compared with pre-admission (p < 0.05). At discharge, the mean change in 28-days medication cost was significantly lower in the intervention group compared with the control group (-34.91€ vs. -0.36€; p < 0.004). Conclusion Applying a PCP model improves pharmacotherapeutic indicators and reduces the costs associated with pharmacological treatment in hospitalized geriatric patients at the EOL, continuing for 3 months after hospital discharge. Future studies must investigate continuity in the transition between hospital care and primary care so that these new care models are offered transversally and not in isolation.
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Affiliation(s)
- Alexander Ferro-Uriguen
- Department of Pharmacy, Ricardo Bermingham Hospital—Matia Foundation, Donostia-San Sebastian, Spain,*Correspondence: Alexander Ferro-Uriguen
| | - Idoia Beobide-Telleria
- Department of Pharmacy, Ricardo Bermingham Hospital—Matia Foundation, Donostia-San Sebastian, Spain
| | - Javier Gil-Goikouria
- Department of Physiology, University of the Basque Country (UPV/EHU), Bilbao, Spain,Network Centre for Biomedical Research in Mental Health to the Institute of Health Carlos III (CIBERSAM ISCIII), Madrid, Spain
| | - Petra Teresa Peña-Labour
- Department of Geriatrics, Ricardo Bermingham Hospital—Matia Foundation, Donostia-San Sebastian, Spain
| | - Andrea Díaz-Vila
- Department of Geriatrics, Ricardo Bermingham Hospital—Matia Foundation, Donostia-San Sebastian, Spain
| | | | - Enrique Echevarría-Orella
- Department of Physiology, University of the Basque Country (UPV/EHU), Bilbao, Spain,Network Centre for Biomedical Research in Mental Health to the Institute of Health Carlos III (CIBERSAM ISCIII), Madrid, Spain
| | - Jesús Seco-Calvo
- Institute of Biomedicine (IBIOMED), University of León, León, Spain,Department of Physiology, University of the Basque Country (UPV/EHU), Bilbao, Spain
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Müller E, Müller MJ, Boehlke C, Ramsenthaler C, Jäger H, Schäfer H, Ostgathe C, Klein C, Simon S, Becker G. Development of a screening tool for the need of specialist palliative care in oncologic inpatients: study protocol for the ScreeningPALL Study. BMJ Open 2022; 12:e059598. [PMID: 36581985 PMCID: PMC9438211 DOI: 10.1136/bmjopen-2021-059598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION A range of referral criteria and scores have been developed in recent years to help with screening for the need of specialist palliative care (SPC) in advanced, incurable cancer patients. However, referral criteria have not yet been widely implemented in oncology, as they usually need to be revised by physicians or nurses with limited time resources. To develop an easily applicable screening for the need for SPC in incurable cancer inpatients, we aim to (a) test inter-rater reliability of multiprofessional expert opinion as reference standard for SPC need (phase I) and (b) explore the diagnostic validity of selected patient-reported outcome measures (PROMs) and routine data for the need of SPC (phase II). METHODS AND ANALYSIS Inclusion criteria for patients are metastatic or locally advanced, incurable cancer, ≥18 years of age and informed consent by patient or proxy. (Exclusion criteria: malignant haematological disease as main diagnosis). In phase I, three palliative care consultation teams (PCTs) of three German university hospitals assess the SPC need of 20 patient cases. Fleiss' Kappa will be calculated for inter-rater reliability. In phase II, 208 patients are consecutively recruited in four inpatient oncology wards of Freiburg University Hospital. The PCT will provide assessment of SPC need. As potential referral criteria, patients complete PROMs and a selection of routine data on person, disease and treatment is documented. Logistic regression models and ROC analyses are employed to test their utility in screening for SPC need. ETHICS AND DISSEMINATION Our findings will be published in peer-reviewed journals and presented at national and international scientific meetings and congresses. Ethical approval was granted by the Ethics Committee of Albert-Ludwigs-University Freiburg, Germany (approval no. 20-1103). TRIAL REGISTRATION NUMBER German Clinical Trials Register, DRKS00021686, registered on 17 December 2020.
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Affiliation(s)
- Evelyn Müller
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Josef Müller
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christopher Boehlke
- Department of Palliative Care, University Hospital Basel, Basel, Switzerland
| | - Christina Ramsenthaler
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Helga Jäger
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Henning Schäfer
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, University Hospital Erlangen-EMN, Comprehensive Cancer Center CCC Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Carsten Klein
- Department of Palliative Medicine, University Hospital Erlangen-EMN, Comprehensive Cancer Center CCC Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Steffen Simon
- Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Gerhild Becker
- Department of Palliative Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Lee JH, Hwang KK. End-of-Life Care for End-stage Heart Failure Patients. Korean Circ J 2022; 52:659-679. [PMID: 36097835 PMCID: PMC9470494 DOI: 10.4070/kcj.2022.0211] [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: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/11/2022] Open
Abstract
Although recent heart failure (HF) guidelines highlight integrative palliative care, including end-of-life (EOL), appropriate discussing EOL issues can be challenging due to possibility of unexpected deterioration throughout HF trajectory. Open communication and discussions with multidisciplinary team are important for setting patient and family expectations and establishing mutually agreed goals of care based firmly on the patient’s ‘human dignity’ and ‘right to self-determination.’ Especially when quality-of-life outweighs expanding quantity-of-life, transition to EOL care should be considered. Advanced care planning including resuscitation, device deactivation, site for last days, and bereavement support should focus on ensuring a good death, and be reviewed regularly. Efforts to improve end-of-life (EOL) care have generally been focused on cancer patients, but high-quality EOL care is also important for patients with other serious medical illnesses including heart failure (HF). Recent HF guidelines offer more clinical considerations for palliative care including EOL care than ever before. Because HF patients can experience rapid, unexpected clinical deterioration or sudden death throughout the disease trajectory, choosing an appropriate time to discuss issues such as advance directives or hospice can be challenging in real clinical situations. Therefore, EOL issues should be discussed early. Conversations are important for understanding patient and family expectations and developing mutually agreed goals of care. In particular, high-quality communication with patient and family through a multidisciplinary team is necessary to define patient-centered goals of care and establish treatment based on goals. Control of symptoms such as dyspnea, pain, anxiety/depression, fatigue, nausea, anorexia, and altered mental status throughout the dying process is an important issue that is often overlooked. When quality-of-life outweighs expanding quantity-of-life, the transition to EOL care should be considered. Advanced care planning including resuscitation (i.e., do-not resuscitate order), device deactivation, site for last days and bereavement support for the family should focus on ensuring a good death and be reviewed regularly. It is essential to ensure that treatment for all HF patients incorporates discussions about the overall goals of care and individual patient preferences at both the EOL and sudden changes in health status. In this review, we focus on EOL care for end-stage HF patients.
