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Valentino TCDO, Paiva CE, de Oliveira MA, Hui D, Bruera E, Julião M, Paiva BSR. Preference and actual place-of-death in advanced cancer: prospective longitudinal study. BMJ Support Palliat Care 2023:spcare-2023-004299. [PMID: 37402541 DOI: 10.1136/spcare-2023-004299] [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: 03/23/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES To evaluate the preferred place-of-death (PPoD) among patients with advanced cancer over time, and the concordance between preferred and actual place-of-death. METHODS Prospective cohort study. A total of 190 patients with advanced cancer and their caregivers (n=190) were interviewed every 3 months, from study enrolment to 12 months (M0, M1, M2, M3, M4). PPoD data were obtained under four different end-of-life scenarios: (1) severe clinical deterioration without further specification; (2) clinical deterioration suffering from severe symptoms; (3) clinical deterioration receiving home-based visits; and (4) clinical deterioration receiving home-based visits and suffering from severe symptoms. RESULTS Home was the most common PPoD over time among patients in scenarios 1 (n=121, 63.7%; n=77, 68.8%; n=39, 57.4%; n=30, 62.5%; n=23, 60.5%) and 3 (n=147, 77.4%; n=87, 77.7%; n=48, 70.6%; n=36, 75.0%; n=30, 78.9%). PPoD in palliative care unit (PCU) and hospital were most frequent at baseline in scenario 2 (n=79, 41.6%; n=78, 41.1%), followed by hospital over time (n=61, 54.5%; n=45, 66.2%; n=35, 72.9%; n=28, 73.7%). During the curse of illness, 6.3% of patients change their PPoD in at least one of end-of-life scenario. About 49.7%, 30.6% and 19.7% of patients died in PCU, hospital and home, respectively. Living in rural area (OR=4.21), poor health self-perception (OR=4.49) and pain at the last days of life (OR=2.77) were associated with death in PPoD. The overall agreement between last preference and actual place-of-death was 51.0% (k=0.252). CONCLUSION Home death was not the preferred place for a large number of patients when this option was presented within a clinical context scenario. The PPoD and actual place-of-death were depending on the clinical situation.
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Affiliation(s)
| | - Carlos Eduardo Paiva
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marco Antonio de Oliveira
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - David Hui
- Palliative Care, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Lisboa, Portugal
| | - Bianca Sakamoto Ribeiro Paiva
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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2
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García-Sanjuán S, Fernández-Alcántara M, Clement-Carbonell V, Campos-Calderón CP, Orts-Beneito N, Cabañero-Martínez MJ. Levels and Determinants of Place-Of-Death Congruence in Palliative Patients: A Systematic Review. Front Psychol 2022; 12:807869. [PMID: 35095694 PMCID: PMC8792401 DOI: 10.3389/fpsyg.2021.807869] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Congruence, understood as the agreement between the patient's preferred place of death and their actual place of death, is emerging as one of the main variables indicating the quality of end-of-life care. The aim of this research was to conduct a systematic literature review on levels and determinants of congruence in palliative patients over the period 2010-2021. Method: A systematic review of the literature in the databases of PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cuiden, the Cochrane Library, CSIC Indexes, and IBECS. Information was extracted on research characteristics, congruence, and associated factors. Results: A total of 30 studies were identified, mainly of retrospective observational design. The congruence values varied substantially between the various studies, ranging from 21 to 100%. The main predictors of congruence include illness-related factors (functional status, treatments and diagnosis), individual factors (age, gender, marital status, and end of life preferences), and environmental factors (place of residence, availability of health, and palliative care services). Conclusion: This review, in comparison with previous studies, shows that treatment-related factors such as physical pain control, marital status, having a non-working relative, age, discussing preferred place of death with a healthcare professional, and caregiver's preference have been associated with higher levels of congruence. Depending on the study, other factors have been associated with either higher or lower congruence, such as the patient's diagnosis, gender, or place of residence. This information is useful for designing interventions aimed towards greater congruence at the end of life.
