1
|
Lally K, Macip-Rodriquez P, Wu C, McGuire H, Pirl W. The Supportive Oncology Collaborative: Expanding upon Collaborative Care to Increase Supportive Care Access in Underserved Populations. J Palliat Med 2024; 27:789-793. [PMID: 38602266 DOI: 10.1089/jpm.2023.0617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
Background: Access to supportive services in community-based oncology is challenging but essential, particularly for underserved populations. Methods: We developed the Supportive Oncology Collaborative (SOC), built upon the tenets of Collaborative Care, an existing model used to increase access to behavioral health in community settings. Using a population-health-based approach with screening, a registry, and shared care, we added palliative care specialists to a team of social workers and a consulting psychiatrist. We provided integrated psychosocial and palliative care at community-based sites of a large comprehensive cancer center. Results: We implemented the model in 2020 at a community site with a racially and ethnically diverse patient population. Encounters grew from 527 in our first year to 2,130 in 2022. Using screening tools, we identify the highest-risk patients for discussion in team meetings. Discussion: We are expanding the SOC across the Dana-Farber Cancer Institute regional campuses and believe it can increase access to integrated psychosocial and palliative care in cancer centers across the country.
Collapse
Affiliation(s)
- Kate Lally
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Perla Macip-Rodriquez
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie Wu
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Hilary McGuire
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute Merrimack Valley, Methuen, Massachusetts, USA
| | - William Pirl
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Wang Y, Koffman J, Gao W, Zhou Y, Chukwusa E, Curcin V. Social media for palliative and end-of-life care research: a systematic review. BMJ Support Palliat Care 2024; 14:149-162. [PMID: 38594059 PMCID: PMC11103321 DOI: 10.1136/spcare-2023-004579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Social media with real-time content and a wide-reaching user network opens up more possibilities for palliative and end-of-life care (PEoLC) researchers who have begun to embrace it as a complementary research tool. This review aims to identify the uses of social media in PEoLC studies and to examine the ethical considerations and data collection approaches raised by this research approach. METHODS Nine online databases were searched for PEoLC research using social media published before December 2022. Thematic analysis and narrative synthesis approach were used to categorise social media applications. RESULTS 21 studies were included. 16 studies used social media to conduct secondary analysis and five studies used social media as a platform for information sharing. Ethical considerations relevant to social media studies varied while 15 studies discussed ethical considerations, only 6 studies obtained ethical approval and 5 studies confirmed participant consent. Among studies that used social media data, most of them manually collected social media data, and other studies relied on Twitter application programming interface or third-party analytical tools. A total of 1 520 329 posts, 325 videos and 33 articles related to PEoLC from 2008 to 2022 were collected and analysed. CONCLUSIONS Social media has emerged as a promising complementary research tool with demonstrated feasibility in various applications. However, we identified the absence of standardised ethical handling and data collection approaches which pose an ongoing challenge. We provided practical recommendations to bridge these pressing gaps for researchers wishing to use social media in future PEoLC-related studies.
Collapse
Affiliation(s)
- Yijun Wang
- Department of Population Health Sciences, King's College London, London, UK
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Wei Gao
- Epidemiology & Health Statistics, Nanchang University, Nanchang, China
| | - Yuxin Zhou
- Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Vasa Curcin
- Department of Population Health Sciences, King's College London, London, UK
| |
Collapse
|
3
|
Chen M, Hui S, Huang Y, Yu H, Yang H, Yang L, Tian L, Wang S. Knowledge, attitudes, and current practices toward lung cancer palliative care management in China: a national survey. Front Oncol 2024; 14:1382496. [PMID: 38812782 PMCID: PMC11133550 DOI: 10.3389/fonc.2024.1382496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024] Open
Abstract
Scope The present investigation seeks to illuminate the current state and disparities in the knowledge, attitudes, and practices (KAP) among healthcare professionals regarding the management of lung cancer palliative care (LCPC) in China, while simultaneously assessing the prevalence and context of patient-controlled analgesia (PCA) usage in the management of cancer-related pain. Methods A total of 2093 healthcare practitioners from 706 hospitals across China completed a structured questionnaire that probed various facets of LCPC management. The questionnaire consisted of seven thematic sections, incorporating chi-square tests and Fisher's exact probabilities to statistically assess the discrepancies in KAP among healthcare professionals across different hospital grades. Ordered data distributions among hospital grades were compared using non-parametric Kruskal-Wallis H and Mann-Whitney U tests. Multiple-choice items were subjected to multiple-response cross-tabulation analysis, while the Spearman rank-order correlation coefficient was employed to gauge potential associations among variables. Results Around 84.2% of the respondents perceived anti-tumor therapy to be of equal importance to palliative care. Statistically significant differences (χ² = 27.402, P = 0.002) in satisfaction levels were observed, with participants from Tertiary hospitals demonstrating higher satisfaction compared to those from Secondary and Primary hospitals. Pain emerged as the most prevalent symptom necessitating LCPC. Major impediments to LCPC adoption included patients' and families' concerns about the safety of long-term palliative care-related drug use. 31.1% of the respondents cited the most frequent rationale for PCA use as cases involving patients who required systemic administration of large opioid doses or exhibited intolerable adverse reactions to opioids. The principal deterrents against the use of PCA for cancer pain management were (1): apprehension about adverse drug reactions due to overdose (2), concern about the potential for opioid addiction, and (3) the anticipated increase in patients' economic burdens. Over the preceding 24-month period, 33.9% of the surveyed healthcare practitioners reported no engagement in either online or offline LCPC-related training initiatives. Conclusion This study emphasizes the pressing need for comprehensive training in LCPC among Chinese health personnels, particularly focusing on the effective management of cancer pain symptoms.
Collapse
Affiliation(s)
- Mengting Chen
- Department of Clinical Nutrition, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Suocheng Hui
- Department of Clinical Nutrition, The People’s Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Yalan Huang
- Outpatient Department, Yunnan Provincial Corps Hospital of Chinese People’s Armed Police Forces, Kunming, Yunnan, China
| | - Huiqing Yu
- Department of Clinical Nutrition, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Hong Yang
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Liejun Yang
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Ling Tian
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Sixiong Wang
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| |
Collapse
|
4
|
Ferrell BR, Firn JI, Temin S, Sanders JJ. Palliative Care for Patients With Cancer: ASCO Guideline Clinical Insights. JCO Oncol Pract 2024:OP2400225. [PMID: 38748948 DOI: 10.1200/op.24.00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/04/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
| | | | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | |
Collapse
|
5
|
Bernhardt F, Bückmann A, Krüger J, Bauer B, Hofmeister U, Juhra C, Eveslage M, Fischhuber K, Storck M, Brix TJ, Lenz P. Telemedicine Plus Standard Care Versus Standard Care Only in Specialized Outpatient Palliative Care: A Randomized Controlled Noninferiority Trial. Telemed J E Health 2024; 30:1459-1469. [PMID: 38294865 DOI: 10.1089/tmj.2023.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Background: Patients suffering from incurable diseases are more likely to die in the hospital than at home. Specialized outpatient palliative care (PC) may be able to counteract this tendency. Similarly, potential benefits of telemedicine in health care were scientifically reported. The aim of this research was to compare patients receiving specialized outpatient PC plus telemedicine with those receiving standard specialized outpatient PC only. In this study, telemedicine is assumed to decrease the number of home visits and therefore should not be considered a mere add-on. Methods: This is a randomized controlled noninferiority trial. Recruitment lasted between January 2020 and October 2021. Quality of care was evaluated using the Integrated Palliative Care Outcome Scale (IPOS) at day 0, 7, and 14 after randomization. Change from day 0 to 7 was defined as the primary outcome (noninferiority margin = 4 points). This study was conducted in an urban setting in collaboration with a university hospital and a local specialized outpatient PC service. Results: A total of 196 patients were screened with 34 patients included (18 telemedicine/16 standard care). The mean change in the total score of the IPOS from day 0 to 7 amounted to -1.8 ± 3.9 (telemedicine) versus 1.2 ± 5.7 (standard care). The telemedicine group was statistically not relevantly inferior to the standard care group (t-test for noninferiority, p = 0.005). Conclusions: Although, due to COVID-19, the sample size remained rather small, our findings indicate that telemedical approaches offer a promising and equally effective option to provide specialized outpatient PC. Clinical Trial Registration Number: NCT06054048.
