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Rogers MM, Friebert S, Williams CSP, Humphrey L, Thienprayoon R, Klick JC. Pediatric Palliative Care Programs in US Hospitals. Pediatrics 2021; 148:peds.2020-021634. [PMID: 34183362 DOI: 10.1542/peds.2020-021634] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric palliative care (PPC) is integral to the care of children living with serious illnesses. Despite the growth in the number of established palliative care programs over the past decade, little is known about the current operational features of PPC programs across the country. METHODS The National Palliative Care Registry collects annualized data on palliative care programs' structures, processes, and staffing. Using data from the 2018 registry survey, we report on the operational features of inpatient PPC programs across the United States. RESULTS Fifty-four inpatient PPC programs submitted data about their operations. Programs reported a median of 3.8 full-time equivalent staff per 10 000 hospital admissions (range 0.7-12.1) across the core interdisciplinary team, yet few (37%) met the minimum standards of practice for staffing. Programs provided more annual consults if they were longer-standing, had more interdisciplinary full-time equivalent staff, offered 24/7 availability for patients and families, or were at larger hospitals. The majority of programs reported concern for burnout (63%) and an inability to meet clinical demand with available staffing (60%). CONCLUSIONS There is considerable variability in PPC program operations and structure in hospitals. This study affirms the need for updated program standards and guidelines, as well as research that describes how different care delivery models impact outcomes for patients, families, staff, and health care systems. Future studies that further define the clinical demand, workload, and sustainability challenges of PPC programs are necessary to foster the provision of high-quality PPC and maintain a vital clinical workforce.
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Affiliation(s)
- Maggie M Rogers
- Center to Advance Palliative Care at the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah Friebert
- Division of Pediatric Palliative Care, Department of Pediatrics and Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Conrad S P Williams
- Palliative Care Program and Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Lisa Humphrey
- Division of Hospice and Palliative Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio
| | - Rachel Thienprayoon
- Department of Anesthesia, Division of Palliative Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey C Klick
- Department of Palliative Care, Children's Healthcare of Atlanta and Division of Palliative Care, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
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Gonella S, Di Giulio P, Palese A, Dimonte V, Campagna S. Qualitative research on end-of-life communication with family carers in nursing homes: A discussion of methodological issues and challenges. Nurs Open 2021; 8:180-190. [PMID: 33318826 PMCID: PMC7729536 DOI: 10.1002/nop2.617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/16/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022] Open
Abstract
Aim To identify and summarize the challenges of conducting qualitative research exploring end-of-life communication between healthcare providers and bereaved family carers in nursing homes. Design A descriptive qualitative study based on in-the-field-notes and research diaries collected during a primary study involving 32 bereaved family carers and 14 nurses across 13 Italian nursing homes in 2018-2019. Methods Two trained female nurses conducted semi-structured, in-depth, open-ended interviews and recorded "in action" (i.e. reflections reported as in-the-field-notes) and "on action" (i.e. retrospective reflections within the team reported immediately in the research diaries) narratives, with the aim of identifying challenges encountered during the research process. A content analysis process was performed to analyse the narratives collected. Results We identified three major categories of challenges: (a) obtaining approval from the ethical committee; (b) approaching nursing homes and family carers; and (c) dealing with participant-related impairments (i.e. memory, emotional, physical).
