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Mallon T, Schulze J, Dams J, Weber J, Asendorf T, Böttcher S, Sekanina U, Schade F, Schneider N, Freitag M, Müller C, König HH, Nauck F, Friede T, Scherer M, Marx G. Evaluating palliative care case conferences in primary care for patients with advanced non-malignant chronic conditions: a cluster-randomised controlled trial (KOPAL). Age Ageing 2024; 53:afae100. [PMID: 38783755 PMCID: PMC11116821 DOI: 10.1093/ageing/afae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia are underrepresented in specialist palliative home care (SPHC). However, the complexity of their conditions requires collaboration between general practitioners (GPs) and SPHC teams and timely integration into SPHC to effectively meet their needs. OBJECTIVE To facilitate joint palliative care planning and the timely transfer of patients with advanced chronic non-malignant conditions to SPHC. METHODS A two-arm, unblinded, cluster-randomised controlled trial. 49 GP practices in northern Germany were randomised using web-based block randomisation. We included patients with advanced CHF, COPD and/or dementia. The KOPAL intervention consisted of a SPHC nurse-patient consultation followed by an interprofessional telephone case conference between SPHC team and GP. The primary outcome was the number of hospital admissions 48 weeks after baseline. Secondary analyses examined the effects on health-related quality of life and self-rated health status, as measured by the EuroQol 5D scale. RESULTS A total of 172 patients were included in the analyses. 80.4% of GP practices had worked with SHPC before, most of them exclusively for cancer patients. At baseline, patients reported a mean EQ-VAS of 48.4, a mean quality of life index (EQ-5D-5L) of 0.63 and an average of 0.80 hospital admissions in the previous year. The intervention did not significantly reduce hospital admissions (incidence rate ratio = 0.79, 95%CI: [0.49, 1.26], P = 0.31) or the number of days spent in hospital (incidence rate ratio = 0.65, 95%CI: [0.28, 1.49], P = 0.29). There was also no significant effect on quality of life (∆ = -0.02, 95%CI: [-0.09, 0.05], P = 0.53) or self-rated health (∆ = -2.48, 95%CI: [-9.95, 4.99], P = 0.51). CONCLUSIONS The study did not show the hypothesised effect on hospitalisations and health-related quality of life. Future research should focus on refining this approach, with particular emphasis on optimising the timing of case conferences and implementing discussed changes to treatment plans, to improve collaboration between GPs and SPHC teams.
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Affiliation(s)
- Tina Mallon
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Josefine Schulze
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Care Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jan Weber
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Centre Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
| | - Silke Böttcher
- Division of General Practice, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Uta Sekanina
- Department of General Practice, University Medical Centre Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
| | - Franziska Schade
- Department of Palliative Medicine, University Medical Centre Göttingen, Von-Siebold-Str. 3, 37075 Göttingen and Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Nils Schneider
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Michael Freitag
- Division of General Practice, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Christiane Müller
- Department of General Practice, University Medical Centre Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Care Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Centre Göttingen, Von-Siebold-Str. 3, 37075 Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Gabriella Marx
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Gebel C, Ditscheid B, Meissner F, Slotina E, Kruschel I, Marschall U, Wedding U, Freytag A. Utilization and quality of palliative care in patients with hematological and solid cancers: a population-based study. J Cancer Res Clin Oncol 2024; 150:191. [PMID: 38607376 PMCID: PMC11014814 DOI: 10.1007/s00432-024-05721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Palliative care (PC) contributes to improved end-of-life care for patients with hematologic malignancies (HM) and solid tumors (ST) by addressing physical and psychological symptoms and spiritual needs. Research on PC in HM vs. ST patients is fragmented and suggests less use. METHODS We analyzed claims data of all deceased members of a large German health insurance provider for the year before death. First, we analyzed the frequency and the beginning of different types of PC and compared patients with HM vs. ST. Second, we analyzed the adjusted impact of PC use on several end-of-life quality outcomes in patients with HM vs. ST. We performed simple and multiple (logistic) regression analysis, adjusted for relevant covariates, and standardized for age and sex. RESULTS Of the 222,493 deceased cancer patients from 2016 to 2020, we included 209,321 in the first analysis and 165,020 in the second analysis. Patients with HM vs. ST received PC less often (40.4 vs. 55.6%) and later (34 vs. 50 days before death). PC use significantly improved all six quality indicators for good end-of-life care. HM patients had worse rates in five of the six indicators compared with ST patients. Interaction terms revealed that patients with ST derived greater benefit from PC in five of six quality indicators than those with HM. CONCLUSION The data highlight the need to integrate PC more often, earlier, and more effectively into the care of patients with HM.