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Affiliation(s)
- Ju-Hee Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
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Aguilar-Fuerte M, Alonso-Ecenarro F, Broch-Petit A, Chover-Sierra E. Palliative Care Needs and Clinical Features Related to Short-Term Mortality in Patients Enrolled in a Heart Failure Unit. Healthcare (Basel) 2022; 10:healthcare10091609. [PMID: 36141221 PMCID: PMC9498741 DOI: 10.3390/healthcare10091609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 01/08/2023] Open
Abstract
(1) Background: Heart failure (HF) is a chronic and complex pathology requiring continuous patient management due to clinical instability, associated comorbidity, and extensive pharmacological treatment. Its unpredictable course makes the advanced stages challenging to recognize and raises the need for palliative care. This study aims to identify palliative care needs in HF patients and describe clinical features related to short-term mortality. (2) Methods: A descriptive, observational, cross-sectional, and retrospective study was carried out in an HF unit of a Spanish tertiary hospital. Patients’ socio-demographic and clinical data were collected from clinical records, and different instruments were used to establish mortality risks and patients’ needs for palliative care. Subsequently, univariate and bivariate descriptive analyses were performed. A binary logistic regression model helped to determine variables that could influence mortality 12 months after admission to the Unit. (3) Results: The studied population, sixty-five percent women, had an average age of 83.27 years. Among other clinical characteristics predominated preserved ejection fraction (pEF) and dyspnea NYHA (New York Heart Association) class II. The most prevalent comorbidities were hypertension and coronary heart disease. Forty-nine percent had a low–intermediate mortality risk in the following year, according to the PROFUND index. The NECPAL CCOMS-ICO© instrument identified subjects who meet the criteria for palliative care. This predictive model identified NECPAL CCOMS-ICO© results, using beta-blockers (BB) or AIIRA (Angiotensin II receptor antagonists) and low glomerular filtration rate (GFR) as explanatory variables of patients’ mortality in the following year. (4) Conclusions: The analysis of the characteristics of the population with HF allows us to identify patients in need of palliative care. The NECPAL CCOMS-ICO© instrument and the PROFUND have helped identify the characteristics of people with HF who would benefit from palliative management.
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Affiliation(s)
- Marta Aguilar-Fuerte
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 València, Spain
| | | | - Alejandro Broch-Petit
- Internal Medicine, Consorcio Hospital General Universitario de Valencia, 46014 València, Spain
| | - Elena Chover-Sierra
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 València, Spain
- Internal Medicine, Consorcio Hospital General Universitario de Valencia, 46014 València, Spain
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 València, Spain
- Correspondence:
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26
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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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van Lummel EV, Ietswaard L, Zuithoff NP, Tjan DH, van Delden JJ. The utility of the surprise question: A useful tool for identifying patients nearing the last phase of life? A systematic review and meta-analysis. Palliat Med 2022; 36:1023-1046. [PMID: 35769037 PMCID: PMC10941345 DOI: 10.1177/02692163221099116] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The surprise question is widely used to identify patients nearing the last phase of life. Potential differences in accuracy between timeframe, patient subgroups and type of healthcare professionals answering the surprise question have been suggested. Recent studies might give new insights. AIM To determine the accuracy of the surprise question in predicting death, differentiating by timeframe, patient subgroup and by type of healthcare professional. DESIGN Systematic review and meta-analysis. DATA SOURCES Electronic databases PubMed, Embase, Cochrane Library, Scopus, Web of Science and CINAHL were searched from inception till 22nd January 2021. Studies were eligible if they used the surprise question prospectively and assessed mortality. Sensitivity, specificity, negative predictive value, positive predictive value and c-statistic were calculated. RESULTS Fifty-nine studies met the inclusion criteria, including 88.268 assessments. The meta-analysis resulted in an estimated sensitivity of 71.4% (95% CI [66.3-76.4]) and specificity of 74.0% (95% CI [69.3-78.6]). The negative predictive value varied from 98.0% (95% CI [97.7-98.3]) to 88.6% (95% CI [87.1-90.0]) with a mortality rate of 5% and 25% respectively. The positive predictive value varied from 12.6% (95% CI [11.0-14.2]) with a mortality rate of 5% to 47.8% (95% CI [44.2-51.3]) with a mortality rate of 25%. Seven studies provided detailed information on different healthcare professionals answering the surprise question. CONCLUSION We found overall reasonable test characteristics for the surprise question. Additionally, this study showed notable differences in performance within patient subgroups. However, we did not find an indication of notable differences between timeframe and healthcare professionals.
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Affiliation(s)
- Eline Vtj van Lummel
- Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Larissa Ietswaard
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolaas Pa Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dave Ht Tjan
- Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Johannes Jm van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Barrena Urieta I, Rodríguez Rocha AJ, Wang Gao Y, Rol Hoyas CM, Aira Ferrer P, Domínguez Lorenzo C. Perfil de pacientes con cronicidad avanzada y necesidades paliativas: un cambio que no llega. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/rcmf.150204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objetivo: estudiar los posibles cambios en el perfil de pacientes con cronicidad avanzada entre dos cohortes en el momento de su inclusión en un equipo de soporte de atención paliativa domiciliaria (ESAPD) en el marco de la implementación de estrategias de cronicidad.
Método: estudio observacional retrospectivo con enfoque analítico de pacientes no oncológicos derivados a un ESAPD de la Comunidad de Madrid, divididos en dos cohortes (2014 y 2019) definidas por el momento de inclusión en programa. Las variables principales fueron: tiempo de permanencia en programa (TPP), carga sintomática (CS) y situación funcional (SF). Se recogieron variables sociodemográficas y clínicas. Se comparó globalmente y por sexo el efecto de la cohorte (bruto y ajustado) sobre las variables principales mediante LogRank y Cox para el TPP, t-Student para la CS y SF y Modelo Lineal Generalizado para la SF.