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Affiliation(s)
- Sofía García-Sanjuán
- Department of Nursing, Alicante Institute for Health and Biomedical Research (ISABIAL), University of Alicante, Alicante, Spain
| | | | | | | | - Núria Orts-Beneito
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María José Cabañero-Martínez
- Department of Nursing, Alicante Institute for Health and Biomedical Research (ISABIAL), University of Alicante, Alicante, Spain
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3
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van der Padt-Pruijsten A, Leys MBL, Oomen-de Hoop E, van der Heide A, van der Rijt CCD. Effects of Implementation of a Standardized Palliative Care Pathway for Patients with Advanced Cancer in a Hospital: A Prospective Pre- and Postintervention Study. J Pain Symptom Manage 2021; 62:451-459. [PMID: 33561492 DOI: 10.1016/j.jpainsymman.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 01/06/2023]
Abstract
CONTEXT Early integration of oncology and palliative care has been recommended to improve patient outcomes at the end of life. A standardized Palliative Care Pathway, consisting of a structured electronic medical checklist, may support such integration. OBJECTIVES We studied the effect of implementation of a Palliative Care Pathway on patients' place of death and advance care planning. METHODS We conducted a prospective pre- and postimplementation study of adult patients with cancer from a single hospital who died between February 2014 and February 2015 (pre-implementation period) or between November 2015 and November 2016 (post-implementation period). RESULTS We included 424 patients in the pre- and 426 in the post-implementation period. The pathway was started for 236 patients (55%) in the post-implementation period, on average 33 days (IQR 12-73 days) before death. 74% and 77% of the patients died outside hospital in the pre- and post-implementation period, respectively (P = 0.360). When the PCP was initiated, 83% died outside hospital. Bad-news conversations (75% and 62%, P < 0.001) and preferred place of death (47% and 32%, P < 0.001) were more often documented in the pre-implementation period, whereas a DNR-code was more often documented during the post-implementation period (79% and 89%, P < 0.001). CONCLUSIONS Implementation of a Palliative Care Pathway had no overall positive effect on place of death and several aspects of advance care planning. Start of a Palliative Care Pathway in the last months of life may be too late to improve end-of-life care. Future research should focus on strategies enabling earlier start of palliative care interventions.
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Affiliation(s)
- Annemieke van der Padt-Pruijsten
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands; Department Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Maria B L Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Esther Oomen-de Hoop
- Department Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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4
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Kjellstadli C, Allore H, Husebo BS, Flo E, Sandvik H, Hunskaar S. General practitioners' provision of end-of-life care and associations with dying at home: a registry-based longitudinal study. Fam Pract 2020; 37:340-347. [PMID: 31995182 PMCID: PMC7377342 DOI: 10.1093/fampra/cmz059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND General practitioners (GPs) may play an important role in providing end-of-life care to community-dwelling people. OBJECTIVE To investigate patients' contacts with GPs, GPs' interdisciplinary collaboration, out-of-hours services and hospitalizations in the last 13 weeks of life and associations with dying at home. Second, investigate whether GP contacts were associated with fewer out-of-hours contacts or days hospitalized. METHODS Individually linked data from the Norwegian Cause of Death Registry, Norwegian Patient Registry, Statistics Norway and Control and Payment of Reimbursement to Health Service Providers database for all 80 813 deceased people in Norway within 2012-13. Outcomes were analyzed with logistic regression and negative binomial multilevel mixed-effect models. RESULTS Overall, 1% of people received GP home visits in Week 13 and 4.6% in the last week before death. During the last 4 weeks of life, 9.2% received one or more GP home visits. Altogether, 6.6% received one or more home visits when the GP had one or more interdisciplinary collaborations during the last 4 weeks, of which <3% died at home. GP office consultations decreased towards the end of life. The likelihood of home death versus another location increased in relation to GP home visits [one home visit odds ratio (OR) 1.92, confidence interval (CI) 1.71-2.15; two or more OR 3.49, CI 3.08-3.96] and GP interdisciplinary collaboration (one contact OR 1.76, CI 1.59-1.96; two or more OR 2.52, CI 2.32-2.74). CONCLUSIONS GPs play a role in enabling people to die at home by performing home visits and collaborating with other health care personnel. Only a minority received such services in Norway.