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Affiliation(s)
- Cordula Gebel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany.
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland.
| | - Bianka Ditscheid
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Franziska Meissner
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Ekaterina Slotina
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Isabel Kruschel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland
| | | | - Ullrich Wedding
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland
| | - Antje Freytag
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
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Gesell D, Hodiamont F, Wikert J, Lehmann-Emele E, Bausewein C, Nauck F, Jansky M. Symptom and problem clusters in German specialist palliative home care - a factor analysis of non-oncological and oncological patients' symptom burden. BMC Palliat Care 2023; 22:183. [PMID: 37978356 PMCID: PMC10655459 DOI: 10.1186/s12904-023-01296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Specialist palliative home care (SPHC) aims to maintain and improve patients' quality of life in the community setting. Symptom burden may differ between oncological and non-oncological patients. However, little is known about diagnosis-related differences of SPHC patients. This study aims to describe the prevalence of physical symptom burden and psychosocial problems of adult patients in SPHC, and to evaluate diagnosis-related symptom clusters. METHODS Secondary analysis of data from a prospective, cross-sectional, multi-centre study on complexity of patients, registered at the German Register for Clinical Studies (DRKS trial registration number: DRKS00020517, 12/10/2020). Descriptive statistics on physical symptom burden and psychosocial problems at the beginning of care episodes. Exploratory and confirmatory factor analyses to identify symptom and problem clusters. RESULTS Seven hundred seventy-eight episodes from nine SPHC teams were included, average age was 75 years, mean duration of episode 18.6 days (SD 19.4). 212/778 (27.2%) had a non-oncological diagnosis. Main burden in non-oncological episodes was due to poor mobility (194/211; 91.9%) with significant diagnosis-related differences (χ² = 8.145, df = 1, p = .004; oncological: 472/562; 84.0%), and due to weakness (522/565; 92.4%) in oncological episodes. Two symptom clusters (psychosocial and physical) for non-oncological and three clusters (psychosocial, physical and communicational/practical) for oncological groups were identified. More patients in the non-oncological group compared to the oncological group showed at least one symptom cluster (83/212; 39.2% vs. 172/566; 30.4%). CONCLUSION Patients with non-oncological diseases had shorter episode durations and were more affected by symptom clusters, whereas patients with oncological diseases showed an additional communicational/practical cluster. Our findings indicate the high relevance of care planning as an important part of SPHC to facilitate anticipatory symptom control in both groups.