Collapse
Affiliation(s)
- Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| | - Andreas Bückmann
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| | - Janina Krüger
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Birgit Bauer
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Ulrike Hofmeister
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Muenster, Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Karen Fischhuber
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Tobias J Brix
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
6
|
Pandey S, Wisniewski R, Morjaria S, Bianchi AL, Newman T, Tan C, Rosa WE, Finlayson CS. Factors Associated with Antimicrobial Use at the End-Of-Life Among Hospitalized Cancer Patients. Am J Hosp Palliat Care 2024; 41:8-15. [PMID: 36812451 PMCID: PMC10442462 DOI: 10.1177/10499091231160185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Background: Antimicrobials are frequently administered at end-of-life (EOL) and their non-beneficial use may subject patients to unnecessary harms. Studies analyzing factors for antimicrobial prescribing in solid tumor cancer patients at the EOL are lacking. Thus, we aimed to identify factors and patterns associated with antimicrobial use in hospitalized adults with cancer at EOL. Methods: We used a retrospective cohort design to review electronic medical records of terminal hospitalized patients ≥18 years with solid tumors admitted to non-intensive care units in a metropolitan comprehensive cancer center during 2019 and assessed antimicrobial use in the last 7 days of life. Results: Among 633 cancer patients, 59% (n = 376) received antimicrobials (AM+) within the last 7 days of life. AM + patients were older (P = .012), mostly of male gender (55%), and non-Hispanic ethnicity (87%). AM + patients were significantly more likely to have a foreign device, suspected signs of infection, neutropenia, positive blood culture result, documented advance directive; receive laboratory or radiologic testing, and a palliative care or infectious disease consultation (all P < .05). No statistically significant differences were observed in the presence of documented goals of care discussions, or EOL discussions/EOL care orders. Conclusion: Antimicrobial use at the EOL is common in solid tumor cancer patients at the EOL and is associated with increased utilization of invasive interventions. There is an opportunity for infectious disease specialists to build primary palliative care skills and partner with antimicrobial stewardship programs to better advise patients, decision makers, and primary teams on the use of antimicrobials at the EOL.
Collapse
Affiliation(s)
- Shila Pandey
- Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Renee Wisniewski
- Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sejal Morjaria
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Anabella Lucca Bianchi
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Employee Health & Wellness Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tiffanny Newman
- Department of Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie Tan
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
7
|
Hooker ER, Chapa J, Vranas KC, Niederhausen M, Goodlin SJ, Slatore CG, Sullivan DR. Intersection of Palliative Care and Hospice Use Among Patients With Advanced Lung Cancer. J Palliat Med 2023; 26:1474-1481. [PMID: 37262128 PMCID: PMC10658737 DOI: 10.1089/jpm.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
Background: Hospice and palliative care (PC) are important components of lung cancer care and independently provide benefits to patients and their families. Objective: To better understand the relationship between hospice and PC and factors that influence this relationship. Methods: A retrospective cohort study of patients diagnosed with advanced lung cancer (stage IIIB/IV) within the U.S. Veterans Health Administration (VA) from 2007 to 2013 with follow-up through 2017 (n = 22,907). Mixed logistic regression models with a random effect for site, adjustment for patient variables, and propensity score weighting were used to examine whether the association between PC and hospice use varied by U.S. region and PC team characteristics. Results: Overall, 57% of patients with lung cancer received PC, 69% received hospice, and 16% received neither. Of those who received hospice, 60% were already enrolled in PC. Patients who received PC had higher odds of hospice enrollment than patients who did not receive PC (adjusted odds ratio = 3.25, 95% confidence interval: 2.43-4.36). There were regional differences among patients who received PC; the predicted probability of hospice enrollment was 85% and 73% in the Southeast and Northeast, respectively. PC team and facility characteristics influenced hospice use in addition to PC; teams with the shortest duration of existence, with formal team training, and at lower hospital complexity were more likely to use hospice (all p < 0.05). Conclusions: Among patients with advanced lung cancer, PC was associated with hospice enrollment. However, this relationship varied by geographic region, and PC team and facility characteristics. Our findings suggest that regional PC resource availability may contribute to substitution effects between PC and hospice for end-of-life care.
Collapse
Affiliation(s)
- Elizabeth R. Hooker
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Joaquin Chapa
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Kelly C. Vranas
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Portland Veterans Affairs Medical Center, Divisions of Pulmonary Critical Care Medicine, Portland, Oregon, USA
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Oregon Health and Science University—Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon, USA
| | - Sarah J. Goodlin
- Geriatrics Section, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Donald R. Sullivan
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
8
|
Buller H, Ferrell BR, Paice JA, Glajchen M, Haythorn T. Interprofessional communication training to address spiritual aspects of cancer care. J Health Care Chaplain 2023; 29:399-411. [PMID: 35853097 PMCID: PMC9850499 DOI: 10.1080/08854726.2022.2097781] [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] [Indexed: 01/21/2023]
Abstract
Effective communication is essential for palliative care clinicians to provide quality spiritual care to cancer patients. Despite attention to spiritual needs having the potential to positively impact a patient's quality of life, clinicians continue to report a lack of confidence in addressing a patient's spiritual distress. This article addresses the development of a 3-day train-the-trainer communication cancer education program (ICC: Interprofessional Communication Curriculum) organized by the 8 domains of the National Consensus Project for Quality Palliative Care. The main objectives of ICC are to train adult oncology clinicians (nurses, social workers, and chaplains) in communication skills across all aspects of palliative care and to help prepare them to provide communication skills training to their colleagues at their home institutions. ICC participants attend in dyads consisting of differing disciplines and create 3 goals for implementing institutional change. To date, 126 participants (69 teams) have attended an ICC training. Pre-course survey results identified spiritual care as participants' least effective area of communication. Immediate post-course evaluation data revealed the spiritual care module and its subsequent lab session as the most useful sessions to participant's practice. Data from the 6-and-12-months post-course follow-up revealed participant's quality improvement projects focused heavily on improving spiritual care.