Resultados: las cohortes 2014 y 2019 constaron, respectivamente, de 98 y 116 pacientes, 63% y 52% de mujeres, 48% y 35% del ámbito rural y 43% y 27% de institucionalizados, con una media de edad y lugar de fallecimiento similares. En el TPP no se evidenciaron diferencias entre ambas cohortes (p=0,098); el análisis de Cox tampoco mostró asociación (HR = 1,01 [0,75; 1,36]). En la CS no se encontraron diferencias clínicamente relevantes. No se observaron diferencias en la SF una vez ajustada por las variables edad, sexo e institucionalización.
Conclusión: no se observaron diferencias en el perfil de pacientes con cronicidad avanzada incluidos en el programa del ESAPD entre los años 2014 y 2019 en el marco de la implementación de estrategias de cronicidad.
Palabras clave: cuidados paliativos, Atención Primaria, enfermedad crónica, diagnóstico precoz, anciano frágil.
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Affiliation(s)
| | | | - Yu Wang Gao
- Especialista en Medicina Familiar y Comunitaria, CS Joaquín Rodrigo, Madrid (España)
| | - Carlos Manuel Rol Hoyas
- Especialista en Medicina Familiar y Comunitaria, Hospital Universitario del Sureste, Arganda del Rey (España)
| | - Pilar Aira Ferrer
- Especialista en Medicina Familiar y Comunitaria. ESAPD Dirección Asistencial Oeste, Madrid (España)
| | - Carmen Domínguez Lorenzo
- Especialista en Medicina Familiar y Comunitaria. ESAPD Dirección Asistencial Oeste, Madrid (España)
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Barrena Urieta I, Rodríguez Rocha J, Wang Gao Y, Rol Hoyas CM, Aira Ferrer P, Domínguez Lorenzo C. Perfil de pacientes con cronicidad avanzada y necesidades paliativas: un cambio que no llega. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/150214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objetivo: estudiar los posibles cambios en el perfil de pacientes con cronicidad avanzada entre dos cohortes en el momento de su inclusión en un equipo de soporte de atención paliativa domiciliaria (ESAPD) en el marco de la implementación de estrategias de cronicidad.
Método: estudio observacional retrospectivo con enfoque analítico de pacientes no oncológicos derivados a un ESAPD de la Comunidad de Madrid, divididos en dos cohortes (2014 y 2019) definidas por el momento de inclusión en programa. Las variables principales fueron: tiempo de permanencia en programa (TPP), carga sintomática (CS) y situación funcional (SF). Se recogieron variables sociodemográficas y clínicas. Se comparó globalmente y por sexo el efecto de la cohorte (bruto y ajustado) sobre las variables principales mediante LogRank y Cox para el TPP, t-Student para la CS y SF y Modelo Lineal Generalizado para la SF.
Resultados: las cohortes 2014 y 2019 constaron, respectivamente, de 98 y 116 pacientes, 63% y 52% de mujeres, 48% y 35% del ámbito rural y 43% y 27% de institucionalizados, con una media de edad y lugar de fallecimiento similares. En el TPP no se evidenciaron diferencias entre ambas cohortes (p=0,098); el análisis de Cox tampoco mostró asociación (HR = 1,01 [0,75; 1,36]). En la CS no se encontraron diferencias clínicamente relevantes. No se observaron diferencias en la SF una vez ajustada por las variables edad, sexo e institucionalización.
Conclusión: no se observaron diferencias en el perfil de pacientes con cronicidad avanzada incluidos en el programa del ESAPD entre los años 2014 y 2019 en el marco de la implementación de estrategias de cronicidad.
Palabras clave: cuidados paliativos, Atención Primaria, enfermedad crónica, diagnóstico precoz, anciano frágil.
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Affiliation(s)
| | - José Rodríguez Rocha
- Especialista en Medicina Familiar y Comunitaria, WellSpan York Hospital, York, Pennsylvania (Estados Unidos)
| | - Yu Wang Gao
- Especialista en Medicina Familiar y Comunitaria, CS Joaquín Rodrigo, Madrid (España)
| | - Carlos Manuel Rol Hoyas
- Especialista en Medicina Familiar y Comunitaria, Hospital Universitario del Sureste, Arganda del Rey (España)
| | - Pilar Aira Ferrer
- Especialista en Medicina Familiar y Comunitaria. ESAPD Dirección Asistencial Oeste, Madrid (España)
| | - Carmen Domínguez Lorenzo
- Especialista en Medicina Familiar y Comunitaria. ESAPD Dirección Asistencial Oeste, Madrid (España)
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Palliative Care for Patients with End-Stage, Non-Oncologic Diseases-A Retrospective Study in Three Public Palliative Care Departments in Northern Italy. Healthcare (Basel) 2022; 10:healthcare10061031. [PMID: 35742082 PMCID: PMC9222892 DOI: 10.3390/healthcare10061031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 02/05/2023] Open
Abstract
Patients with irreversible malignant and non-malignant diseases have comparable mortality rates, symptom burdens, and quality of life issues; however, non-cancer patients seldom receive palliative care (PC) or receive it late in their disease trajectory. To explore the characteristics of non-cancer patients receiving PC in northern Italy, as well as the features and outcomes of their care, we retrospectively analyzed the charts of all non-cancer patients initiating PC regimens during 2019 in three publicly funded PC departments in Italy’s populous Lombardy region. We recorded the baseline variables (including data collected with the NECPAL CCOMS-ICO-derived questionnaire used since 2018 to evaluate all admissions to the region’s PC network), as well as treatment features (setting and duration) and outcomes (including time and setting of death). Of the 2043 patients admitted in 2019, only 12% (243 patients—131 females; mean age 83.5 years) had non-oncological primary diagnoses (mainly dementia [n = 78], heart disease [n = 55], and lung disease [n = 30]). All 243 had Karnofsky performance statuses ≤ 40% (10−20% in 64%); most (82%) were malnourished, 92% had ≥2 comorbidities, and 61% reported 2−3 severe symptoms (pain, dyspnea, and fatigue). Fifteen withdrew or were discharged from the study PCN; the other 228 remained in the PCN and died in hospice (n = 133), at home (n = 9), or after family-requested transfer to an emergency department (n = 1). Most deaths (172/228, 75%) occurred <3 weeks after PC initiation. These findings indicate that the PCN network we studied cares for few patients with life-limiting non-malignant diseases. Those admitted have advanced-stage illness, heavy symptom burdens, low performance statuses, and poor survival. Additional efforts are needed to improve PCN accessibility for non-cancer patients.