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Affiliation(s)
- Daniela Gesell
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Julia Wikert
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva Lehmann-Emele
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Maximiliane Jansky
- Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
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Jansky M, Heyl L, Hach M, Kranz S, Lehmann T, Freytag A, Wedding U, Meißner W, Krauss SH, Schneider W, Nauck F. Structural characteristics and contractual terms of specialist palliative homecare in Germany. BMC Palliat Care 2023; 22:166. [PMID: 37904160 PMCID: PMC10617175 DOI: 10.1186/s12904-023-01274-6] [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: 12/05/2022] [Accepted: 10/01/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Multi-professional specialist palliative homecare (SPHC) teams care for palliative patients with complex symptoms. In Germany, the SPHC directive regulates care provision, but model contracts for each federal state are heterogeneous regarding staff requirements, cooperation with other healthcare providers, and financial reimbursement. The structural characteristics of SPHC teams also vary. AIM We provide a structured overview of the existing model contracts, as well as a nationwide assessment of SPHC teams and their structural characteristics. Furthermore, we explore whether these characteristics serve to find specifc patterns of SPHC team models, based on empirical data. METHODS This study is part of the multi-methods research project "SAVOIR", funded by the German Innovations Fund. Most model contracts are publicly available. Structural characteristics (e.g. number, professions, and affiliations of team members, and external cooperation) were assessed via an online database ("Wegweiser Hospiz- und Palliativversorgung") based on voluntary information obtained from SPHC teams. All the data were updated by phone during the assessment process. Data were descriptively analysed regarding staff, cooperation requirements, and reimbursement schemes, while latent class analysis (LCA) was used to identify structural team models. RESULTS Model contracts have heterogeneous contract partners and terms related to staff requirements (number and qualifications) and cooperation with other services. Fourteen reimbursement schemes were available, all combining different payment models. Of the 283 SPHC teams, 196 provided structural characteristics. Teams reported between one and 298 members (mean: 30.3, median: 18), mainly nurses and physicians, while 37.8% had a psychosocial professional as a team member. Most teams were composed of nurses and physicians employed in different settings; for example, staff was employed by the team, in private practices/nursing services, or in hospitals. Latent class analysis identified four structural team models, based on the team size, team members' affiliation, and care organisation. CONCLUSION Both the contractual terms and teams' structural characteristics vary substantially, and this must be considered when analysing patient data from SPHC. The identified patterns of team models can form a starting point from which to analyse different forms of care provision and their impact on care quality.
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Affiliation(s)
- Maximiliane Jansky
- Department of Palliative Medicine, University Medical Center, Goettingen, Germany.
| | - Lia Heyl
- German Association for Palliative Medicine (DGP), Berlin, Germany
| | - Michaela Hach
- Bundesarbeitsgemeinschaft SAPV (BAG), Wiesbaden, Germany
| | - Steven Kranz
- German Association for Palliative Medicine (DGP), Berlin, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Ulrich Wedding
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - Winfried Meißner
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - Sabine H Krauss
- Center for Interdisciplinary Health Research, University of Augsburg, Augsburg, Germany
| | - Werner Schneider
- Center for Interdisciplinary Health Research, University of Augsburg, Augsburg, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center, Goettingen, Germany
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Freytag A, Meissner F, Krause M, Lehmann T, Jansky MK, Marschall U, Schmid A, Schneider N, Vollmar HC, Wedding U, Ditscheid B. [A regional comparison of outcomes quality and costs of general and specialized palliative care in Germany: a claims data analysis]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1135-1145. [PMID: 37535086 PMCID: PMC10539464 DOI: 10.1007/s00103-023-03746-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/23/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The main framework conditions for palliative care are set at the regional level. The scope of the forms of care used (outpatient, inpatient, general, specialized) varies widely. What is the quality of outcomes achieved by the palliative care provided on a federal states level? What are the associated costs of care? METHOD Retrospective observational study using BARMER claims data from 145,372 individuals who died between 2016 and 2019 and had palliative care in the last year of life. Regional comparison with regard to the following outcomes: proportion of palliative care patients who died in the hospital, potentially burdensome care in the last 30 days of life (ambulance calls, [intensive care] hospitalizations, chemotherapy, feeding tubes, parenteral nutrition), total cost of care (last three months), cost of palliative care (last year), and cost-effectiveness ratios. Calculation of patient/resident characteristic adjusted rates, costs, and ratios. RESULTS Federal states vary significantly with respect to the outcomes (also adjusted) of palliative care. Palliative care costs vary widely, most strongly for specialized outpatient palliative care (SAPV). Across all indicators and the cost-effectiveness ratio of total cost of care to at-home deaths, Westphalia-Lippe shows favorable results. CONCLUSION Regions with better quality and more favorable cost (ratios) can provide guidance for other regions. The extent to which the new federal SAPV agreement can incorporate the empirical findings should be reviewed. Patient-relevant outcome parameters should be given greater weight than parameters aiming at structures of care.