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Affiliation(s)
- Camilla Kjellstadli
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
| | - Elisabeth Flo
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Hogne Sandvik
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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5
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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6
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Benson JJ, Schwarz B, Tofle RB, Parker Oliver D. The Motivations and Consequences of Dying at Home: Family Caregiver Perspectives. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/02763893.2018.1505460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jacquelyn J. Benson
- Human Development and Family Science, University of Missouri, Columbia, Missouri, USA
| | - Benyamin Schwarz
- Department of Architectural Studies, University of Missouri, Columbia, Missouri, USA
| | - Ruth Brent Tofle
- Department of Architectural Studies, University of Missouri, Columbia, Missouri, USA
| | - Debra Parker Oliver
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
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7
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Giezendanner S, Bally K, Haller DM, Jung C, Otte IC, Banderet HR, Elger BS, Zemp E, Gudat H. Reasons for and Frequency of End-of-Life Hospital Admissions: General Practitioners' Perspective on Reducing End-of-Life Hospital Referrals. J Palliat Med 2018; 21:1122-1130. [DOI: 10.1089/jpm.2017.0489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stéphanie Giezendanner
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Klaus Bally
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Dagmar M. Haller
- Department of Community Health and Medicine, Primary Care Unit, University of Geneva, Geneva, Switzerland
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Corinna Jung
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
- Department of Health Care, Careum Forschung, Kaleidos Fachhochschule, Zurich, Switzerland
| | - Ina C. Otte
- Faculty of Medicine, Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Medical Faculty, Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Hans-Ruedi Banderet
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Bernice S. Elger
- Faculty of Medicine, Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center of Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Heike Gudat
- Hospiz im Park, Hospital for Palliative Care, Arlesheim, Basel, Switzerland
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8
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Heins M, Hofstede J, Rijken M, Korevaar J, Donker G, Francke A. Palliative care for patients with cancer: do patients receive the care they consider important? A survey study. BMC Palliat Care 2018; 17:61. [PMID: 29665807 PMCID: PMC5905150 DOI: 10.1186/s12904-018-0315-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In many countries, GPs and home care nurses are involved in care for patients with advanced cancer. Given the varied and complex needs of these patients, providing satisfactory care is a major challenge for them. We therefore aimed to study which aspects of care patients, GPs and home care nurses consider important and whether patients receive these aspects. METHODS Seventy-two Dutch patients with advanced cancer, 87 GPs and 26 home care nurses rated the importance of support when experiencing symptoms, respect for patients' autonomy and information provision. Patients also rated whether they received these aspects. Questionnaires were based on the CQ index palliative care. RESULTS Almost all patients rated information provision and respect for their autonomy as important. The majority also rated support when suffering from specific symptoms as important, especially support when in pain. In general, patients received the care they considered important. However, 49% of those who considered it important to receive support when suffering from fatigue and 23% of those who wanted to receive information on the expected course of their illness did not receive this or only did so sometimes. CONCLUSION For most patients with advanced cancer, the palliative care that they receive matches what they consider important. Support for patients experiencing fatigue may need more attention. When symptoms are difficult to control, GPs and nurses may still provide emotional support and practical advice. Furthermore, we recommend that GPs discuss patients' need for information about the expected course of their illness.
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Affiliation(s)
- Marianne Heins
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Jolien Hofstede
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Joke Korevaar
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Gé Donker
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Anneke Francke
- Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands.,Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands.,Expertise center palliative care, VU University Medical Center, Amsterdam, the Netherlands
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9
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Raijmakers NJH, de Veer AJE, Zwaan R, Hofstede JM, Francke AL. Which patients die in their preferred place? A secondary analysis of questionnaire data from bereaved relatives. Palliat Med 2018; 32:347-356. [PMID: 28590159 DOI: 10.1177/0269216317710383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies on factors influencing the place of death have focused on cancer patients dying at home. However, home is not always the preferred place. AIM To provide insight into the extent to which patients with various diseases die in their preferred place and into factors associated with dying in the preferred place. DESIGN A secondary analysis of the data set of the evaluation study of the National Quality Improvement Programme for Palliative Care was undertaken to explore factors related to 'dying in the preferred place'. SETTING/PARTICIPANTS A total of 797 bereaved relatives filled in the Consumer Quality Index Palliative Care, a validated and reliable questionnaire. RESULTS Two-thirds of the patients died in the preferred place. A preference for dying at home and having had a stroke decreased the likelihood of dying in the preferred place, while having a partner, dementia, contact with the general practitioner in the last week before death, and continuity of care between professionals increased the likelihood of dying in the preferred place. Furthermore, people who wanted to die at home and also had dementia were more likely to die elsewhere than people without dementia who wanted to die at home. CONCLUSION Positive associations were found between continuity of care between healthcare professionals and contact with the general practitioner and the chance of people dying in their preferred place. Moreover, special attention for people who have had a stroke and for people with dementia who want to die at home seems indicated as their diagnosis is negatively associated with dying in their preferred place.