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31
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Berry P, Kotha S. Improving end of life care in liver disease. J Hepatol 2022; 76:1225-1226. [PMID: 35063299 DOI: 10.1016/j.jhep.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom.
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Waller A, Hobden B, Fakes K, Clark K. A Systematic Review of the Development and Implementation of Needs-Based Palliative Care Tools in Heart Failure and Chronic Respiratory Disease. Front Cardiovasc Med 2022; 9:878428. [PMID: 35498028 PMCID: PMC9043454 DOI: 10.3389/fcvm.2022.878428] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background The impetus to develop and implement tools for non-malignant patient groups is reflected in the increasing number of instruments being developed for heart failure and chronic respiratory diseases. Evidence syntheses of psychometric quality and clinical utility of these tools is required to inform research and clinical practice. Aims This systematic review examined palliative care needs tools for people diagnosed with advanced heart failure or chronic respiratory diseases, to determine their: (1) psychometric quality; and (2) acceptability, feasibility and clinical utility when implemented in clinical practice. Methods Systematic searches of MEDLINE, CINAHL, Embase, Cochrane and PsycINFO from database inception until June 2021 were undertaken. Additionally, the reference lists of included studies were searched for relevant articles. Psychometric properties of identified measures were evaluated against pre-determined and standard criteria. Results Eighteen tools met inclusion criteria: 11 were developed to assess unmet patient palliative care needs. Of those, 6 were generic, 4 were developed for heart failure and 1 was developed for interstitial lung disease. Seven tools identified those who may benefit from palliative care and include general and disease-specific indicators. The psychometric qualities of the tools varied. None met all of the accepted criteria for psychometric rigor in heart failure or respiratory disease populations. There is limited implementation of needs assessment tools in practice. Conclusion Several tools were identified, however further validation studies in heart failure and respiratory disease populations are required. Rigorous evaluation to determine the impact of adopting a systematic needs-based approach for heart failure and lung disease on the physical and psychosocial outcomes of patients and carers, as well as the economic costs and benefits to the healthcare system, is required.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- *Correspondence: Amy Waller
| | - Breanne Hobden
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Kristy Fakes
- Health Behaviour Research Collaborative, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Katherine Clark
- Northern Sydney Local Health District (NSLHD) Supportive and Palliative Care Network, St Leonards, NSW, Australia
- Northern Clinical School, The University of Sydney, Darlington, NSW, Australia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
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Kabelka L, Dušek L. NECPAL Tool Aids Early Identification of Palliative Care Needs. J Palliat Med 2022; 25:1398-1403. [DOI: 10.1089/jpm.2022.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ladislav Kabelka
- Centre of Palliative Care and Community Services, Trebic, Vysocina, Czech Republic
- Faculty Hospital Sv., Anna, Brno, Czech Republic
- Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Ladislav Dušek
- Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
- Institute of Biostatistics and Analyses Brno, Brno, Czech Republic
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Herreros B, Ruiz de Luna R, de la Calle N, Gayoso D, Martínez P, Olaciregui Dague K, Palacios G. Operation of a triage committee for advanced life support during the COVID-19 pandemic. Philos Ethics Humanit Med 2022; 17:5. [PMID: 35292071 PMCID: PMC8923824 DOI: 10.1186/s13010-022-00117-1] [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: 08/11/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND During the first weeks of March 2020 in Spain, the cases of severe respiratory failure progressively increased, generating an imbalance between the clinical needs for advanced life support (ALS) measures and the effective availability of ALS resources. To address this problem, the creation of triage committees (TC) was proposed, whose main function is to select the best candidates to receive ALS. The main objective of our study is to describe the clinical characteristics of the patients evaluated by the TC of the Alcorcón Foundation University Hospital (AFUH) during the first wave of SARS CoV-2. Other objectives are to determine if there are differences between the patients considered candidates / not candidates for ALS and to analyze the functioning of the TC. METHODS Retrospective observational study of all patients assessed by the AFUH TC. RESULTS There were 19 meetings, in which 181 patients were evaluated, 65.4% male and with a mean age of 70.1 years. 31% had some degree of functional dependence, the Barthel median was 100 and Charlson 4. 58.5% were not considered a candidate for ALS at that time. The patients considered candidates to receive ALS were younger (72 vs 66; p < 0.001), had less comorbidity (Charlson 4 vs 3; p < 0.001) and had a better previous functional situation. A median of 5 physicians participated in each meeting and, after being assessed by the TC, 13.6% received ALS: 29.3% of those considered candidates for ALS and 2% of the non-candidates. CONCLUSIONS The patients evaluated by the TC had a mean age of 70 years, high comorbidity and almost a third had some degree of functional dependence. More than half were not considered candidates for ALS at that time, these patients being older, with more comorbidity and a worse previous functional situation. TC decisions, based on objective clinical criteria, were almost always respected. Public institutions must get involved in triage procedures, which should and in our opinion must include the creation of TC in health centers. The implementation of Anticipated Decision programs (ADP) would help enable patients affected by triage decisions to participate in them.