Collapse
Affiliation(s)
- Haley Buller
- Division of Nursing Research and Education, City of Hope National Medical Center, 1500 E. Duarte Road, Pop Sci Bldg 173, Duarte CA 91010
| | - Betty R. Ferrell
- Division of Nursing Research and Education, City of Hope National Medical Center
| | - Judith A. Paice
- Cancer Pain Program, Division, Hematology-Oncology, Northwestern University, Feinberg School of Medicine
| | | | - Trace Haythorn
- Association for Clinical Pastoral Education (ACPE), 55 Ivan Allen Jr. Boulevard, Suite 835, Atlanta, GA 30308
| |
Collapse
|
9
|
Chen M, Yu H, Yang L, Yang H, Cao H, Lei L, Ma L, Liu S, Tian L, Wang S. Combined early palliative care for non-small-cell lung cancer patients: a randomized controlled trial in Chongqing, China. Front Oncol 2023; 13:1184961. [PMID: 37781179 PMCID: PMC10539600 DOI: 10.3389/fonc.2023.1184961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose More effective approaches are needed to improve the prognosis of non-small-cell lung cancer (NSCLC) patients. Thus, we used the E-warm model to assess how early integration of interdisciplinary palliative care was related to the quality of life (QoL), psychological functioning, pain management, and nutrition factors of NSCLC patients. Methods This randomized controlled trial enrolled 280 newly diagnosed NSCLC patients, which were randomly divided (1:1) into combined early palliative care (CEPC) and standard oncological care (SC) groups. At baseline and after 24 weeks, the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale, Hospital Anxiety and Depression Scale (HADS), and the Patient Health Questionnaire-9 (PHQ-9) were used to assess QoL and psychological function, respectively. The Numerical Rating Scale (NRS) and Patient-Generated Subjective Global Assessment (PG-SGA) were used to assess cancer patients' pain and nutrition levels. The primary outcome was overall survival (OS). Secondary outcomes comprised changes in the QoL, psychological functioning, pain, and nutrition state. The intention-to-treat method was applied for analysis. This study was registered at www.chictr.org.cn (ChiCTR2200062617). Results Of the 140 patients enrolled in the CEPC and SC groups, 102 and 82 completed the research. The CEPC group presented higher QoL than the SC group (p < 0.05). Additionally, fewer patients presented depressive symptoms in the CEPC group than in the SC group (p < 0.05), as well as better nutritional status (p = 0.007) and pain management (p = 0.003). Compared to the SC group, CEPC patients had significantly longer OS (20.4 vs. 24.6 months, p = 0.042; HR: 0.19; 95% CI: 0.04-0.85, p = 0.029). Conclusion With combined early palliative care, NSCLC patients lived longer, had better QoL, were psychologically stable, were in less pain, and were more nutritionally satisfied.
Collapse
Affiliation(s)
- Mengting Chen
- Department of Clinical Nutrition, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Huiqing Yu
- Department of Clinical Nutrition, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Liejun Yang
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Hong Yang
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Haoyang Cao
- Department of Clinical Nutrition, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Lei Lei
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Liling Ma
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Shihong Liu
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Ling Tian
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Sixiong Wang
- Department of Geriatric Oncology and Department of Palliative Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| |
Collapse
|
10
|
Braulke F, Para S, Alt-Epping B, Tewes M, Bäumer M, Haberland B, Mayer-Steinacker R, Hopprich A, de Wit M, Grabe M, Bender-Säbelkampf S, Weßling C, Aulmann C, Gerlach C, Regincos P, Fischer F, Haarmann S, Huys T, Drygas S, Rambau A, Kiani A, Schnabel A, Buhl C, Seipke S, Hiemer S, Polata S, Meßmann M, Hansmeier A, Anastasiadou L, Letsch A, Wecht D, Hellberg-Naegele M, Krug U, Wedding U, van Oorschot B. Systematic symptom screening in patients with advanced cancer treated in certified oncology centers: results of the prospective multicenter German KeSBa project. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04818-8. [PMID: 37145199 PMCID: PMC10374724 DOI: 10.1007/s00432-023-04818-8] [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: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Guidelines recommend a structured symptom screening (SC) for especially advanced cancer patients (CPs). The aim of this multicenter German prospective quality assurance project KeSBa (Kennzahl Symptom- und Belastungserfassung) was to gain knowledge on SC procedures in Oncology Centers (OCs) for advanced cancer patients and a first impression on the consequences of SC. METHODS The KeSBa project consisted of three phases: pilot, 3 months screening and feedback phase. Participating OCs decided to use either the Minimal Documentation System (MIDOS) or the Integrated Palliative care Outcome Scale (IPOS) and defined the cutoff values for positive screening results. RESULTS Out of 172 certified German OCs, 40 (23%) participated in the KeSBa pilot phase, 29 (16.8%) in the 3 months screening phase using MIDOS (n = 18, 58.6%) or IPOS (n = 11, 41.3%) and in the feedback round. 25/29 performed paper-based screening (86.2%). 2.963 CPs were screened. Results were documented for 1255 (42.2%, SC +) positive and 874 (29.5%, SC-) negative screenings depending on the center´s schedules: 452 SC + CPs (28.4%) and 42 SC- CPs (2.6%) had contact to specialized palliative care or other supportive specialist teams afterwards, 458 SC + CPs (28.8%) and 605 SC- CPs (38.1%) remained in standard oncology care. In the feedback round missing resources (personal and IT) and improved communication were mentioned most often. CONCLUSION Routine SC is feasible in advanced CPs treated in OCs but associated with considerable workload. In 42.2% of CPs SC was classified as positive, indicating the need of further diagnostics or professional judgment. SC requires staff and IT resources.
Collapse
Affiliation(s)
- Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Servet Para
- Interdisciplinary Center Palliative Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Bäumer
- Kliniken Maria Hilf GmbH Mönchengladbach, Mönchengladbach, Germany
| | | | | | - Anne Hopprich
- Department of Radiooncology and Radiotherapy, University Medical Center Mainz, Mainz, Germany
| | - Maike de Wit
- Cancer Center Berlin-Neukölln - Vivantes Klinikum Neukölln, Berlin, Germany
| | - Michaela Grabe
- Cancer Center Rems-Murr-Hospital Winnenden, Winnenden, Germany
| | | | | | | | - Christina Gerlach
- Department of Palliative Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Pascale Regincos
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Soraya Haarmann
- Kliniken Heilbronn GmbH, Fachklinik Löwenstein, Löwenstein, Germany
| | | | - Sabine Drygas
- Brüderkrankenhaus St. Josef Paderborn, Paderborn, Germany
| | - Anett Rambau
- Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Alexander Kiani
- Klinikum Bayreuth GmbH, and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | | | - Christoph Buhl
- Department of Oncology, Hematology, Palliative Medicine, Special Pain Therapy, Hospital Leverkusen, Leverkusen, Germany
| | - Stefanie Seipke
- Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | | | - Silke Polata
- Evangelisches Waldkrankenhaus Berlin-Spandau, Berlin, Germany
| | - Maximilian Meßmann
- Department of Palliative Medicine, Hospital St. Elisabeth Straubing GmbH, Straubing, Germany
| | | | | | - Anne Letsch
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Daniel Wecht
- Specialist Care in Oncology and Palliative Care, University Hospital Gießen and Marburg, Marburg, Germany
| | | | - Utz Krug
- Department of Oncology, Hematology, Palliative Medicine, Special Pain Therapy, Hospital Leverkusen, Leverkusen, Germany
| | - Ulrich Wedding
- Department of Palliative Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Birgitt van Oorschot
- Interdisciplinary Center Palliative Medicine, University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
11
|
Motlana MKTN, Makhunga SE, Jafta N, Ginindza TG. Quality measures for palliative care in patients living with cancer in low- and middle-income countries: a scoping review protocol. Syst Rev 2023; 12:77. [PMID: 37143159 PMCID: PMC10157897 DOI: 10.1186/s13643-023-02237-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/14/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Quality assessment is a critical component of determining the value of medical services, including palliative care. The utilisation of palliative care quality measures could assist in assessing the degree to which patients living with cancer conform to best practice of palliative care, identifying gaps and monitoring changes in cancer care delivery models in different setting. This scoping review aims to map the available data on the usage of palliative care quality indicators that are relevant to cancer patients in low- and middle-income countries (LMICs). METHODS To structure this study, we will use the framework developed by Arksey and O'Malley, the Levac et al. recommendations and the Joanna Briggs Institute recommendations. We will search EBSCOHost, Web of Science, ProQuest One Academic, MEDLINE and Google Scholar for evidence on palliative care quality measures applicable for patients living with cancer published from inception till 2022. We will search grey literature in the form of dissertations, conference proceedings and websites of international organisations such as the World Health Organisation (WHO) reporting palliative care quality measures applicable to patients living with cancer in LMICs. DISCUSSION The purpose of this study is to establish the extent of existing research on the palliative care quality measures in LMICs. Although palliative care is still a new phenomenon, understanding of the palliative care quality measures applicable for cancer patients will assist to improve care across all components of health systems. ETHICS AND DISSEMINATION No ethical approval is required for the study as the data collection and results of the proposed scoping review will be conducted and disseminated electronically using peer-reviewed journals, print and presentations at scientific conferences and stakeholder presentations.