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Affiliation(s)
- Silvia Gonella
- Department of Biomedicine and PreventionUniversity of Roma Tor VergataRomaItaly
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di TorinoTorinoItaly
| | - Paola Di Giulio
- Department of Public Health and PediatricsUniversity of TorinoTorinoItaly
| | - Alvisa Palese
- Department of Medical SciencesUniversity of UdineUdineItaly
| | - Valerio Dimonte
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di TorinoTorinoItaly
- Department of Public Health and PediatricsUniversity of TorinoTorinoItaly
| | - Sara Campagna
- Department of Public Health and PediatricsUniversity of TorinoTorinoItaly
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Miller EG, Weaver MS, Ragsdale L, Hills T, Humphrey L, Williams CSP, Morvant A, Pitts B, Waldman E, Lotstein D, Linebarger J, Feudtner C, Klick JC. Lessons Learned: Identifying Items Felt To Be Critical to Leading a Pediatric Palliative Care Program in the Current Era of Program Development. J Palliat Med 2020; 24:40-45. [PMID: 32552386 DOI: 10.1089/jpm.2020.0205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The experience of starting and growing a pediatric palliative care program (PPCP) has changed over the last 10 years as rapid increases of patient volume have amplified challenges related to staffing, funding, standards of practice, team resilience, moral injury, and burnout. These challenges have stretched new directors' leadership skills, yet, guidance in the literature on identifying and managing these challenges is limited. Methods: A convenience sample of 15 PPCP directors who assumed their duties within the last 10 years were first asked the following open-ended question: What do you wish you had known before starting or taking over leadership of a PPCP? Responses were grouped into themes based on similarity of content. Participants then ranked these themes based on importance, and an online discussion further elucidated the top ten themes. Results: Thirteen directors responded (86.7%; 69% female). The median age of their current-state PPCP was 5.1 years (range: 0.3-9.3), and the median number of covered pediatric-specific hospital beds was 283 (range: 170-630). Their responses generated 51 distinct items, grouped into 17 themes. Themes ranked as most important included "Learn how to manage, not just lead," "Negotiate everything before you sign anything," and "Balance patient volume with scope of practice." Conclusion: These themes regarding challenges and opportunities PPCP directors encountered in the current era of program growth can be used as a guide for program development, a self-assessment tool for program directors, a needs-assessment for program leadership, and a blueprint for educational offerings for PPCP directors.
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Affiliation(s)
- Elissa G Miller
- Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Lindsay Ragsdale
- Division of Pediatric Palliative Care, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky, USA
| | - Tracy Hills
- Section of Pediatric Palliative Care, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lisa Humphrey
- Division of Palliative Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Conrad S P Williams
- Palliative Care Program, Department of Pediatrics, Medical University of South Carolina Children's Health System, Charleston, South Carolina, USA
| | - Alexis Morvant
- Pediatric Palliative Care Program at Children's Hospital New Orleans, Division of Ambulatory Medicine, Department of Pediatrics, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA
| | - Blaine Pitts
- Division of Palliative Medicine, Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Elisha Waldman
- Division of Palliative Care, Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Debra Lotstein
- Division of Comfort and Palliative Care, Department of Anesthesia Critical Care Medicine, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Linebarger
- Section of Palliative Care, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey C Klick
- Department of Palliative Care, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Palliative Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Delivering Pediatric Palliative Care: From Denial, Palliphobia, Pallilalia to Palliactive. CHILDREN-BASEL 2018; 5:children5090120. [PMID: 30200370 PMCID: PMC6162556 DOI: 10.3390/children5090120] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022]
Abstract
Among the over 21 million children with life-limiting conditions worldwide that would benefit annually from a pediatric palliative care (PPC) approach, more than eight million would need specialized PPC services. In the United States alone, more than 42,000 children die every year, half of them infants younger than one year. Advanced interdisciplinary pediatric palliative care for children with serious illnesses is now an expected standard of pediatric medicine. Unfortunately, in many institutions there remain significant barriers to achieving optimal care related to lack of formal education, reimbursement issues, the emotional impact of caring for a dying child, and most importantly, the lack of interdisciplinary PPC teams with sufficient staffing and funding. Data reveals the majority of distressing symptoms in children with serious illness (such as pain, dyspnea and nausea/vomiting) were not addressed during their end-of-life period, and when treated, therapy was commonly ineffective. Whenever possible, treatment should focus on continued efforts to control the underlying illness. At the same time, children and their families should have access to interdisciplinary care aimed at promoting optimal physical, psychological and spiritual wellbeing. Persistent myths and misconceptions have led to inadequate symptom control in children with life-limiting diseases. Pediatric Palliative Care advocates the provision of comfort care, pain, and symptom management concurrently with disease-directed treatments. Families no longer have to opt for one over the other. They can pursue both, and include integrative care to maximize the child's quality of life. Since most of the sickest children with serious illness are being taken care of in a hospital, every children's hospital is now expected to offer an interdisciplinary palliative care service as the standard of care. This article addresses common myths and misconceptions which may pose clinical obstacles to effective PPC delivery and discusses the four typical stages of pediatric palliative care program implementation.