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Affiliation(s)
- Benjamín Herreros
- Internal Medicine Unit, Alcorcón Foundation University Hospital, Alcorcón, Spain
- Francisco Vallés Institute of Clinical Ethics, European University, Madrid, Spain
| | - Rafael Ruiz de Luna
- Intensive Medicine Unit, Alcorcón Foundation University Hospital, Madrid, Spain
| | - Natalia de la Calle
- Intensive Medicine Unit, Alcorcón Foundation University Hospital, Madrid, Spain
| | - Diego Gayoso
- Internal Medicine Unit, Alcorcón Foundation University Hospital, Alcorcón, Spain
| | - Paula Martínez
- Internal Medicine Unit, Alcorcón Foundation University Hospital, Alcorcón, Spain
| | | | - Gregorio Palacios
- Internal Medicine Unit, Alcorcón Foundation University Hospital, Alcorcón, Spain
- Francisco Vallés Institute of Clinical Ethics, European University, Madrid, Spain
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Tripodoro VA, Llanos V, Daud ML, Muñoz P, Del Mar E, Tranier R, Sandjian S, Lellis SD, Días JM, Saurí A, De Simone GG, Gómez-Batiste X. Palliative and prognostic approach in cancer patients identified in the multicentre NECesidades PALiativas 2 study in Argentina. Ecancermedicalscience 2022; 15:1316. [PMID: 35047067 PMCID: PMC8723739 DOI: 10.3332/ecancer.2021.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Early identification of palliative needs has proven benefits in quality of life, survival and decision-making. The NECesidades PALiativas (NECPAL) Centro Coordinador Organización Mundial de la Salud - Instituto Catalán de Oncología (CCOMS-ICO©) tool combines the physician’s insight with objective disease progression parameters and advanced chronic conditions. Some parameters have been independently associated with mortality risk in different populations. According to the concept of the ‘prognostic approach’ as a companion of the ‘palliative approach’, predictive models that identify individuals at high mortality risk are needed. Objective We aimed to identify prognostic factors of mortality in cancer in our cultural context. Method We assessed cancer patients with palliative needs until death using this validated predictive tool at three hospitals in Buenos Aires City. This multifactorial, quantitative and qualitative non-dichotomous assessment process combines subjective perception (the surprise question: Would you be surprised if this patient dies in the next year?) with other parameters, including the request (and need) for palliative care (PC), the assessment of disease severity, geriatric syndromes, psychosocial factors and comorbidities, as well as the use of healthcare resources. Results 2,104 cancer patients were identified, 681 were NECPAL+ (32.3%). During a 2-year follow-up period, 422 NECPAL+ patients died (61.9%). The mean overall survival was 8 months. A multivariate model was constructed with significant indicators in univariate analysis. The best predictors of mortality were: nutritional decline (p < 0.000), functional decline (p < 0.000), palliative performance scale (PPS) ≤ 50 (p < 0.000), persistent symptoms (p < 0.002), functional dependence (p < 0.000), poor treatment response (p < 0.000), primary cancer diagnosis (p = 0.024) and condition (in/outpatients) (p < 0.000). Only three variables remained as survival predictors: low response to treatment (p < 0.001), PPS ≤ 50 (p < 0.000) and condition (in/outpatients) (p < 0.000). Conclusion This prospective model aimed to improve cancer survival prediction and timely PC referral in Argentinian hospitals.
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Affiliation(s)
- Vilma Adriana Tripodoro
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Av Combatientes de Malvinas 3150, C1427 ARN, Buenos Aires, Argentina.,Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina.,https://orcid.org/0000-0003-2328-6032
| | - Victoria Llanos
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Av Combatientes de Malvinas 3150, C1427 ARN, Buenos Aires, Argentina.,Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - María Laura Daud
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - Pilar Muñoz
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - Eden Del Mar
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Av Combatientes de Malvinas 3150, C1427 ARN, Buenos Aires, Argentina
| | - Romina Tranier
- Instituto de Oncología Ángel Roffo, Universidad de Buenos Aires, Av San Martín 5481 (1417), Ciudad de Buenos Aires, Argentina
| | - Sol Sandjian
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - Silvina De Lellis
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - Juan Manuel Días
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina
| | - Alvaro Saurí
- Instituto de Oncología Ángel Roffo, Universidad de Buenos Aires, Av San Martín 5481 (1417), Ciudad de Buenos Aires, Argentina
| | - Gustavo Gabriel De Simone
- Instituto Pallium Latinoamérica, Bonpland 2257 (1425), Ciudad de Buenos Aires, Argentina.,Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Av Caseros 2061 (1264), Ciudad de Buenos Aires, Argentina
| | - Xavier Gómez-Batiste
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya, C Miquel Martí i Pol 1, 08500 Vic, Catalonia, Spain
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Ferré C, Canelles S, Daniel X, Rubio O, Esteban F, Pobo A. Detection of frailty and palliative needs from discharged critical care patients in collaboration with primary care. Med Intensiva 2021; 46:101-103. [PMID: 34863667 DOI: 10.1016/j.medine.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/04/2020] [Accepted: 11/29/2020] [Indexed: 10/19/2022]
Affiliation(s)
- C Ferré
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain
| | - S Canelles
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain
| | - X Daniel
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain
| | - O Rubio
- Unidad de Cuidados Intensivos, Hospital Sant Joan de Déu, Fundació Althaia Xarxa Universitària, Manresa, Barcelona, Spain
| | - F Esteban
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain
| | - A Pobo
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain.
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Torrente Jiménez I, Cabrera Pajarón M, Moreno-Ariño M, Palou Campmol M, Comet Monte R. Prevalence and Mortality of Patients with Palliative Needs in an Acute Respiratory Setting. Arch Bronconeumol 2021; 57:728. [PMID: 35699025 DOI: 10.1016/j.arbr.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/07/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Isabel Torrente Jiménez
- Unidad de Geriatría de Agudos y Paciente Crónico Complejo. Corporació Sanitària Parc Taulí, Sabadell, Spain; Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Spain.
| | | | - Marc Moreno-Ariño
- Unidad de Geriatría de Agudos y Paciente Crónico Complejo. Corporació Sanitària Parc Taulí, Sabadell, Spain
| | | | - Ricard Comet Monte
- Unidad de Geriatría de Agudos y Paciente Crónico Complejo. Corporació Sanitària Parc Taulí, Sabadell, Spain
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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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González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Molist-Brunet N, Codina-Jané C, Espaulella-Panicot J. Factors Associated with Medication Non-Adherence among Patients with Multimorbidity and Polypharmacy Admitted to an Intermediate Care Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9606. [PMID: 34574530 PMCID: PMC8464705 DOI: 10.3390/ijerph18189606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022]
Abstract
Identifying determinants of medication non-adherence in patients with multimorbidity would provide a step forward in developing patient-centered strategies to optimize their care. Medication appropriateness has been proposed to play a major role in medication non-adherence, reinforcing the importance of interdisciplinary medication review. This study examines factors associated with medication non-adherence among older patients with multimorbidity and polypharmacy. A cross-sectional study of non-institutionalized patients aged ≥65 years with ≥2 chronic conditions and ≥5 long-term medications admitted to an intermediate care center was performed. Ninety-three patients were included (mean age 83.0 ± 6.1 years). The prevalence of non-adherence based on patients' multiple discretized proportion of days covered was 79.6% (n = 74). According to multivariable analyses, individuals with a suboptimal self-report adherence (by using the Spanish-version Adherence to Refills and Medications Scale) were more likely to be non-adherent to medications (OR = 8.99, 95% CI 2.80-28.84, p < 0.001). Having ≥3 potentially inappropriate prescribing (OR = 3.90, 95% CI 0.95-15.99, p = 0.059) was barely below the level of significance. These two factors seem to capture most of the non-adherence determinants identified in bivariate analyses, including medication burden, medication appropriateness and patients' experiences related to medication management. Thus, the relationship between patients' self-reported adherence and medication appropriateness provides a basis to implement targeted strategies to improve effective prescribing in patients with multimorbidity.