Collapse
Affiliation(s)
- M K T N Motlana
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001, South Africa.
| | - S E Makhunga
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001, South Africa
| | - N Jafta
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - T G Ginindza
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001, South Africa
| |
Collapse
|
12
|
Bückmann A, Bernhardt F, Eveslage M, Storck M, Thölking G, Buss H, Domagk D, Juhra C, Lenz P. Telemedical Consultations in Palliative Care: Benefits through Knowledge Exchange and Intercollegiate Collaboration-Findings from the German oVID Project. Cancers (Basel) 2023; 15:cancers15092512. [PMID: 37173978 PMCID: PMC10177576 DOI: 10.3390/cancers15092512] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: As the number of people receiving specialized palliative care (PC) continues to rise, there is a need to ensure the transfer of this expertise from university-based PC departments to primary care hospitals without such in-house access. The present study examines the potential of telemedicine to bridge these gaps. (2) Methods: This is a prospective multi-center feasibility trial. All physicians were appropriately pre-equipped and instructed to conduct telemedical consultations (TCs), which took place within fixed meetings or on-call appointments either related or unrelated to individual patients (allowing TCs also for educational and knowledge exchange purposes). (3) Results: An inquiry for participation was submitted to 11 hospitals, with 5 external hospitals actively cooperating. In the first study section, a total of 57 patient cases were included within 95 patient-related TCs during 80 meetings. Other university disciplines were involved in 21 meetings (26.2%). Therapy adjustments resulted following 25 of 71 affected TCs (35.2%). In 20 cases (21.1%), an on-site consultation at the university hospital was avoided, and in 12 cases (12.6%), a transfer was avoided. Overall, TCs were considered helpful in resolving issues for 97.9% of the cases (n = 93). Yet, technical problems arose in about one-third of all meetings for at least one physician (36.2%; n = 29). Besides, in the second study section, we also conducted 43 meetings between physicians for education and knowledge exchange only. (4) Conclusions: Telemedicine has the potential to transfer university expertise to external hospitals through simple means. It improves collaboration among physicians, may prevent unnecessary transfers or outpatient presentations, and is thus likely to lower costs.
Collapse
Affiliation(s)
- Andreas Bückmann
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| | - Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Muenster, 48149 Muenster, Germany
| | - Gerold Thölking
- Department of Internal Medicine and Nephrology, University Hospital Muenster Marienhospital Steinfurt, 48565 Steinfurt, Germany
| | - Helga Buss
- Department of Geriatrics, EVK Muenster Alexianer Johannisstift GmbH, 48147 Muenster, Germany
| | - Dirk Domagk
- Department of Medicine I: Internal Medicine and Gastroenterology, Josephs-Hospital Warendorf, Academic Teaching Hospital of the University of Muenster, 48231 Warendorf, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Muenster, 48149 Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| |
Collapse
|
13
|
Ghoshal A, Joad AK, Spruijt O, Nair S, Rajagopal MR, Patel F, Damani A, Deodhar J, Goswami D, Joshi G, Butola S, Singh C, Rao SR, Bhatwadekar M, Muckaden MA, Bhatnagar S. Situational analysis of the quality of palliative care services across India: a cross-sectional survey. Ecancermedicalscience 2022; 16:1486. [PMID: 36819806 PMCID: PMC9934966 DOI: 10.3332/ecancer.2022.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Palliative care services in India were established in the 1980s but there is no detailed up-to-date knowledge about the quality-of-service provision nationally. We aim to describe the current quality of palliative care provision in India, as measured against nationally adopted standards. Method A digital survey adapted from the Indian Association of Palliative Care Standards Audit Tool was administered to 250 palliative care centres. Results Two hundred and twenty-three (89%) palliative care centres participated - 26.4% were government-run, while the rest include non-governmental organisations, private hospitals, community-led initiatives and hospices. About 200 centres 'often' or 'always' fulfilled 16/21 desirable criteria; however, only 2/15 essential criteria were 'often' or 'always' fulfilled. Only 5.8% provide uninterrupted access to oral morphine. Significance of the results Palliative care centres in India are falling short of meeting the essential quality standards, indicating the urgent need for new initiatives to drive national change.
Collapse
Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anjum Khan Joad
- Department of Anaesthesia and Palliative Care Medicine, Bhagwan Mahaveer Cancer Hospital and Research Center, Jaipur 302017, India
| | - Odette Spruijt
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Shobha Nair
- Department of Palliative Medicine, Amrita Hospital, Kochi 682041, India
| | - MR Rajagopal
- Trivandrum Institute of Palliative Sciences and Pallium India, Aisha Memorial Hospital Building, Paruthikuzhy, Thiruvananthapuram 695009, India
| | - Firuza Patel
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Dinesh Goswami
- Guwahati Pain and Palliative Care Society, Uzan Bazar, Guwahati, Assam 781001, India
| | - Geeta Joshi
- Community Oncology Center, Gujarat Cancer Society, Ahmedabad 380007, India
| | - Savita Butola
- Border Security Force Sector Hospital, Panisagar, Tripura 799260, India
| | - Charu Singh
- Department of Palliative Medicine, Amrita Hospital, Kochi 682041, India
| | | | | | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|
14
|
Brunelli C, Zecca E, Pigni A, Bracchi P, Caputo M, Lo Dico S, Fusetti V, Tallarita A, Bergamini C, Brambilla M, Raimondi A, Niger M, Provenzano S, Sepe P, Alfieri S, Tinè G, De Braud F, Caraceni AT. Outpatient palliative care referral system (PCRS) for patients with advanced cancer: an impact evaluation protocol. BMJ Open 2022; 12:e059410. [PMID: 36307164 PMCID: PMC9621186 DOI: 10.1136/bmjopen-2021-059410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Early palliative care (PC) in the clinical pathway of advanced cancer patients improves symptom control, quality of life and has a positive impact on overall quality of care. At present, standardised criteria for appropriate referral for early PC in oncology care are lacking. The aim of this project is to develop a set of standardised referral criteria and procedures to implement appropriate early PC for advanced cancer patients (the palliative care referral system, PCRS) and test its impact on user perception of quality of care received, on patient quality of life and on the use of healthcare resources. SETTING Selected oncology clinics and PC outpatient clinic. METHODS AND ANALYSIS A scoping literature review and an expert consultation through a nominal group technique will be used to revise existing referral tools and to develop a new one, the PCRS. 25 patients will be enrolled in a pilot study to assess feasibility of the implementation of PCRS; 10 interviews with patients and healthcare professionals will be carried out to evaluate applicability.A pretest-post-test quasiexperimental study involving 150 patients before implementation of the PCRS and 150 patients after implementation will be carried out.Patient satisfaction with care received, quality of life and use of resources, and caregiver satisfaction with care will also be assessed to explore the impact of the intervention. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by the Institutional Review board of the Fondazione IRCCS Istituto Nazionale Tumori; approval reference INT201/19.Results will be disseminated through open access publications and through scientific communication presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT04936568.
