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Philip J, Chang YK, Collins A, Smallwood N, Sullivan DR, Yawn BP, Mularski R, Ekström M, Yang IA, McDonald CF, Mori M, Perez-Cruz P, Halpin DMG, Cheng SY, Hui D. Consensus palliative care referral criteria for people with chronic obstructive pulmonary disease. Thorax 2024:thorax-2024-221721. [PMID: 39174326 DOI: 10.1136/thorax-2024-221721] [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: 04/01/2024] [Accepted: 07/08/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE People with advanced chronic obstructive pulmonary disease (COPD) have substantial palliative care needs, but uncertainty exists around appropriate identification of patients for palliative care referral.We conducted a Delphi study of international experts to identify consensus referral criteria for specialist outpatient palliative care for people with COPD. METHODS Clinicians in the fields of respiratory medicine, palliative and primary care from five continents with expertise in respiratory medicine and palliative care rated 81 criteria over three Delphi rounds. Consensus was defined a priori as ≥70% agreement. A criterion was considered 'major' if experts endorsed meeting that criterion alone justified palliative care referral. RESULTS Response rates from the 57 panellists were 86% (49), 84% (48) and 91% (52) over first, second and third rounds, respectively. Panellists reached consensus on 17 major criteria for specialist outpatient palliative care referral, categorised under: (1) 'Health service use and need for advanced respiratory therapies' (six criteria, eg, need for home non-invasive ventilation); (2) 'Presence of symptoms, psychosocial and decision-making needs' (eight criteria, eg, severe (7-10 on a 10 point scale) chronic breathlessness); and (3) 'Prognostic estimate and performance status' (three criteria, eg, physician-estimated life expectancy of 6 months or less). CONCLUSIONS International experts evaluated 81 potential referral criteria, reaching consensus on 17 major criteria for referral to specialist outpatient palliative care for people with COPD. Evaluation of the feasibility of these criteria in practice is required to improve standardised palliative care delivery for people with COPD.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
- Palliative Care, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- Department of Palliative Care, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Yuchieh Kathryn Chang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anna Collins
- Department of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Natasha Smallwood
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Donald Richard Sullivan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Barbara P Yawn
- Department of Family and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Richard Mularski
- Kaiser Permanente Bernard J Tyson School of Medicine, Portland, Oregon, USA
| | - Magnus Ekström
- Department of Clinical Sciences Lund Respiratory Medicine, Lund University, Lund, Sweden
| | - Ian A Yang
- The University of Queensland, Brisbane, Queensland, Australia
- The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Christine F McDonald
- Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Masanori Mori
- Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Pedro Perez-Cruz
- Sección de Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David M G Halpin
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Shao-Yi Cheng
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Selvam D, Crawford GB, Rizvi F, Bellingham K, Philip J. CarePlus: A Model to Address Barriers to Early Palliative Care in Cancer. J Pain Symptom Manage 2024; 67:e495-e497. [PMID: 38278188 DOI: 10.1016/j.jpainsymman.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024]
Affiliation(s)
- Dalini Selvam
- University of Melbourne (D.S., F.R., K.B., J.P.), Victoria, Australia; University of Adelaide (G.B.C.), South Australia, Australia; Northern Adelaide Local Health Network (G.B.C.), South Australia, Australia; St. Vincent's Hospital (F.R., K.B., J.P.), Victoria, Australia.