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Affiliation(s)
- Natasja J H Raijmakers
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,2 Comprehensive Cancer Center the Netherlands, Utrecht, The Netherlands
| | - Anke J E de Veer
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Rosanne Zwaan
- 3 Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jolien M Hofstede
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Anneke L Francke
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,4 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,5 Expertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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10
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Hoek PD, Schers HJ, Hendriks JCM, Vissers KCP, Hasselaar JGJ. Palliative care consultations in primary care: a cross-sectional survey among Dutch general practitioners. BMJ Support Palliat Care 2016; 9:e30. [PMID: 27316637 DOI: 10.1136/bmjspcare-2015-000967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 04/25/2016] [Accepted: 05/31/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Expert consultation supports general practitioners (GPs) in delivering adequate palliative homecare. Insight into consultation practices from a GP's perspective is needed in order to shape consultation services to their wishes and needs. AIM To explore palliative care consultation practices from a GP's perspective. DESIGN AND SETTING Cross-sectional web-based survey among all GPs (n=235) in the region of Nijmegen, the Netherlands. METHODS Our questionnaire contained questions about the delivery of palliative care by GPs, their consultation practices and satisfaction with current services. Questions consisted mainly of 5-point Likert scales. We transformed these scales into numerical values to calculate mean scores. Linear mixed models for repeated measurements were used to study differences in scores. RESULTS GPs most often consulted informal caregivers (mean score 3.6) or fellow GPs (mean score 3.3). Physical problems were discussed the most (mean score 3.5), while social and existential issues were discussed least (mean score 1.9 for both). In their choice of a particular consultation service, GPs considered the quality of the provided advice to be the most important factor. GPs were satisfied with current consultation services, with fellow GPs receiving the highest satisfaction scores (mean score 4.6). Finally, when recalling their last palliative patient, most GPs started requesting consultation during this patient's last month of life. CONCLUSIONS Next to informal caregivers, GPs preferably seek advice from fellow GPs. Physical issues receive much attention during consultations; however, other vital aspects of palliative care seem to remain relatively neglected, such as social and existential issues and a proactive care approach.
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Affiliation(s)
- Patrick D Hoek
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk J Schers
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan C M Hendriks
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen G J Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C. The expanding role of primary care in cancer control. Lancet Oncol 2015; 16:1231-72. [PMID: 26431866 DOI: 10.1016/s1470-2045(15)00205-3] [Citation(s) in RCA: 355] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022]
Abstract
The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.
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Affiliation(s)
- Greg Rubin
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK.
| | - Annette Berendsen
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | | | - Rachel Dommett
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Craig Earle
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Jon Emery
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Tom Fahey
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Sumit Gupta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - David Hunter
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | | | - Una Macleod
- Hull-York Medical School, University of Hull, Hull, UK
| | - Robert Mason
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Geoffrey Mitchell
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | | | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bohumil Seifert
- Department of General Practice, Charles University, Prague, Czech Republic
| | - Jeff Sisler
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Stephen Taplin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Peter Vedsted
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Teja Voruganti
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fiona Walter
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Eila Watson
- Department of Clinical Health Care, Oxford Brookes University, Oxford, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Jeremy Whelan
- Research Department of Oncology, University College London, London, UK
| | - James Whitlock
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | - Niek de Wit
- Department of General Practice, University Medical Center Utrecht, Utrecht, Netherlands
| | - Camilla Zimmermann
- Division of Medical Oncology and Haematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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12
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Lindqvist O, Tishelman C. Room for Death--International museum-visitors' preferences regarding the end of their life. Soc Sci Med 2015; 139:1-8. [PMID: 26121179 DOI: 10.1016/j.socscimed.2015.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Just as pain medications aim to relieve physical suffering, supportive surrounding for death and dying may facilitate well-being and comfort. However, little has been written of the experience of or preferences for the surroundings in which death and dying take place. In this study, we aim to complement our research from perspectives of patients, family members and staff, with perspectives from an international sample of the general public. Data derives from a project teaming artists and craftspeople together to create prototypes of space for difficult conversations in end-of-life (EoL) settings. These prototypes were presented in a museum exhibition, "Room for Death", in Stockholm in 2012. As project consultants, palliative care researchers contributed a question to the public viewing the exhibition, to explore their reflections: "How would you like it to be around you when you are dying?" Five-hundred and twelve responses were obtained from visitors from 46 countries. While preliminary analysis pointed to many similarities in responses across countries, continued analysis with a phenomenographic approach allowed us to distinguish different foci related to how preferences for surroundings for EoL were conceptualized. Responses were categorized in the following inductively-derived categories: The familiar death, The 'larger-than life' death, The lone death, The mediated death, The calm and peaceful death, The sensuous death, The 'green' death, and The distanced death. The responses could relate to a single category or be composites uniting different categories in individual combinations, and provide insight into different facets of contemporary reflections about death and dying. Despite the selective sample, these data give reason to consider how underlying assumptions and care provision in established forms for end-of-life care may differ from people's preferences. This project can be seen as an example of innovative endeavors to promote public awareness of issues related to death and dying, within the framework of health-promoting palliative care.