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Affiliation(s)
- Javier González-Bueno
- Pharmacy Department, Consorci Hospitalari de Vic, 08500 Barcelona, Spain;
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
| | - Daniel Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
- Pharmacy Department, Parc Sanitari Pere Virgili, 08023 Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Epidemiology Unit, Consorci Hospitalari de Vic, 08500 Barcelona, Spain;
- Tissue Repair and Regeneration Laboratory (TR2Lab) Group, Faculty of Sciences and Technology & Faculty of Medicine, University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain
| | - Núria Molist-Brunet
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
- Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de la Santa Creu de Vic, 08500 Barcelona, Spain
| | - Carles Codina-Jané
- Pharmacy Department, Consorci Hospitalari de Vic, 08500 Barcelona, Spain;
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
| | - Joan Espaulella-Panicot
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
- Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de la Santa Creu de Vic, 08500 Barcelona, Spain
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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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González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Molist-Brunet N, Codina-Jané C, Espaulella-Panicot J. Improving medication adherence and effective prescribing through a patient-centered prescription model in patients with multimorbidity. Eur J Clin Pharmacol 2021; 78:127-137. [PMID: 34448906 DOI: 10.1007/s00228-021-03207-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to assess the impact of the patient-centered prescription (PCP) model in medication adherence and effective prescribing in patients with multimorbidity. METHODS Uncontrolled before-after study in an intermediate care facility in a mixed urban-rural district. Inpatients aged ≥ 65 years with multimorbidity exposed to polypharmacy before hospital admission were consecutively enrolled. Every patient's treatment plan was analyzed through the PCP model, which includes interventions aimed at improving medication adherence. The primary endpoint was the change in the proportion of adherent patients between pre-admission and after discharge for all regularly scheduled long-term medications, using the proportion of days covered (PDC). Secondary endpoints included the change on mean PDC for all long-term medications, number of long-term medications, proportion of patients with hyperpolypharmacy, medication regimen complexity index (MRCI) score, drug burden index (DBI) score, number of potential inappropriate prescribing (PIP), and proportion of patients with ≥ 2 PIPs. RESULTS Ninety-three non-institutionalized patients were included (mean age 83.0 ± SD 6.1 years). The proportion of adherent patients increased from 22.1 to 51.9% (P < 0.001). Intervention also improved mean PDC [mean difference (95% CI) 10.6 (7.7, 13.5)] and effective prescribing through a reduction on the number of long-term medications [- 1.3 (- 1.7, - 0.9)], proportion of patients exposed to hyperpolypharmacy (- 16.1%, P < 0.001), MRCI score [- 2.2 (- 3.4, - 1.0)], DBI score [- 0.16 (- 1.8, - 1.3)], number of PIPs [- 1.6 (- 1.8, - 1.3)], and proportion of patients with ≥ 2 PIPs (- 53.7%, P < 0.001). CONCLUSION Studied intervention provides significant effective prescribing and medication adherence enhancements in non-institutionalized older patients with multimorbidity and polypharmacy.
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Affiliation(s)
- J González-Bueno
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain. .,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.
| | - D Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Pharmacy Department, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - E Puigoriol-Juvanteny
- Epidemiology Unit, Consorci Hospitalari de Vic, Vic, Barcelona, Spain.,Tissue Repair and Regeneration Laboratory (TR2Lab) Group, Faculty of Sciences and Technology & Faculty of Medicine, University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - N Molist-Brunet
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain
| | - C Codina-Jané
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain.,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - J Espaulella-Panicot
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain
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Stevens J, Pype P, Eecloo K, Deliens L, Pardon K, De Vleminck A. Facilitating advance care planning in the general practice setting for patients with a chronic, life-limiting illness: protocol for a phase-III cluster-randomized controlled trial and process evaluation of the ACP-GP intervention. BMC Palliat Care 2021; 20:97. [PMID: 34172030 PMCID: PMC8231078 DOI: 10.1186/s12904-021-00796-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Advance care planning (ACP), a process of communication about patients’ preferences for future medical care, should be initiated in a timely manner. Ideally situated for this initiation is the general practitioner (GP). The intervention to improve the initiation of ACP for patients with a chronic life-limiting illness in general practice (ACP-GP) includes an ACP workbook for patients, ACP communication training for GPs, planned ACP conversations, and documentation of ACP conversation outcomes in a structured template. We present the study protocol of a Phase-III randomized controlled trial (RCT) of ACP-GP that aims to evaluate its effects on outcomes at the GP, patient, and surrogate decision maker (SDM) levels; and to assess the implementation process of the intervention. Methods This RCT will take place in Flanders, Belgium. Thirty-six GPs, 108 patients with a chronic, life-limiting illness, and their (potential) SDM will be recruited, then cluster-randomized to the ACP-GP intervention or the control condition. The primary outcome for GPs is ACP self-efficacy; primary outcome for patients is level of ACP engagement. Secondary outcomes for GPs are ACP practices, knowledge and attitudes; and documentation of ACP discussion outcomes. Secondary outcomes for patients are quality of life; anxiety; depression; appointment of an SDM; completion of new ACP documents; thinking about ACP; and communication with the GP. The secondary outcome for the SDM is level of engagement with ACP. A process evaluation will assess the recruitment and implementation of the intervention using the RE-AIM framework. Discussion While the general practice setting holds promise for timely initiation of ACP, there is a lack of randomized trial studies evaluating the effectiveness of ACP interventions implemented in this setting. After this Phase-III RCT, we will be able to present valuable evidence of the effects of this ACP-GP intervention, with the potential for offering a well-tested and evaluated program to be implemented in general practice. The results of the process evaluation will provide insight into what contributes to or detracts from implementation success, as well as how the intervention can be adapted to specific contexts or needs. Trial registration Prospectively registered at with ISRCTN (ISRCTN12995230); registered 19/06/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00796-1.