| | - Gregory B Crawford
- University of Melbourne (D.S., F.R., K.B., J.P.), Victoria, Australia; University of Adelaide (G.B.C.), South Australia, Australia; Northern Adelaide Local Health Network (G.B.C.), South Australia, Australia; St. Vincent's Hospital (F.R., K.B., J.P.), Victoria, Australia
| | - Farwa Rizvi
- University of Melbourne (D.S., F.R., K.B., J.P.), Victoria, Australia; University of Adelaide (G.B.C.), South Australia, Australia; Northern Adelaide Local Health Network (G.B.C.), South Australia, Australia; St. Vincent's Hospital (F.R., K.B., J.P.), Victoria, Australia
| | - Kylee Bellingham
- University of Melbourne (D.S., F.R., K.B., J.P.), Victoria, Australia; University of Adelaide (G.B.C.), South Australia, Australia; Northern Adelaide Local Health Network (G.B.C.), South Australia, Australia; St. Vincent's Hospital (F.R., K.B., J.P.), Victoria, Australia
| | - Jennifer Philip
- University of Melbourne (D.S., F.R., K.B., J.P.), Victoria, Australia; University of Adelaide (G.B.C.), South Australia, Australia; Northern Adelaide Local Health Network (G.B.C.), South Australia, Australia; St. Vincent's Hospital (F.R., K.B., J.P.), Victoria, Australia
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Geddie PI, Loerzel VW. Adult Cancer Patients' Perceptions of Factors That Influence Hospital Admissions. CLIN NURSE SPEC 2024; 38:122-130. [PMID: 38625801 DOI: 10.1097/nur.0000000000000816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
PURPOSE/AIMS To explore cancer patients' perceptions of factors that influence hospital readmissions. DESIGN A cross-sectional, prospective design was employed utilizing a 1-time survey and brief interviews to measure patients' perceptions and unplanned hospital admissions. METHODS AND VARIABLES The principal investigator collected data from medical record review, the Hospital Admission Survey, and interviews to measure patient characteristics and perceptions of influencing factors that contributed to an unplanned hospital admission upon admission. Data were analyzed using descriptive statistics to categorize patient perceptions of influencing factors of unplanned hospital admissions. RESULTS The top reasons for admission were symptoms of uncontrolled gastrointestinal, pain, fever, and respiratory problems. The majority perceived the admission was unavoidable and wanted to avoid an admission. Perceived influencing factors were related to survey categories of 1) communication (ie, cannot reach physician anytime, cannot get a next-day appointment, medical problems are out of control, advised to go to the emergency department) and 2) home environment (ie, unable to adequately manage symptoms at home and hospital admission is the best place for care). Other survey categories of patient education and palliative care were not perceived as influencing or contributing factors. CONCLUSIONS These findings highlight opportunities for clinical nurse specialists to target these vulnerable patients and provide expert consultation to address potential barriers and gaps in utilization of appropriate supportive services that may reduce unplanned hospital admissions.
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Affiliation(s)
- Patricia I Geddie
- Author Affiliations: Nurse Scientist, H. Lee Moffitt Cancer Center & Research Institute (Dr Geddie); and Professor and Beat M. and Jill L. Kahli Endowed Professor in Oncology Nursing, University of Central Florida, College of Nursing (Dr Loerzel)
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Allende-Pérez SR, Sandoval-Carrera NC, Asencio-Huertas L, Rodríguez-Mayoral O, Cruz-Sánchez JJ, Verástegui-Avilés E. Utilization of medical interventions in hospitalized Mexican adults with cancer at the end of life in a referral hospital: The importance of early palliative care. Palliat Support Care 2024:1-8. [PMID: 38450451 DOI: 10.1017/s1478951524000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVES To investigate the impact of early vs. late palliative care (PC) on the frequency of admissions to acute hospital settings and the utilization of end-of-life (EoL) interventions in cancer decedents. METHODS In this single-center, cross-sectional study, we examined the frequency of intensive care unit (ICU) and emergency department (ED) admissions among adult cancer decedents between 2018 and 2022 in a referral hospital in México. Additionally, we assessed EoL medical interventions, categorizing patients into 3 groups: those who received early PC (EPC), late PC (LPC), and those who did not receive PC (NPC). RESULTS We analyzed data from 1762 patients, averaging 56 ± 16.3 years old, with a predominant representation of women (56.8%). PC was administered to 45.2% of patients, but EPC was limited to only 12.3%. The median time from the initiation of PC to death was 5 days (interquartile range: 2.0-31.5). Hematological malignancies were the most prevalent, affecting 21.5% of patients. EPC recipients demonstrated notable reductions in ICU and ED admissions, as well as diminished utilization of chemotherapy, radiotherapy (RT), antibiotics, blood transfusions, and surgery when compared to both LPC and NPC groups. EPC also exhibited fewer medical interventions in the last 14 days of life, except for RT. SIGNIFICANCE OF RESULTS The findings of this study indicate that a significant proportion of EoL cancer patients receive PC; however, few receive EPC, emphasizing the need to improve accessibility to these services. Moreover, the results underscore the importance of thoughtful deliberation regarding the application of EoL medical interventions in cancer patients.