Collapse
Affiliation(s)
- Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ernesto Zecca
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandra Pigni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paola Bracchi
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mariangela Caputo
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Silvia Lo Dico
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Viviana Fusetti
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Università degli Studi di Roma Tor Vergata, Roma, Lazio, Italy
| | - Antonino Tallarita
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cristiana Bergamini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marta Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandra Raimondi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Salvatore Provenzano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Pierangela Sepe
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sara Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Gabriele Tinè
- Unit of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo De Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Università degli Studi di Milano, Milano, Italy
| | - Augusto Tommaso Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
15
|
Masukawa K, Aoyama M, Yokota S, Nakamura J, Ishida R, Nakayama M, Miyashita M. Machine learning models to detect social distress, spiritual pain, and severe physical psychological symptoms in terminally ill patients with cancer from unstructured text data in electronic medical records. Palliat Med 2022; 36:1207-1216. [PMID: 35773973 DOI: 10.1177/02692163221105595] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Few studies have developed automatic systems for identifying social distress, spiritual pain, and severe physical and phycological symptoms from text data in electronic medical records. AIM To develop models to detect social distress, spiritual pain, and severe physical and psychological symptoms in terminally ill patients with cancer from unstructured text data contained in electronic medical records. DESIGN A retrospective study of 1,554,736 narrative clinical records was analyzed 1 month before patients died. Supervised machine learning models were trained to detect comprehensive symptoms, and the performance of the models was tested using the area under the receiver operating characteristic curve (AUROC) and precision recall curve (AUPRC). SETTING/PARTICIPANTS A total of 808 patients was included in the study using records obtained from a university hospital in Japan between January 1, 2018 and December 31, 2019. As training data, we used medical records labeled for detecting social distress (n = 10,000) and spiritual pain (n = 10,000), and records that could be combined with the Support Team Assessment Schedule (based on date) for detecting severe physical/psychological symptoms (n = 5409). RESULTS Machine learning models for detecting social distress had AUROC and AUPRC values of 0.98 and 0.61, respectively; values for spiritual pain, were 0.90 and 0.58, respectively. The machine learning models accurately identified severe symptoms (pain, dyspnea, nausea, insomnia, and anxiety) with a high level of discrimination (AUROC > 0.8). CONCLUSION The machine learning models could detect social distress, spiritual pain, and severe symptoms in terminally ill patients with cancer from text data contained in electronic medical records.
Collapse
Affiliation(s)
- Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shinichiroh Yokota
- Faculty of Medicine, The University of Tokyo, Hongo, Tokyo, Japan.,Department of Healthcare Information Management, The University of Tokyo Hospital, Hongo, Tokyo, Japan
| | - Jyunya Nakamura
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ryoka Ishida
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| |
Collapse
|
16
|
Hahn W, Schütte K, Schultz K, Wolkenhauer O, Sedlmayr M, Schuler U, Eichler M, Bej S, Wolfien M. Contribution of Synthetic Data Generation towards an Improved Patient Stratification in Palliative Care. J Pers Med 2022; 12:1278. [PMID: 36013227 PMCID: PMC9409663 DOI: 10.3390/jpm12081278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
AI model development for synthetic data generation to improve Machine Learning (ML) methodologies is an integral part of research in Computer Science and is currently being transferred to related medical fields, such as Systems Medicine and Medical Informatics. In general, the idea of personalized decision-making support based on patient data has driven the motivation of researchers in the medical domain for more than a decade, but the overall sparsity and scarcity of data are still major limitations. This is in contrast to currently applied technology that allows us to generate and analyze patient data in diverse forms, such as tabular data on health records, medical images, genomics data, or even audio and video. One solution arising to overcome these data limitations in relation to medical records is the synthetic generation of tabular data based on real world data. Consequently, ML-assisted decision-support can be interpreted more conveniently, using more relevant patient data at hand. At a methodological level, several state-of-the-art ML algorithms generate and derive decisions from such data. However, there remain key issues that hinder a broad practical implementation in real-life clinical settings. In this review, we will give for the first time insights towards current perspectives and potential impacts of using synthetic data generation in palliative care screening because it is a challenging prime example of highly individualized, sparsely available patient information. Taken together, the reader will obtain initial starting points and suitable solutions relevant for generating and using synthetic data for ML-based screenings in palliative care and beyond.
Collapse
Affiliation(s)
- Waldemar Hahn
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Katharina Schütte
- University Palliative Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Kristian Schultz
- Department of Systems Biology and Bioinformatics, University of Rostock, Universitätsplatz 1, 18051 Rostock, Germany
| | - Olaf Wolkenhauer
- Department of Systems Biology and Bioinformatics, University of Rostock, Universitätsplatz 1, 18051 Rostock, Germany
- Leibniz-Institute for Food Systems Biology, Technical University Munich, 85354 Freising, Germany
- Stellenbosch Institute of Advanced Study, Wallenberg Research Centre, Stellenbosch University, Stellenbosch 7602, South Africa
| | - Martin Sedlmayr
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ulrich Schuler
- University Palliative Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Martin Eichler
- National Center for Tumor Diseases Dresden (NCT/UCC), Fetscherstraße 74, 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Bautzner Landstraße 400, 01328 Dresden, Germany
| | - Saptarshi Bej
- Department of Systems Biology and Bioinformatics, University of Rostock, Universitätsplatz 1, 18051 Rostock, Germany
- Leibniz-Institute for Food Systems Biology, Technical University Munich, 85354 Freising, Germany
| | - Markus Wolfien
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| |
Collapse
|
17
|
Evolution of Oncology and Palliative Nursing in Meeting the Changing Landscape of Cancer Care. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3831705. [PMID: 35469226 PMCID: PMC9034913 DOI: 10.1155/2022/3831705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
Nursing is a vital health profession. In almost all clinical and hospital settings, nurses offer primary palliative care. Nurses are recognized for their strong philosophy of care for a wide spectrum of disorders. No matter the sickness, condition, or clinical situation, palliative care is considered essential in nursing practice. Palliative care nursing is the provision of palliative care services to cancer patients and their families, regardless of whether cancer can be cured or not. A large body of evidence shows that early palliative care nursing integration improves the quality of life and survival of cancer patients. Due to the intricacy of cancer, the landscape of cancer care is shifting. Cancer is a life-threatening disease with a high mortality rate. Oncology nurses' skills and experience are vital in providing specialized patient care and fulfilling the needs of patients and their families. The current study examines the shifting environment of palliative care nursing in oncology. However, new palliative care nursing approaches are required to adapt to the evolving cancer scenario.