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Kobewka D, Ronksley P, McIsaac D, Mulpuru S, Forster A. Prevalence of symptoms at the end of life in an acute care hospital: a retrospective cohort study. CMAJ Open 2017; 5:E222-E228. [PMID: 28401138 PMCID: PMC5378541 DOI: 10.9778/cmajo.20160123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is currently debate over the benefits and harms of physician-assisted death. One of the factors influencing this debate is concern about symptoms in the days before death. The objective of this study was to describe the frequency of symptoms before death and determine patient characteristics associated with these symptoms. METHODS We reviewed the medical record of every patient who died at a multisite academic teaching hospital over a 3-month period. We determined the number of episodes of pain, dyspnea, agitation and nausea during the final 48 hours of life and assessed the patient and encounter characteristics associated with 2 or more episodes of symptoms. RESULTS A total of 480 patients died during the study period. Of these patients, 29.2% (140/480) had 2 or more symptoms in the final 48 hours of life. Higher Elixhauser comorbidity scores (relative risk [RR] 1.35, 95% confidence interval [CI] 1.23-1.49), having a family doctor (RR 2.33, 95% CI 1.02-5.38), being admitted to the medical oncology service (RR 1.51, 95% CI 1.11-2.05) and having a documented order for no resuscitation written early during the stay in hospital (RR 1.38, 95% CI 1.01-1.89) were independently associated with symptoms. Admission to intensive care was associated with fewer symptoms (RR 0.39, CI 95% 0.19-0.80). INTERPRETATION Symptoms are common in the final 48 hours of life, particularly in patients with multimorbidity who want limitations on the aggressiveness of their care. An integrated palliative approach is needed for select at-risk patients.
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Affiliation(s)
- Daniel Kobewka
- Department of Medicine (Kobewka, Mulpuru, Forster), Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa; Ottawa Hospital Research Institute (Kobewka, McIsaac, Mulpuru, Forster), Ottawa, Ont.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Department of Anesthesiology and Pain Medicine (McIsaac) - The Ottawa Hospital, University of Ottawa; Performance Measurement (Forster), The Ottawa Hospital, Ottawa, Ont
| | - Paul Ronksley
- Department of Medicine (Kobewka, Mulpuru, Forster), Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa; Ottawa Hospital Research Institute (Kobewka, McIsaac, Mulpuru, Forster), Ottawa, Ont.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Department of Anesthesiology and Pain Medicine (McIsaac) - The Ottawa Hospital, University of Ottawa; Performance Measurement (Forster), The Ottawa Hospital, Ottawa, Ont
| | - Dan McIsaac
- Department of Medicine (Kobewka, Mulpuru, Forster), Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa; Ottawa Hospital Research Institute (Kobewka, McIsaac, Mulpuru, Forster), Ottawa, Ont.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Department of Anesthesiology and Pain Medicine (McIsaac) - The Ottawa Hospital, University of Ottawa; Performance Measurement (Forster), The Ottawa Hospital, Ottawa, Ont
| | - Sunita Mulpuru
- Department of Medicine (Kobewka, Mulpuru, Forster), Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa; Ottawa Hospital Research Institute (Kobewka, McIsaac, Mulpuru, Forster), Ottawa, Ont.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Department of Anesthesiology and Pain Medicine (McIsaac) - The Ottawa Hospital, University of Ottawa; Performance Measurement (Forster), The Ottawa Hospital, Ottawa, Ont
| | - Alan Forster
- Department of Medicine (Kobewka, Mulpuru, Forster), Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa; Ottawa Hospital Research Institute (Kobewka, McIsaac, Mulpuru, Forster), Ottawa, Ont.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Department of Anesthesiology and Pain Medicine (McIsaac) - The Ottawa Hospital, University of Ottawa; Performance Measurement (Forster), The Ottawa Hospital, Ottawa, Ont
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Wong A, Reddy A, Williams JL, Wu J, Liu D, Bruera E, Wong A, Reddy A, Williams JL, Wu J, Liu D, Bruera E. ReCAP: Attitudes, Beliefs, and Awareness of Graduate Medical Education Trainees Regarding Palliative Care at a Comprehensive Cancer Center. J Oncol Pract 2016; 12:149-50; e127-37. [PMID: 26787756 PMCID: PMC5702790 DOI: 10.1200/jop.2015.006619] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Palliative care (PC) training and integration with oncology care remain suboptimal. Current attitudes and beliefs of the oncology trainees regarding PC are not fully known. This study was undertaken in an attempt to address this issue. PARTICIPANTS AND METHODS We conducted a survey to determine awareness of PC among graduate medical trainees at a comprehensive cancer center with an established PC program. One hundred seventy oncology trainees who completed$9 months of training in medical, surgical, gynecologic, and radiation oncology fellowships and residency programs during the 2013 academic year completed an online questionnaire. Descriptive, univariable, and multivariable analyses were performed. RESULTS The response rate was 78% (132 of 170 trainees); 10 trainees without hands-on patient care were excluded. Medical (53 of 60 [88%]), gynecologic (six of six [100%]), and radiation oncology (20 of 20 [100%]) trainees reported more awareness of PC compared with surgical oncology (22 of 36 [61%]) trainees (P = .001). One hundred twelve of 122 (92%) perceived PC as beneficial to patients and families. One hundred eight of 122 (89%) perceived that PC can reduce health care costs, 78 (64%) believed that PC can increase survival, and 90 (74%) would consult PC for a patient with newly diagnosed cancer with symptoms. Eighty-two trainees (67%) believed a mandatory PC rotation is important. Trainees with previous exposure to PC rotations were more aware of the role of PC services than were trainees without PC rotation (96% [46 of 48] v 74% [55 of 74]; P = .005, respectively). CONCLUSION Surgical trainees and trainees without previous PC rotation had significantly less awareness of PC. Overall, trainees perceived PC as beneficial to patients and capable of reducing costs while increasing survival; they also supported early PC referrals and endorsed a mandatory PC rotation.