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Pilgrim CHC, Finn N, Stuart E, Philip J, Steel S, Croagh D, Lee B, Tebbutt NC. Changing patterns of care for pancreas cancer in Victoria: the 2022 Pancreas Tumour Summit. ANZ J Surg 2023; 93:2638-2647. [PMID: 37221964 DOI: 10.1111/ans.18522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The Victorian Government convened the second Pancreas Cancer Summit in 2021 to identify unwarranted variation in care 2016-2019, and to assess trends compared with the first Summit 2017 (reporting 2011-2015). State-wide administrative data were assessed at population level in alignment with optimal care pathways across all stages of the cancer care continuum. METHODS Data linkage performed by Centre for Victorian Data Linkage combined data from Victorian Cancer Registry with other administrative data sets including Victorian Admitted Episodes Dataset, Victorian Radiotherapy Minimum Data Set, Victorian Emergency Minimum Dataset and Victorian Death Index. A Cancer Service Performance Indicator audit was carried out providing an in-depth analysis of identified areas of interest. RESULTS Of 3138 Victorians diagnosed with pancreas ductal adenocarcinoma 2016-2019, 63% were metastatic at diagnosis. One-year survival increased between time periods, from 29.7% overall 2011-2015 (59.1% for non-metastatic, and 15.1% metastatic) to 32.5% overall 2016-2019 (P < 0.001), 61.2% non-metastatic (P = 0.008), 15.7% metastatic (P = NS). A higher proportion of non-metastatic patients progressed to surgery (35% vs. 31%, P = 0.020), and more received neoadjuvant therapy (16% vs. 4%, P < 0.001). Postoperative mortality following pancreatectomy at 30 and 90 days remained low at 2%. Utilization of 5FU-based chemotherapy regimens increased between 2016 and 2020. Multidisciplinary Meeting (MDM) presentation was still below the 85% target (74%) as was supportive care screening (39%, target 80%). CONCLUSIONS Surgical outcomes remain world-class and there has been an appropriate shift in chemotherapy administration towards neoadjuvant timing with increasing use of 5FU-based regimens. MDM presentation rates, supportive care and overall care coordination remain areas of deficiency.
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Affiliation(s)
- Charles H C Pilgrim
- Hepatopancreaticobiliary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Victoria, Australia
- School of Public Health and Preventative Medicine, Monash University, Victoria, Australia
| | - Norah Finn
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
- Department of Health, Cancer Support, Treatment and Research, Melbourne, Victoria, Australia
| | - Ella Stuart
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
- Department of Health, Cancer Support, Treatment and Research, Melbourne, Victoria, Australia
| | - Jennifer Philip
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Palliative Care Service, St Vincent's Hospital, Fitzroy, Victoria, Australia
- Palliative Care Service, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Simone Steel
- Department of Medical Oncology, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medical Oncology, Peninsula Private Hospital, Langwarrin, Victoria, Australia
| | - Dan Croagh
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Surgery, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
- Department of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Belinda Lee
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Department of Medical Oncology, Northern Health, Epping, Victoria, Australia
- Division of Personalised Oncology, Walter & Eliza Hall Institute, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Science, University of Melbourne, Parkville, Victoria, Australia
| | - Niall C Tebbutt
- Department of Medical Oncology, Austin Health, Heidelberg, Victoria, Australia
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Khan NN, Evans SM, Ioannou LJ, Pilgrim CHC, Blanchard M, Daveson B, Philip J, Zalcberg JR, Te Marvelde L. Characteristics of patients diagnosed with pancreatic cancer who access palliative care: An observational study. Qual Life Res 2023:10.1007/s11136-023-03425-x. [PMID: 37133625 PMCID: PMC10393853 DOI: 10.1007/s11136-023-03425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE Despite the benefits of palliative care (PC) in pancreatic cancer, little is known about patients who access PC. This observational study examines the characteristics of patients with pancreatic cancer at their first episode of PC. METHODS First-time, specialist PC episodes captured through the Palliative Care Outcomes Collaboration (PCOC), in Victoria, Australia between 2014 and 2020, for pancreatic cancer, were identified. Multivariable logistic regression analyses examined the impact of patient- and service-level characteristics on symptom burden (measured through patient-reported outcome measures and clinician-rated scores) at first PC episode. RESULTS Of 2890 eligible episodes, 45% began