Collapse
|
18
|
Ellsworth BL, Metz AK, Mott NM, Kazemi R, Stover M, Hughes T, Dossett LA. Review of Cancer-Specific Quality Measures Promoting the Avoidance of Low-Value Care. Ann Surg Oncol 2022; 29:3750-3762. [DOI: 10.1245/s10434-021-11303-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/18/2021] [Indexed: 12/28/2022]
|
19
|
Saravia A, Kong KA, Roy R, Barry R, Guidry C, McDaniel LS, Raven MC, Pou AM, Mays AC. Referral Patterns of Outpatient Palliative Care among the Head and Neck Cancer Population. Int Arch Otorhinolaryngol 2022; 26:e538-e547. [DOI: 10.1055/s-0041-1741436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Patients with head and neck cancer (HNC) experience unique physical and psychosocial challenges that impact their health and quality of life. Early implementation of palliative care has been shown to improve various health care outcomes.
Objective The aim of the present study was to evaluate the patterns of referral of patients with HNC to outpatient palliative care as they relate to utilization of resources and end-of-life discussions.
Methods We performed a retrospective review of 245 patients with HNC referred to outpatient palliative care services at two Louisiana tertiary care centers from June 1, 2014, to October 1, 2019. The control group consisted of those that were referred but did not follow-up. Reasons for referral were obtained, and outcome measures such as emergency department (ED) visits, hospital readmissions, and advance care planning (ACP) documentation were assessed according to predictive variables.
Results There were 177 patients in the treatment group and 68 in the control group. Patients were more likely to follow up to outpatient palliative care services if referred for pain management. Hospital system, prior inpatient palliative care, and number of outpatient visits were associated with an increased likelihood for ED visits and hospital readmissions. Those in the palliative care treatment group were also more likely to have ACP discussions.
Conclusion Early implementation of outpatient palliative care among patients with HNC can initiate ACP discussions. However, there are discrepancies in referral reasons to palliative care and continued existing barriers to its effective utilization.
Collapse
Affiliation(s)
- Ari Saravia
- Louisiana State University School of Medicine, New Orleans, Louisiana, United States
| | - Keonho Albert Kong
- Department of Otolaryngology, University of North Carolina-Chapel Hill , Chapel Hill, North Carolina USA
| | - Ryan Roy
- Louisiana State University School of Medicine, New Orleans, Louisiana, United States
| | - Rachel Barry
- Barry Ear Nose and Throat. 4212 W Congress St, Suite 1500, Lafayette, Louisiana, USA
| | - Christine Guidry
- Department of Palliative Medicine, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States
| | - Lee S. McDaniel
- Department of Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
| | - Mary C. Raven
- Department of Palliative Medicine, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States
| | - Anna M. Pou
- Oschner Health System, New Orleans, Louisiana, USA
| | - Ashley C. Mays
- Department of Otolaryngology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
| |
Collapse
|
20
|
Kutluk T, Ahmed F, Cemaloğlu M, Aydın B, Şengelen M, Kirazli M, Yurduşen S, Sullivan R, Harding R. Progress in palliative care for cancer in Turkey: a review of the literature. Ecancermedicalscience 2021; 15:1321. [PMID: 35047072 PMCID: PMC8723752 DOI: 10.3332/ecancer.2021.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The demographic transition in Turkey is shifting the burden of diseases towards non-communicable diseases including cancer. Palliative care (PC) as a component of Universal Health Coverage assures patient and family-centred care provision throughout the spectrum of cancer. OBJECTIVES This study aimed to make a detailed evaluation of the progress achieved since the mid-90s and the current situation of cancer PC in Turkey. METHODS A literature review was conducted in PubMed, Scopus, Embase, ScienceDirect, Web of Science, Google Scholar, The Turkish Academic Network and Information Centre databases, Ministry of Health documents, Council of Higher Education's thesis 01/1995 to 07/2020. The information was categorised into the six domains: history of the cancer PC; law and regulations; education and research; opioid use; patient care and palliative centres; public awareness, psychosocial support and end of life ethics. RESULTS Of 27,489 studies, 331 met the inclusion criteria. The majority were published in the Turkish language and were journal articles. The findings showed that the development of PC in Turkey can be divided into three stages: early initiatives before 2000, the dissemination stage, 2000-2010 and the advanced stage after 2010. There is evidence of progress in terms of legal regulations, opioid use and number of PC services and research output. However, there is still a need for improvement in professional education, public awareness and end of life care. CONCLUSION There is evidence of progress, barriers and opportunities. However, bringing research into practice is needed for scale-up and integration of PC in cancer care in Turkey.
Collapse
Affiliation(s)
- Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Fahad Ahmed
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Mustafa Cemaloğlu
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Burça Aydın
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Meltem Şengelen
- Department of Public Health, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
| | - Meral Kirazli
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Sema Yurduşen
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Richard Sullivan
- King’s College London, Institute of Cancer Policy, Conflict & Health Research Group, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
| |
Collapse
|
21
|
Patil VM, Singhai P, Noronha V, Bhattacharjee A, Deodhar J, Salins N, Joshi A, Menon NS, Abhyankar A, Khake A, Dhumal SB, Tambe R, Muckaden MA, Prabhash K. Effect of Early Palliative Care on Quality of Life of Advanced Head and Neck Cancer Patients: A Phase III Trial. J Natl Cancer Inst 2021; 113:1228-1237. [PMID: 33606023 DOI: 10.1093/jnci/djab020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/30/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Early palliative care (EPC) is an important aspect of cancer management but, to our knowledge, has never been evaluated in patients with head and neck cancer. Hence, we performed this study to determine whether the addition of EPC to standard therapy leads to an improvement in the quality of life (QOL), decrease in symptom burden, and improvement in overall survival. METHODS Adult patients with squamous cell carcinoma of the head and neck region planned for palliative systemic therapy were allocated 1:1 to either standard systemic therapy without or with comprehensive EPC service referral. Patients were administered the revised Edmonton Symptom Assessment Scale and the Functional Assessment of Cancer Therapy for head and neck cancer (FACT-H&N) questionnaire at baseline and every 1 month thereafter for 3 months. The primary endpoint was a change in the QOL measured at 3 months after random assignment. All statistical tests were 2-sided. RESULTS Ninety patients were randomly assigned to each arm. There was no statistical difference in the change in the FACT-H&N total score (P = .94), FACT-H&N Trial Outcome Index (P = .95), FACT-general total (P = .84), and Edmonton Symptom Assessment Scale scores at 3 months between the 2 arms. The median overall survival was similar between the 2 arms (hazard ratio for death = 1.01, 95% confidence interval = 0.74 to 1.35). There were 5 in-hospital deaths in both arms (5.6% for both, P = .99). CONCLUSIONS In this phase III study, the integration of EPC in head and neck cancer patients did not lead to an improvement in the QOL or survival.