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Affiliation(s)
| | - Akhila Reddy
- The University of Texas MD Anderson Cancer Center
| | | | - Jimin Wu
- The University of Texas MD Anderson Cancer Center
| | - Diane Liu
- The University of Texas MD Anderson Cancer Center
| | | | - Angelique Wong
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Akhila Reddy
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jimin Wu
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diane Liu
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Houston, TX.
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Medical oncologists' perception of palliative care programs and the impact of name change to supportive care on communication with patients during the referral process. A qualitative study. Palliat Support Care 2013; 11:397-404. [PMID: 23302500 DOI: 10.1017/s1478951512000685] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In a simultaneous care model, patients have concurrent access to both cancer-directed therapies and palliative care. As oncologists play a critical role in determining the need/timing of referral to palliative care programs, their understanding of the service and ability to communicate this with patients is of paramount importance. Our study aimed to examine oncologists' perceptions of the supportive care program at M.D. Anderson Cancer Center, and to determine whether renaming “palliative care” to “supportive care” influenced communication regarding referrals. METHOD This qualitative study used semi-directed interviews, and we analyzed data using grounded theory and qualitative methods. RESULTS We interviewed 17 oncologists. Supportive care was perceived as an important time-saving application, and symptom control, transitioning to end-of-life care, family counseling, and improving patients' ability to tolerate cancer therapies were cited as important functions. Although most claimed that early referrals to the service are preferable, oncologists identified several challenges, related to the timing and communication with patients regarding the referral, as well as with the supportive care team after the referral was made. Whereas oncologists stated that the name change had no impact on their referral patterns, the majority supported it, as they perceived their patients preferred it. SIGNIFICANCE OF RESULTS Although the majority of oncologists favorably viewed supportive care, communication barriers were identified, which need further confirmation. Simultaneous care models that effectively incorporate palliative care with cancer treatments need further development.
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Rhondali W, Filbet M, Bruera É. La médecine palliative dans les dix prochaines années. MEDECINE PALLIATIVE 2012. [DOI: 10.1016/j.medpal.2011.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Gaertner J, Wuerstlein R, Klein U, Scheicht D, Frechen S, Wolf J, Hellmich M, Mallmann P, Harbeck N, Voltz R. Integrating Palliative Medicine into Comprehensive Breast Cancer Therapy - a Pilot Project. ACTA ACUST UNITED AC 2011; 6:215-220. [PMID: 21779227 DOI: 10.1159/000328162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND: To comply with the World Health Organization (WHO) recommendations, our institution's administrative directives were adopted to advocate the provision of palliative care (PC) early in the disease trajectory of breast cancer (BC). To assess the outcome of this recommendation, this study evaluated the effects of this approach. METHODS: A retrospective systematic chart analysis of a 2-year period was performed. The first PC consultation of patients was analyzed according to (a) physical condition, (b) symptom burden of the patients, and (c) reasons for PC consultation. RESULTS: Many patients were already in a reduced physical state and experienced burdening symptoms when first counselled by PC. After a 1-year experience with PC consultations, the number of burdening symptoms identified at first PC consultation decreased and senologists increasingly requested PC support also for non-somatic issues. CONCLUSIONS: A development towards a better understanding of PC competencies after a 1-year initiation period could be demonstrated, but BC patients continued to be in late stages of the disease at the time of first PC contact. Disease-specific guidelines may facilitate and optimize the integration of PC into breast cancer therapy.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital, Cologne, Cologne, Germany