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Affiliation(s)
- Julie Stevens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Peter Pype
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kim Eecloo
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Koen Pardon
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Aline De Vleminck
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
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43
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Piers R, De Brauwer I, Baeyens H, Velghe A, Hens L, Deschepper E, Henrard S, De Pauw M, Van Den Noortgate N, De Saint-Hubert M. Supportive and Palliative Care Indicators Tool prognostic value in older hospitalised patients: a prospective multicentre study. BMJ Support Palliat Care 2021:bmjspcare-2021-003042. [PMID: 34059507 DOI: 10.1136/bmjspcare-2021-003042] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND An increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population. AIM To validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients. DESIGN Prospective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed. SETTING/PARTICIPANTS Patients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals. RESULTS In total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only.The HR of dying was 2.9 (95% CI 1.1 to 8.7) in SPICT-identified versus non-identified after adjustment for hospital strata, age, gender and did not differ between units. One-year mortality was 24% and 22%, respectively, on acute geriatric versus CUs (p=0.488). Pooled average sensitivity, specificity and partial area under the curve differed significantly between acute geriatric and CUs (p<0.001), respectively, 0.82 (95%CI 0.66 to 0.91), 0.49 (95%CI 0.40 to 0.58) and 0.82 in geriatric vs 0.69 (95% CI 0.42 to 0.87), 0.66 (95% CI 0.55 to 0.77) and 0.65 in CUs. CONCLUSIONS SPICT may be used as a tool to identify older hospitalised patients at risk of dying within 1 year and who may benefit from a palliative care approach including advance care planning. The prognostic accuracy of SPICT is better in older patients admitted at the acute geriatric versus the CU.
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Affiliation(s)
- Ruth Piers
- Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Isabelle De Brauwer
- Department of Geriatric Medicine, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
- UCL Institute of Health and Society, Bruxelles, Belgium
| | - Hilde Baeyens
- Department of Geriatric Medicine, AZ Alma campus Eeklo, Eeklo, Belgium
| | - Anja Velghe
- Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Lineke Hens
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Séverine Henrard
- UCL Institute of Health and Society, Bruxelles, Belgium
- UCLouvain Louvain Drug Research Institute, Bruxelles, Belgium
| | - Michel De Pauw
- Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
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Bevins J, Bhulani N, Goksu SY, Sanford NN, Gao A, Ahn C, Paulk ME, Terauchi S, Pruitt SL, Tavakkoli A, Rhodes RL, Ali Kazmi SM, Beg MS. Early Palliative Care Is Associated With Reduced Emergency Department Utilization in Pancreatic Cancer. Am J Clin Oncol 2021; 44:181-186. [PMID: 33710133 PMCID: PMC8062302 DOI: 10.1097/coc.0000000000000802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Most patients with pancreatic cancer have high symptom burden and poor outcomes. Palliative care (PC) can improve the quality of care through expert symptom management, although the optimal timing of PC referral is still poorly understood. We aimed to assess the association of early PC on health care utilization and charges of care for pancreatic cancer patients. MATERIALS AND METHODS We selected patients with pancreatic cancer diagnosed between 2000 and 2009 who received at least 1 PC encounter using the Surveillance, Epidemiology, and End Results (SEER)-Medicare. Patients who had unknown follow-up were excluded. We defined "early PC" if the patients received PC within 30 days of diagnosis. RESULTS A total of 3166 patients had a PC encounter; 28% had an early PC. Patients receiving early PC were more likely to be female and have older age compared with patients receiving late PC (P<0.001). Patients receiving early PC had fewer emergency department (ED) visits (2.6 vs. 3.0 visits, P=0.004) and lower total charges of ED care ($3158 vs. $3981, P<0.001) compared with patients receiving late PC. Patients receiving early PC also had lower intensive care unit admissions (0.82 vs. 0.98 visits, P=0.006) and total charges of intensive care unit care ($14,466 vs. $18,687, P=0.01). On multivariable analysis, patients receiving early PC were significantly associated with fewer ED visits (P=0.007) and lower charges of ED care (P=0.018) for all patients. CONCLUSIONS Early PC referrals were associated with lower ED visits and ED-related charges. Our findings support oncology society guideline recommendations for early PC in patients with advanced malignancies such as pancreatic cancer.
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Affiliation(s)
- Jack Bevins
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Nizar Bhulani
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Suleyman Yasin Goksu
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Nina Niu Sanford
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Ang Gao
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Chul Ahn
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Mary Elizabeth Paulk
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Palliative Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Stephanie Terauchi
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Palliative Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Anna Tavakkoli
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX
| | - Ramona L. Rhodes
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Geriatric Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Syed Mohammad Ali Kazmi
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Muhammad Shaalan Beg
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
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Torrente Jiménez I, Cabrera Pajarón M, Moreno-Ariño M, Palou Campmol M, Comet Monte R. Prevalence and Mortality of Patients with Palliative Needs in an Acute Respiratory Setting. Arch Bronconeumol 2021; 57:S0300-2896(21)00128-9. [PMID: 33985843 DOI: 10.1016/j.arbres.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Isabel Torrente Jiménez
- Unidad de Geriatría de Agudos y Paciente Crónico Complejo. Corporació Sanitària Parc Taulí, Sabadell, España; Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, España.