Collapse
Affiliation(s)
- Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pankaj Singhai
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Naveen Salins
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nandini Sharrel Menon
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anuja Abhyankar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwini Khake
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sachin Babanrao Dhumal
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rupali Tambe
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| |
Collapse
|
22
|
Yang GM, Zhou S, Xu Z, Goh SS, Zhu X, Chong DQ, Tan DS, Kanesvaran R, Yee AC, Neo PS, Cheung YB. Comparing the effect of a consult model versus an integrated palliative care and medical oncology co-rounding model on health care utilization in an acute hospital - an open-label stepped-wedge cluster-randomized trial. Palliat Med 2021; 35:1578-1589. [PMID: 34524044 DOI: 10.1177/02692163211022957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The benefit of specialist palliative care for cancer inpatients is established, but the best method to deliver specialist palliative care is unknown. AIM To compare a consult model versus a co-rounding model; both provide the same content of specialist palliative care to individual patients but differ in the level of integration between palliative care and oncology clinicians. DESIGN An open-label, cluster-randomized trial with stepped-wedge design. The primary outcome was hospital length of stay; secondary outcomes were 30-day readmissions and access to specialist palliative care. ClinicalTrials.gov number NCT03330509. SETTING/PARTICIPANTS Cancer patients admitted to the oncology inpatient service of an acute hospital in Singapore. RESULTS A total of 5681 admissions from December 2017 to July 2019 were included, of which 5295 involved stage 3-4 cancer and 1221 received specialist palliative care review. Admissions in the co-rounding model had a shorter hospital length of stay than those in the consult model by 0.70 days (95%CI -0.04 to 1.45, p = 0.065) for all admissions. In the sub-group of stage 3-4 cancer patients, the length of stay was 0.85 days shorter (95%CI 0.05-1.65, p = 0.038). In the sub-group of admissions that received specialist palliative care review, the length of stay was 2.62 days shorter (95%CI 0.63-4.61, p = 0.010). Hospital readmission within 30 days (OR1.03, 95%CI 0.79-1.35, p = 0.822) and access to specialist palliative care (OR1.19, 95%CI 0.90-1.58, p = 0.215) were similar between the consult and co-rounding models. CONCLUSIONS The co-rounding model was associated with a shorter hospital length of stay. Readmissions within 30 days and access to specialist palliative care were similar.
Collapse
Affiliation(s)
- Grace M Yang
- National Cancer Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Sengkang General Hospital, Singapore
| | - Siqin Zhou
- National Cancer Centre Singapore, Singapore
| | - Zhizhen Xu
- National Cancer Centre Singapore, Singapore
| | | | - Xia Zhu
- National Cancer Centre Singapore, Singapore
| | | | | | | | | | | | - Yin-Bun Cheung
- Duke-NUS Medical School, Singapore.,Tampere University, Finland
| |
Collapse
|
23
|
Puchalski C, Ferrell BR, Borneman T, DiFrances Remein C, Haythorn T, Jacobs C. Implementing quality improvement efforts in spiritual care: outcomes from the interprofessional spiritual care education curriculum. J Health Care Chaplain 2021; 28:431-442. [PMID: 34396929 DOI: 10.1080/08854726.2021.1917168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Interprofessional Spiritual Care Curriculum (ISPEC) was created to train interdisciplinary health care teams to recognize and address the spiritual needs of seriously or chronically ill patients. The curriculum, in a train-the-trainer format, employs didactic presentations, discussions, lab sessions, skill demonstrations, and video clips. In course applications, participants were required to submit goals to achieve and demonstrate institutional support. For the first ISPEC course, in July 2018, 48 clinician-chaplain teams attended. Following the 2½ day course, participants had access to online training modules for 1-year, ISPEC faculty mentoring support, and regular conference calls on goal implementation progress. Participants reported recognizing the importance of providing spiritual care and a new understanding of how collaborating as interprofessional teams enabled them to integrate this care into their home institution settings. In a mixed-methods evaluation survey completed 12 months after the ISPEC course, participants reported on the percentage of their goals completed, number and types of professionals they had educated in spiritual care, and personal confidence regarding spiritual care leadership skills. This data can serve as a model to guide other organizations striving to improve spiritual care, practiced collaboratively by clinicians and chaplains, as an essential aspect of overall QI efforts in palliative care.
Collapse
Affiliation(s)
- Christina Puchalski
- George Washington Institute for Spirituality and Health (GWish), Washington, DC, USA
| | - Betty R Ferrell
- Department of Nursing Research and Education, City of Hope Medical Center, Duarte, CA, USA
| | - Tami Borneman
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Medical Center, Duarte, CA, USA
| | | | - Trace Haythorn
- Association for Clinical Pastoral Education (ACPE), Atlanta, GA, USA
| | - Carolyn Jacobs
- Smith College School for Social Work, Northampton, MA, USA
| |
Collapse
|
24
|
Frasca M, Orazio S, Amadeo B, Sabathe C, Berteaud E, Galvin A, Burucoa B, Coureau G, Baldi I, Monnereau A, Mathoulin-Pelissier S. Palliative care referral in cancer patients with regard to initial cancer prognosis: a population-based study. Public Health 2021; 195:24-31. [PMID: 34034002 DOI: 10.1016/j.puhe.2021.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/23/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES More than half of cancer patients require palliative care; however, inequality in access and late referral in the illness trajectory are major issues. This study assessed the cumulative incidence of first hospital-based palliative care (HPC) referral, as well as the influence of patient-, tumor-, and care-related factors. STUDY DESIGN This is a retrospective population-based study. METHODS The study included patients from the 2014 population-based cancer registry of Gironde, France. International Classification of Diseases, Tenth Revision, coding for palliative care identified HPC referrals from 2014 to 2018. The study included 8424 patients. Analyses considered the competing risk of death and were stratified by initial cancer prognosis (favorable vs unfavorable [if metastatic or progressive cancer]). RESULTS The 4-year incidence of HPC was 16.7% (95% confidence interval, 16.6-16.8). Lung cancer led to more referrals, whereas breast, colorectal, and prostatic locations were associated to less frequent HPC compared with other solid tumors. Favorable prognosis central nervous system tumors and unfavorable prognosis hematological malignancies also showed less HPC. The incidence of HPC was higher in tertiary centers, particularly for older patients. In the favorable prognosis subgroup, older and non-deprived patients received more HPC. In the unfavorable prognosis subgroup, the incidence of HPC was lower in patients who lived in rural areas than those who lived in urban areas. CONCLUSIONS One-sixth of cancer patients require HPC. Some factors influencing referral depend on the initial cancer prognosis. Our findings support actions to improve accessibility, especially for deprived patients, people living in rural areas, those with hematological malignancies, and those treated outside tertiary centers. In addition, consideration of age as factor of HPC may allow for improved design of the referral system.
Collapse
Affiliation(s)
- Matthieu Frasca
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France; Department of Palliative Medicine, CHU Bordeaux, 33000, Bordeaux, France.
| | - Sébastien Orazio
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Brice Amadeo
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Camille Sabathe
- Biostatistic team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Biostatistic Team, UMR 1219, 33000, Bordeaux, France
| | - Emilie Berteaud
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Angeline Galvin
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Benoît Burucoa
- Department of Palliative Medicine, CHU Bordeaux, 33000, Bordeaux, France
| | - Gaelle Coureau
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Isabelle Baldi
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Alain Monnereau
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Simone Mathoulin-Pelissier
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France; Unité d'épidémiologie et de recherche cliniques, Institut Bergonié, 33000, Bordeaux, France
| |
Collapse
|
25
|
Bogetz JF, Rosenberg AR. Adults are just big children: What we can learn about quality end-of-life care from pediatrics. Cancer 2021; 127:2393-2396. [PMID: 33784414 DOI: 10.1002/cncr.33548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Jori F Bogetz
- Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington
| | - Abby R Rosenberg
- Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington
| |
Collapse
|
26
|
Yoon SJ. Barriers to Early Palliative Care. HAN'GUK HOSUP'ISU WANHWA UIRYO HAKHOE CHI = THE KOREAN JOURNAL OF HOSPICE AND PALLIATIVE CARE 2020; 23:252-255. [PMID: 37497469 PMCID: PMC10332725 DOI: 10.14475/kjhpc.2020.23.4.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 07/28/2023]
Abstract
This article aims to discuss the barriers hindering cancer patients from receiving early palliative care, which has been demonstrated to be more effective in improving quality of life and controlling symptoms. Specifically, there are barriers in four aspects of delivering early palliative care. First, the difficulty of starting discussions about early palliative care and the lack of adequate appointment time can impede communication between oncologists and patients and their family members. Second, determining the timing of referral and deciding upon and applying a standard for referral can be barriers in the process of referral from oncology to palliative care. Third, palliative care patients and their family members can face difficulties regarding in what format and by whom the services will be delivered. Fourth, biases, misinformation, and inaccurate beliefs can be barriers in the process of patients and their family members accepting care. In order to facilitate early palliative care, research and policy regarding these barriers are necessary, along with efforts made by medical staff.