when the patient was deteriorating and 32% ended in death. High fatigue and appetite-related distress were most common. Generally, increasing age, higher performance status and more recent year of diagnosis predicted lower symptom burden. No significant differences were noted between symptom burden of regional/remote versus major city dwellers; however, only 11% of episodes recorded the patient as a regional/remote resident. A greater proportion of first episodes for non-English-speaking patients began when the patient was unstable, deteriorating or terminal, ended in death and were more likely to be associated with high family/carer problems. Community PC setting predicted high symptom burden, with the exception of pain. CONCLUSION A large proportion of first-time specialist PC episodes in pancreatic cancer begin at a deteriorating phase and end in death, suggesting late access to PC. Timely referrals to community-based specialist PC, access in regional/remote areas, as well as development of culturally diverse support systems require further investigation.
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Affiliation(s)
- Nadia N Khan
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sue M Evans
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Liane J Ioannou
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Charles H C Pilgrim
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Megan Blanchard
- Palliative Care Outcomes Collaboration, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Barbara Daveson
- Palliative Care Outcomes Collaboration, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Jennifer Philip
- Department of Medicine, University of Melbourne, St Vincent's Hospital Campus, Victoria Pde, Fitzroy, VIC, 3000, Australia
| | - John R Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Luc Te Marvelde
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.
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Collins A, Sundararajan V, Le B, Mileshkin L, Hanson S, Emery J, Philip J. The feasibility of triggers for the integration of Standardised, Early Palliative (STEP) Care in advanced cancer: A phase II trial. Front Oncol 2022; 12:991843. [PMID: 36185312 PMCID: PMC9520487 DOI: 10.3389/fonc.2022.991843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background While multiple clinical trials have demonstrated benefits of early palliative care for people with cancer, access to these services is frequently very late if at all. Establishing evidence-based, disease-specific ‘triggers’ or times for the routine integration of early palliative care may address this evidence-practice gap. Aim To test the feasibility of using defined triggers for the integration of standardised, early palliative (STEP) care across three advanced cancers. Method Phase II, multi-site, open-label, parallel-arm, randomised trial of usual best practice cancer care +/- STEP Care conducted in four metropolitan tertiary cancer services in Melbourne, Australia in patients with advanced breast, prostate and brain cancer. The primary outcome was the feasibility of using triggers for times of integration of STEP Care, defined as enrolment of at least 30 patients per cancer in 24 months. Triggers were based on hospital admission with metastatic disease (for breast and prostate cancer), or development of disease recurrence (for brain tumour cohort). A mixed method study design was employed to understand issues of feasibility and acceptability underpinning trigger points. Results The triggers underpinning times for the integration of STEP care were shown to be feasible for brain but not breast or prostate cancers, with enrolment of 49, 6 and 10 patients across the three disease groups respectively. The varied feasibility across these cancer groups suggested some important characteristics of triggers which may aid their utility in future work. Conclusions Achieving the implementation of early palliative care as a standardized component of quality care for all oncology patients will require further attention to defining triggers. Triggers which are 1) linked to objective points within the illness course (not dependent on recognition by individual clinicians), 2) Identifiable and visible (heralded through established service-level activities) and 3) Not reliant upon additional screening measures may enhance their feasibility.
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Affiliation(s)
- Anna Collins
- Department of Medicine, St Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Anna Collins,
| | - Vijaya Sundararajan
- Department of Medicine, St Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Le
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Jon Emery
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Philip
- Department of Medicine, St Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Palliative Care Service, St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
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