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Affiliation(s)
- Antje Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland.
| | - Franziska Meissner
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
| | - Markus Krause
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
| | - Thomas Lehmann
- Zentrum für Klinische Studien, Universitätsklinikum Jena, Jena, Deutschland
| | | | - Ursula Marschall
- BARMER Institut für Gesundheitssystemforschung, Wuppertal, Wuppertal, Deutschland
| | - Andreas Schmid
- Gesundheitsökonomie und -management, Rechts- und Wirtschaftswissenschaftliche Fakultät, Universität Bayreuth, Bayreuth, Deutschland
- Oberender AG, Bayreuth, Bayreuth, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Horst Christian Vollmar
- Abteilung für Allgemeinmedizin (AM RUB), Medizinische Fakultät, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Ulrich Wedding
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | - Bianka Ditscheid
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
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Ditscheid B, Meissner F, Gebel C, Hennig B, Marschall U, Meißner W, Wedding U, Freytag A. [Utilization of palliative care at the end of life in Germany: temporal trend (2016-2019) and regional variability]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:432-442. [PMID: 36897332 PMCID: PMC10063517 DOI: 10.1007/s00103-023-03683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND In Germany, palliative care (PC) is provided on a homecare, inpatient, general, and specialized basis. Since little is currently known about the temporal course and regional differences in the forms of care, the present study was aimed to investigate this. METHOD In a retrospective routine data study with 417,405 BARMER-insured persons who died between 2016 and 2019, we determined the utilization rates of primary PC (PPC), specially qualified and coordinated palliative homecare (PPC+), specialized palliative homecare (SPHC), inpatient PC, and hospice care on the basis of services billed at least once in the last year of life. We calculated time trends and regional variability and controlled for needs-related patient characteristics and access-related county of community characteristics. RESULTS From 2016 to 2019, total PC increased from 33.8 to 36.2%, SPHC from 13.3 to 16.0% (max: Rhineland-Palatinate), and inpatient PC from 8.9 to 9.9% (max: Thuringia). PPC decreased from 25.8 to 23.9% (min: Brandenburg) and PPC+ came in at 4.4% (max: Saarland) in 2019. Hospice care remained constant at 3.4%. Regional variability in utilization rates remained high, increased for PPC and inpatient PC from 2016 to 2019, and decreased for SPHC and hospice care. The regional differences were also evident after adjustment. CONCLUSION Increasingly more SPHC, less PPC, and high regional variability, which cannot be explained by demand- or access-related characteristics, indicate that the use of PC forms is oriented less to demand than to regionally available care capacities. In view of the growing need for palliative care due to demographic factors and decreasing personnel resources, this development must be viewed critically.
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Affiliation(s)
- Bianka Ditscheid
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
| | - Franziska Meissner
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
| | - Cordula Gebel
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | | | | | - Winfried Meißner
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | - Ulrich Wedding
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | - Antje Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland.