Collapse
Affiliation(s)
- Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| |
Collapse
|
27
|
Virdun C, Luckett T, Davidson PM, Phillips J. Strengthening palliative care in the hospital setting: a codesign study. BMJ Support Palliat Care 2020:bmjspcare-2020-002645. [PMID: 33115832 DOI: 10.1136/bmjspcare-2020-002645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify actions required to strengthen the delivery of person and family centred hospital-based palliative care so that it addressed the domains of care identified as important for inpatients with palliative care needs and their families. METHODS A codesign study involving a workshop with palliative care and acute hospital policy, consumer and clinical representatives in Australia. A modified nominal group process generated a series of actions, which were thematically analysed and refined, before being circulated to participants to gain consensus. RESULTS More than half (n=30, 58%) of the invited representatives (n=52) participated in the codesign process. Nine actions were identified as required to strengthen inpatient palliative care provision being: (a) evidence-informed practice and national benchmarking; (b) funding reforms; (c) securing executive level support; (d) mandatory clinical and ancillary education; (e) fostering greater community awareness; (f) policy reviews of care of the dying; (g) better integration of advance care planning; (h) strengthen nursing leadership; and (i) develop communities of practice for improving palliative care. CONCLUSIONS Changes to policy, practice, education and further research are required to optimise palliative care within hospital settings, in accordance with the domains inpatients with palliative care needs and their families consider to be important. Achieving these changes will require a whole of sector approach and significant national and jurisdictional leadership.
Collapse
Affiliation(s)
- Claudia Virdun
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Patricia M Davidson
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jane Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
28
|
Frasca M, Galvin A, Raherison C, Soubeyran P, Burucoa B, Bellera C, Mathoulin-Pelissier S. Palliative versus hospice care in patients with cancer: a systematic review. BMJ Support Palliat Care 2020; 11:188-199. [PMID: 32680891 DOI: 10.1136/bmjspcare-2020-002195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Guidelines recommend an early access to specialised palliative medicine services for patients with cancer, but studies have reported a continued underuse. Palliative care facilities deliver early care, alongside antineoplastic treatments, whereas hospice care structures intervene lately, when cancer-modifying treatments stop. AIM This review identified factors associated with early and late interventions of specialised services, by considering the type of structures studied (palliative vs hospice care). DESIGN We performed a systematic review, prospectively registered on PROSPERO (ID: CRD42018110063). DATA SOURCES We searched Medline and Scopus databases for population-based studies. Two independent reviewers extracted the data and assessed the study quality using Joanna Briggs Institute critical appraisal checklists. RESULTS The 51 included articles performed 67 analyses. Most were based on retrospective cohorts and US populations. The median quality scores were 19/22 for cohorts and 15/16 for cross-sectional studies. Most analyses focused on hospice care (n=37). Older patients, men, people with haematological cancer or treated in small centres had less specialised interventions. Palliative and hospice facilities addressed different populations. Older patients received less palliative care but more hospice care. Patients with high-stage tumours had more palliative care while women and patients with a low comorbidity burden received more hospice care. CONCLUSION Main disparities concerned older patients, men and people with haematological cancer. We highlighted the challenges of early interventions for older patients and of late deliveries for men and highly comorbid patients. Additional data on non-American populations, outpatients and factors related to quality of life and socioeconomic status are needed.
Collapse
Affiliation(s)
- Matthieu Frasca
- Department of Palliative Medicine, CHU of Bordeaux, Bordeaux, Aquitaine, France .,Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Angeline Galvin
- Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Chantal Raherison
- Department of Pneumology, CHU of Bordeaux, Bordeaux, Aquitaine, France
| | - Pierre Soubeyran
- CIC1401, Bergonie institute, Comprehensive Cancer Center, Bordeaux, Aquitaine, France.,UMR 1218, ACTION, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Benoît Burucoa
- Department of Palliative Medicine, CHU of Bordeaux, Bordeaux, Aquitaine, France
| | - Carine Bellera
- Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France.,CIC1401, Bergonie institute, Comprehensive Cancer Center, Bordeaux, Aquitaine, France
| | - Simone Mathoulin-Pelissier
- Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France.,UMR 1218, ACTION, University of Bordeaux, Bordeaux, Aquitaine, France
| |
Collapse
|
29
|
Damani A, Salins N, Ghoshal A, Chowdhury J, Muckaden MA, Deodhar J, Pramesh CS. Provision of palliative care in National Cancer Grid treatment centres in India: a cross-sectional gap analysis survey. BMJ Support Palliat Care 2020; 12:bmjspcare-2019-002152. [PMID: 32518130 DOI: 10.1136/bmjspcare-2019-002152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to identify gaps in palliative care (PC) provision across the National Cancer Grid (NCG) centres in India. METHODS We performed a cross-sectional validated web-based survey on 102 NCG cancer centres (Nov '17 to April '18). The survey questionnaire had seven sections collecting data relating to the capacity to provide cancer care and PC, drug availability for pain and symptom control, education, advocacy, and quality assurance activities for PC. RESULTS Eighty-nine NCG centres responded for this study-72.5% of centres had doctors with generalist PC training, whereas 34.1% of centres had full-time PC physicians; 53.8% had nurses with 6 weeks of PC training; 68.1% of the centres have an outpatient PC and 66.3% have the facility to provide inpatient PC; 38.5% of centres offer home-based PC services; 44% of the centres make a hospice referral and 68.1% of the centres offer concurrent cancer therapy alongside PC. Among the centres, 84.3% have a licence to procure, store and dispense opioids, but only 77.5% have an uninterrupted supply of oral morphine for patients; 61.5% centres have no dedicated funds for PC, 23.1% centres have no support from hospital administration, staff shortage-69.2% have no social workers, 60.4% have no counsellors and 76.9% have no volunteers. Although end-of-life care is recognised, there is a lack of institutional policy. Very few centres take part in quality control measures. CONCLUSIONS The majority of the NCG centres have the facilities to provide PC but suffer from poor implementation of existing policies, funding and human resources.
Collapse
Affiliation(s)
- Anuja Damani
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - C S Pramesh
- Director (Tata Memorial Hospital), Professor of Thoracic Surgery (Surgical Oncology), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| |
Collapse
|
30
|
Temel JS, Jacobsen PB. Palliative Care in Oncology: Continuing to Build the Evidence Base and Disseminate Effective Care Models. J Clin Oncol 2020; 38:849-851. [PMID: 32023160 DOI: 10.1200/jco.19.01069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|