| | | | - Marc Moreno-Ariño
- Unidad de Geriatría de Agudos y Paciente Crónico Complejo. Corporació Sanitària Parc Taulí, Sabadell, España
| | | | - Ricard Comet Monte
- Unidad de Geriatría de Agudos y Paciente Crónico Complejo. Corporació Sanitària Parc Taulí, Sabadell, España
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46
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Clustering Complex Chronic Patients: A Cross-Sectional Community Study From the General Practitioner's Perspective. Int J Integr Care 2021; 21:4. [PMID: 33976594 PMCID: PMC8064281 DOI: 10.5334/ijic.5496] [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] [Indexed: 11/22/2022] Open
Abstract
Objective: Characterize subgroups of Complex Chronic Patients (CCPs) with cluster analysis from the general practitioner’s perspective. Study design: Cross-sectional population-based study. Setting: Three Primary Care urban centres for a reference population of 43,647 inhabitants over 14 years old in Sabadell, Catalonia, Spain. Methods: Complexity is defined by the independent clinical judgment of general practitioners with the aid of complexity domains (both clinical and social). We used a Two-Step Cluster method to identify relevant subgroups of CCPs. Results: Three relevant subgroups were identified. The first one was mainly managed by primary care professionals, and 63% of its CCPs belonged to the high-risk stratum of the Adjusted Morbidity Groups (GMA). The second subgroup included younger patients than the other two clusters, and showed the highest ratios of social deprivation and severe mental disease; 48% of its CCPs belonged to the high-risk stratum of the GMA. A third cluster included patients who belonged to the high-risk stratum of the GMA. Their age was similar to that of the patients in the first cluster, but they showed the highest values in the following areas: (i) risk of admission; (ii) proportion of advanced chronic disease and limited-life prognosis; (iii) functional loss and (iv) geriatric syndromes, along with special uncertainty in decision-making and clinical management. Conclusions: Characterization of CCPs shows clearly distinct profiles of needs, which provides an improved epidemiological picture by identifying clusters of patients who are likely to benefit from targeted interventions.
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Esteban-Burgos AA, Lozano-Terrón MJ, Puente-Fernandez D, Hueso-Montoro C, Montoya-Juárez R, García-Caro MP. A New Approach to the Identification of Palliative Care Needs and Advanced Chronic Patients among Nursing Home Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063171. [PMID: 33808567 PMCID: PMC8003433 DOI: 10.3390/ijerph18063171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 01/05/2023]
Abstract
Background: Proper planning of Palliative Care in nursing homes requires advanced knowledge of the care needs that residents show. The aim of the study was to evaluate Palliative Needs and other conditions such as fragility, complexity, and prognosis and also to suggest new indicators for the establishment of the resident’s advanced chronic condition. Methods: Cross-sectional study conducted in 149 nursing homes Complex Chronic residents evaluated by trained professionals. Palliative Care Needs, assessed by the NECPAL ICO-CCOMS© tool, and fragility, case and palliative complexity and prognosis were evaluate through a comprehensive assessment. Descriptive analyses and association measures were performed setting the statistical significance at 0.05. Results: More than 50% of the residents had positive Surprise Question and other Palliative Needs and were classified as Advanced Chronic Patients. Distress and/or Severe Adaptative Disorder was the most frequent need shown by the residents and significant differences in levels of frailty and other characteristics, were found between the Positive and the Negative Surprise Question Groups. Statistically significant correlations were also found between aspects of both groups. Conclusions: Nursing homes residents show Palliative Needs regardless of the response to the Surprise Question of the NECPAL tool. Other characteristics such as presence of an intermediate level of frailty are suggested as a new perspective to identify advanced chronic patients among nursing homes residents.
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Affiliation(s)
- Ana A. Esteban-Burgos
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Doctoral Programme in Clinical Medicine and Public Health, University of Granada, 18012 Granada, Spain
| | | | - Daniel Puente-Fernandez
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Doctoral Programme in Clinical Medicine and Public Health, University of Granada, 18012 Granada, Spain
- Correspondence:
| | - César Hueso-Montoro
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
| | - Rafael Montoya-Juárez
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
| | - María P. García-Caro
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
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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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49
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Turrillas P, Peñafiel J, Tebé C, Amblàs-Novellas J, Gómez-Batiste X. NECPAL prognostic tool: a palliative medicine retrospective cohort study. BMJ Support Palliat Care 2021:bmjspcare-2020-002567. [PMID: 33593868 DOI: 10.1136/bmjspcare-2020-002567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To develop and validate a prognostic model to assess mortality risk at 24 months in patients with advanced chronic conditions. METHODS Retrospective design based on a previous population cohort study with 789 adults who were identified with the surprise question and NECPAL tool from primary and intermediate care centres, nursing homes and one acute hospital of Spain. A Cox regression model was used to derive a mortality predictive model based on patients' age and six previously selected NECPAL prognostic factors (palliative care need identified by healthcare professionals, functional decline, nutritional decline, multimorbidity, use of resources, disease-specific criteria of severity/progression). Patients were split into derivation/validation cohorts, and four steps were followed: descriptive analysis, predictors' assessment, model estimation and model assessment. RESULTS All predictive variables were independently associated with increased risk of mortality at 24 months. Performance model including age was good; discrimination power by area under the curve (AUC) was 0.72/0.67 in the derivation/validation cohorts, and correlation between expected and observed (E/O) mortality ratio was 0.74/0.70. The model showed similar performance across settings (AUC 0.65-0.74, E/O 1.00-1.01), the best performance in oncological patients (AUC 0.78, E/O 0.76) and the worst in dementia patients (AUC 0.58, E/O 0.85). Based on the number of factors affected, three prognostic stages with significant differences and a median survival of 38, 17.2 and 3.6 months (p<0.001) were defined. CONCLUSION The NECPAL prognostic tool is accurate and eventually useful at the clinical practice. Stratification in risk groups may enable early intervention and enhance policy-making and service planning.
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Affiliation(s)
- Pamela Turrillas
- The 'Qualy' Observatory, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain
| | - Judith Peñafiel
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Biostatistics Unit, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebé
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Biostatistics Unit, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Amblàs-Novellas
- The 'Qualy' Observatory, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - Xavier Gómez-Batiste
- The 'Qualy' Observatory, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
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50
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Ferré C, Canelles S, Daniel X, Rubio O, Esteban F, Pobo A. Detection of frailty and palliative needs from discharged critical care patients in collaboration with primary care. Med Intensiva 2021; 46:S0210-5691(20)30397-1. [PMID: 33531189 DOI: 10.1016/j.medin.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/04/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022]
Affiliation(s)
- C Ferré
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, España
| | - S Canelles
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, España
| | - X Daniel
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, España
| | - O Rubio
- Unidad de Cuidados Intensivos, Hospital Sant Joan de Déu, Fundació Althaia Xarxa Universitària, Manresa, Barcelona, España
| | - F Esteban
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, España
| | - A Pobo
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, España.
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