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Chiaruttini MV, Corli O, Pizzuto M, Nobili A, Fortini G, Fortino I, Leoni O, Bosetti C. Palliative medicine favourably influences end-of-life cancer care intensity: a large retrospective database study. BMJ Support Palliat Care 2022:spcare-2022-004050. [PMID: 36522144 DOI: 10.1136/spcare-2022-004050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Hospice and home palliative care have been associated to a reduction of aggressive treatments in the end-of-life, but data in the Italian context are scanty. Therefore, we aim to investigate the role of palliative care on indicators of end-of-life intensity of care among patients with cancer in Lombardy, the largest Italian region. METHODS Within a retrospective study using the healthcare utilisation databases of Lombardy, Italy, we selected all residents who died in 2019 with a diagnosis of cancer. We considered as exposure variables admission to palliative care and time at palliative care admission, and as indicators of aggressive care hospitalisations, diagnostic/therapeutic procedures, in-hospital death, emergency department visits and chemotherapy over a time window of 30 days before death; chemotherapy in the last 14 days was also considered. RESULTS Our cohort included 26 539 individuals; of these, 14 320 (54%) were admitted to palliative care before death. Individuals who were admitted to palliative care had an odds ratio (OR) of 0.27 for one hospitalisation, 0.14 for ≥2 hospitalisations, 0.25 for hospital stay ≥12 days, 0.38 for minor diagnostic/therapeutic procedures, 0.18 for major diagnostic/therapeutic procedures, 0.02 for in-hospital death, 0.35 for one emergency department visit, 0.29 for ≥2 emergency department visits and 0.66 for chemotherapy use in the last 30 days; the OR was 0.56 for chemotherapy use in the last 14 days. CONCLUSIONS This large real-world analysis confirms and further support the importance of palliative care assistance for patients with cancer in the end- of- life; this is associated to a significant reduction in unnecessary treatments.
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Affiliation(s)
| | - Oscar Corli
- Dipartimento di Oncologia, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Alessandro Nobili
- Dipartimento di Politiche per la Salute, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Ida Fortino
- Regione Lombardia Direzione Generale Welfare, Milano, Italy
| | - Olivia Leoni
- Regione Lombardia Direzione Generale Welfare, Milano, Italy
| | - Cristina Bosetti
- Dipartimento di Oncologia, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Higashibata T, Iwata N, Kazama I, Irie Y, Yokosuka K, Okita J, Hamano J, Nagaoka H. Association of a home-based nursing service during chemotherapy with the transfer to home care immediately after the last chemotherapy treatment in patients with advanced cancer. Jpn J Clin Oncol 2022; 52:1039-1044. [PMID: 35649382 PMCID: PMC9486912 DOI: 10.1093/jjco/hyac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background The appropriate timing of introducing the home-based nursing service to patients with advanced cancer has not been clarified. This study conducted a retrospective cohort study to investigate the associations of the early utilization of the home-based nursing service during chemotherapy with the place of care immediately after the last chemotherapy treatment in patients with advanced cancer. Methods Among the patients referred to the palliative care team of the University of Tsukuba Hospital between January 2018 and December 2019, patients with advanced cancer undergoing chemotherapy or before the start of chemotherapy at referral were included. The study patients who utilized the home-based nursing service during chemotherapy were classified into the early utilization group. The primary endpoint was the place of care immediately after the last chemotherapy treatment. Results Of the 1154 patients referred to the palliative care team during the study period, 261 were eligible for this study. Of these patients, 15.3% of patients (n = 40) received the home-based nursing service during chemotherapy. The proportion of patients transferred to home care after the last chemotherapy treatment was 17.5% in the early utilization group and 7.2% in the control group. The multivariate analysis revealed that the early utilization of the home-based nursing service during chemotherapy was significantly associated with the transfer to home care (odds ratio = 3.077; 95% confidence interval, 1.113–8.502). Conclusion The early utilization of the home-based nursing service during chemotherapy might be associated with the transfer to home care immediately after the last chemotherapy treatment.
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Affiliation(s)
- Takahiro Higashibata
- Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan
| | - Naoko Iwata
- Medical Liaison and Patient Support Services Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Ikuko Kazama
- Division of Nursing, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiko Irie
- Division of Nursing, University of Tsukuba Hospital, Tsukuba, Japan
| | - Kyoko Yokosuka
- Department of Palliative Care, Tsuboi Hospital, Koriyama, Japan
| | - Junya Okita
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Jun Hamano
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroka Nagaoka
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Oechsle K. Specialized Outpatient Palliative Care-an Interim Assessment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:325-326. [PMID: 35971253 DOI: 10.3238/arztebl.m2022.0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 03/27/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Karin Oechsle
- Palliative Care Unit, Medical Department II, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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