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Affiliation(s)
- Olav Lindqvist
- Department of Learning, Informatics, Management and Ethics/Medical Management Center, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Nursing, Umeå University, 901 87 Umeå, Sweden.
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics/Medical Management Center, Karolinska Institutet, 171 77 Stockholm, Sweden; Karolinska University Hospital, Center for Innovation, 141 86 Stockholm, Sweden.
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Sercu M, Renterghem VV, Pype P, Aelbrecht K, Derese A, Deveugele M. "It is not the fading candle that one expects": general practitioners' perspectives on life-preserving versus "letting go" decision-making in end-of-life home care. Scand J Prim Health Care 2015; 33:233-42. [PMID: 26654583 PMCID: PMC4750732 DOI: 10.3109/02813432.2015.1118837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many general practitioners (GPs) are willing to provide end-of-life (EoL) home care for their patients. International research on GPs' approach to care in patients' final weeks of life showed a combination of palliative measures with life-preserving actions. AIM To explore the GP's perspective on life-preserving versus "letting go" decision-making in EoL home care. DESIGN Qualitative analysis of semi-structured interviews with 52 Belgian GPs involved in EoL home care. RESULTS Nearly all GPs adopted a palliative approach and an accepting attitude towards death. The erratic course of terminal illness can challenge this approach. Disruptive medical events threaten the prospect of a peaceful end-phase and death at home and force the GP either to maintain the patient's (quality of) life for the time being or to recognize the event as a step to life closure and "letting the patient go". Making the "right" decision was very difficult. Influencing factors included: the nature and time of the crisis, a patient's clinical condition at the event itself, a GP's level of determination in deciding and negotiating "letting go" and the patient's/family's wishes and preparedness regarding this death. Hospitalization was often a way out. CONCLUSIONS GPs regard alternation between palliation and life-preservation as part of palliative care. They feel uncertain about their mandate in deciding and negotiating the final step to life closure. A shortage of knowledge of (acute) palliative medicine as one cause of difficulties in letting-go decisions may be underestimated. Sharing all these professional responsibilities with the specialist palliative home care teams would lighten a GP's burden considerably. Key Points A late transition from a life-preserving mindset to one of "letting go" has been reported as a reason why physicians resort to life-preserving actions in an end-of-life (EoL) context. We investigated GPs' perspectives on this matter. Not all GPs involved in EoL home care adopt a "letting go" mindset. For those who do, this mindset is challenged by the erratic course of terminal illness. GPs prioritize the quality of the remaining life and the serenity of the dying process, which is threatened by disruptive medical events. Making the "right" decision is difficult. GPs feel uncertain about their own role and responsibility in deciding and negotiating the final step to life closure.
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Affiliation(s)
- Maria Sercu
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
- CONTACT Maria Sercu, MD, General Practitioner, PhD student Department of Family Medicine and Primary Health Care, University Hospital 6K3, De Pintelaan 185, 9000 Ghent, Belgium
| | | | - Peter Pype
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
| | - Karolien Aelbrecht
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
| | - Anselme Derese
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
| | - Myriam Deveugele
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
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Humphrey L, Kang TI. Palliative care in pediatric patients with hematologic malignancies. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:490-495. [PMID: 26637763 DOI: 10.1182/asheducation-2015.1.490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Children with advanced cancer, including those with hematologic malignancies, can benefit from interdisciplinary palliative care services. Palliative care includes management of distressing symptoms, attention to psychosocial and spiritual needs, and assistance with navigating complex medical decisions with the ultimate goal of maximizing the quality-of-life of the child and family. Palliative care is distinct from hospice care and can assist with the care of patients throughout the cancer continuum, irrespective of prognosis. While key healthcare organizations, including the Institute of Medicine, the American Academy of Pediatrics and the American Society of Clinical Oncology among many others endorse palliative care for children with advanced illness, barriers to integration of palliative care into cancer care still exist. Providing assistance with advance care planning, guiding patients and families through prognostic uncertainty, and managing transitions of care are also included in goals of palliative care involvement. For patients with advanced malignancy, legislation, included in the Patient Protection and Affordable Health Care Act allows patients and families more options as they make the difficult transition from disease directed therapy to care focused on comfort and quality-of-life.
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Affiliation(s)
| | - Tammy I Kang
- The Children's Hospital of Philadelphia, Philadelphia, PA
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