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Gaertner J, Wuerstlein R, Ostgathe C, Mallmann P, Harbeck N, Voltz R. Facilitating Early Integration of Palliative Care into Breast Cancer Therapy. Promoting Disease-Specific Guidelines. ACTA ACUST UNITED AC 2011; 6:240-244. [PMID: 21779232 DOI: 10.1159/000329007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To comply with patients' needs as well as ASCO and WHO recommendations, our institution aims to integrate palliative care (PC) early in the course of breast cancer (BC) therapy. The evaluation of relevant pilot project data revealed that these recommendations were too vague to trigger PC integration. Therefore, a standard operating procedure (SOP) was developed by our interdisciplinary working group to provide disease-specific information to overcome the ambiguity of the WHO recommendations and guide PC integration. Literally, the SOP states that 'Specialized PC is recommended regularly for all BC patients without curative treatment options, specifically for patients with i) metastasized and inoperable, or ii) locally advanced and inoperable, or iii) relapsing BC, who are receiving intravenous chemotherapy'. This SOP for the first time presents disease-specific guidelines for PC integration into comprehensive BC therapy by defining 'green flags' for early integration of PC and delineating PC from senology assignments. Although disease-specific SOPs have also been developed by this working group for other malignancies, the decision when to first integrate PC into BC therapy differs substantially because of the different clinical characteristics of the disease.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital Cologne, Germany
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11
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Investment of palliative medicine in bridging the gap with academia: A call to action. Eur J Cancer 2011; 47:491-5. [DOI: 10.1016/j.ejca.2010.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 12/14/2010] [Indexed: 11/19/2022]
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12
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Gaertner J, Wolf J, Scheicht D, Frechen S, Klein U, Hellmich M, Ostgathe C, Hallek M, Voltz R. Implementing WHO recommendations for palliative care into routine lung cancer therapy: a feasibility project. J Palliat Med 2010; 13:727-32. [PMID: 20597705 DOI: 10.1089/jpm.2009.0399] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) explicitly recommends the integration of palliative care (PC) early in the disease trajectory as part of the WHO definition of PC. Our comprehensive cancer centre decided to include this recommendation in the administrative directives for principles of cancer care. The aim of this study was to assess, for patients with lung cancer, (a) at what point in the disease trajectory the patients were first provided PC and (b) whether - over one year - an earlier integration of PC could be achieved. OBJECTIVE A retrospective systematic chart analysis of a two year period was performed. We assumed that seeing patients relatively early during the course of the illness would be reflected by seeing patients that would be not already (i) in a reduced performance status, (ii) experiencing symptoms that are indicators for advanced disease (e.g., dyspnoea and pain) and (iii) close to death. Therefore, the first PC consultation for every lung cancer patient was analyzed to assess in what physical condition patients receive first PC consultation, what burdening symptoms they already experienced and how long the patients lived after their first consultations. RESULTS Most patients were already in a reduced physical state, were experiencing burdening symptoms and many died shortly after the first PC consultation. After a one year period, the number of burdening symptoms identified at first PC consultation and the admissions to the in-patient PC was decreased while non-PC physicians increasingly requested PC support for psychosocial interventions. CONCLUSION Though some degree of development towards a better understanding of PC competencies and the "early integration" approach could be demonstrated, the adoption of the WHO recommendation alone did not suffice to integrate PC into routine cancer care early in the course of the illness. Therefore, the development of disease specific guidelines is advocated by our working group.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital, Cologne, Germany.
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Affiliation(s)
| | - Eduardo Bruera
- University of Texas M. D. Anderson Cancer Center, Houston, Texas
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Wenk R, Bertolino M. Palliative care development in South America: a focus on Argentina. J Pain Symptom Manage 2007; 33:645-50. [PMID: 17482062 DOI: 10.1016/j.jpainsymman.2007.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 02/01/2007] [Indexed: 11/26/2022]
Abstract
Many Latin American and Caribbean national health systems mainly focus on disease prevention, prenatal assistance, undernourishment, etc. They still do not have the conditions for developing palliative care (PC). In general, quality of life during the dying process is poor, with fragmented assistance, uncontrolled suffering, poor communication between professionals, patients, and families, and a great burden on family caregivers. The development of PC in the region started around 1981, but it is still not available to an acceptable number of patients.
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Affiliation(s)
- Roberto Wenk
- Argentine Program for Palliative Medicine, Foundation of the Medical Federation of the Province of Buenos Aires, Buenos Aires, Argentina.
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