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Crowley F, Sheppard R, Lehrman S, Easton E, Marron TU, Doroshow D, Afezolli D. Optimizing care in early phase cancer trials: The role of palliative care. Cancer Treat Rev 2024; 128:102767. [PMID: 38776612 DOI: 10.1016/j.ctrv.2024.102767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
Advancements in cancer treatment have led to improved survival rates, with early phase clinical trials (EPCTs) serving as important initial steps in evaluating novel therapies. Recent studies have shown that response rates in these trials have doubled in the last twenty years. Patients who enroll on EPCTs have advanced cancer and heightened symptomatology yet maintain a robust performance status that qualifies them for clinical trial participation. It is well established that many of these patients have needs that can be addressed by palliative care, including symptom management, value assessments, advance care planning, and psychosocial and spiritual support. Several small studies have aimed to identify the most beneficial palliative care intervention for this cohort of patients, ranging from formal clinic-based multidisciplinary palliative care interventions to home-based interventions. While outcomes have trended towards benefit for patients, especially pertaining to psychological well-being, most studies were not powered to detect additional benefits for improved physical symptom management, reduction in care utilization or increased length of time on trial. In this review, we discuss the unique palliative care needs of this population and what we can learn from results of past interventional studies. We advocate for a tailored palliative care approach that acknowledges the time toxicity experienced by patients enrolled in EPCTs and address challenges posed by shortages within the palliative care workforce.
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Affiliation(s)
- Fionnuala Crowley
- Department of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, USA; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Richard Sheppard
- Department of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Eve Easton
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Thomas U Marron
- Department of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, USA; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Early Phase Trials Unit, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deborah Doroshow
- Department of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, USA; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Early Phase Trials Unit, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Debora Afezolli
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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Bower KA, Hallock J, Li X, Kent T, Wardlow L. Cost and Utilization Implications of a Health Plan's Home-Based Palliative Care Program. J Palliat Med 2024; 27:464-470. [PMID: 38271576 PMCID: PMC10998702 DOI: 10.1089/jpm.2023.0401] [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] [Accepted: 10/30/2023] [Indexed: 01/27/2024] Open
Abstract
Background: A California-based health plan offered home-based palliative care (HBPC) to members who needed support at home but did not yet qualify for hospice. Objectives: This study compares hospital and emergency department (ED) utilization and costs and mortality for individuals receiving HBPC to a cohort not receiving palliative care services (Usual Care). Design: This is an observational retrospective study using claims data covering a prestudy period and a study period during which time half of the study population received HBPC services. Setting/Subjects: Seriously ill individuals who received HBPC were matched with those receiving Usual Care using a propensity-based matching algorithm. Intervention: Interdisciplinary teams from home health and hospice agencies provided HBPC services. Measurements: Outcome measures included hospital and ED utilization and cost before and during the study period and mortality during the study period. Results: For both groups, hospital and ED utilization and associated costs were higher during the prestudy period than during the study period. No differences were found in outcome measures between groups during the study period. Average time in the study period was longer for the HBPC group than that in the Usual Care group, indicating that they lived longer or transitioned to hospice later. Conclusion: Although individuals in both groups were living with serious illnesses for which worsening health and increased acute care utilization are expected over time, both groups had reduced acute care utilization and costs during the study period compared with the prestudy period. Reduced utilization and costs were equivalent for both groups.
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Affiliation(s)
- Kimberly A. Bower
- Pediatric Palliative Care, Rady Children's Hospital San Diego, San Diego, California, USA
- Blue Shield of California, Oakland, California, USA
| | | | - Xiaoli Li
- Blue Shield of California, Oakland, California, USA
| | - Tyler Kent
- West Health Institute, La Jolla, California, USA
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Alamery S, AlAjmi A, Wani TA, Zargar S. In Silico and In Vitro Exploration of Poziotinib and Olmutinib Synergy in Lung Cancer: Role of hsa-miR-7-5p in Regulating Apoptotic Pathway Marker Genes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1923. [PMID: 38003971 PMCID: PMC10673591 DOI: 10.3390/medicina59111923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background and objectives: Non-small cell lung cancer (NSCLC) is often caused by EGFR mutations, leading to overactive cell growth pathways. Drug resistance is a significant challenge in lung cancer treatment, affecting therapy effectiveness and patient survival. However, combining drugs in research shows promise in addressing or delaying resistance, offering a more effective approach to cancer treatment. In this study, we investigated the potential alterations in the apoptotic pathway in A549 cells induced by a combined targeted therapy using tyrosine kinase inhibitors (TKIs) olmutinib and poziotinib, focusing on cell proliferation, differential gene expression, and in silico analysis of apoptotic markers. Methods: A combined targeted therapy involving olmutinib and poziotinib was investigated for its impact on the apoptotic pathway in A549 cells. Cell proliferation, quantitative differential gene expression, and in silico analysis of apoptotic markers were examined. A549 cells were treated with varying concentrations (1, 2.5, and 5 μM) of poziotinib, olmutinib, and their combination. Results: Treatment with poziotinib, olmutinib, and their combination significantly reduced cell proliferation, with the most pronounced effect at 2.5 μM (p < 0.005). A synergistic antiproliferative effect was observed with the combination of poziotinib and olmutinib (p < 0.0005). Quantitative differential gene expression showed synergistic action of the drug combination, impacting key apoptotic genes including STK-11, Bcl-2, Bax, and the Bax/Bcl-2 ratio. In silico analysis revealed direct interactions between EGFR and ERBB2 genes, accounting for 77.64% of their interactions, and 8% co-expression with downstream apoptotic genes. Molecular docking indicated strong binding of poziotinib and olmutinib to extrinsic and intrinsic apoptotic pathway markers, with binding energies of -9.4 kcal/mol and -8.5 kcal/mol, respectively, on interacting with STK-11. Conclusions: Combining poziotinib and olmutinib therapies may significantly improve drug tolerance and conquer drug resistance more effectively than using them individually in lung cancer patients, as suggested by this study's mechanisms.
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Affiliation(s)
- Salman Alamery
- Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (A.A.)
| | - Anfal AlAjmi
- Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (A.A.)
| | - Tanveer A. Wani
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Seema Zargar
- Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (A.A.)
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Rosa WE, McDarby M, Buller H, Ferrell BR. Palliative Care Clinician Perspectives on Person-Centered End-of-Life Communication for Racially and Culturally Minoritized Persons with Cancer. Cancers (Basel) 2023; 15:4076. [PMID: 37627105 PMCID: PMC10452546 DOI: 10.3390/cancers15164076] [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] [Received: 06/14/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of this study was to examine interdisciplinary clinicians' perceptions of priorities in serious illness communication and shared decision-making with racially and culturally minoritized persons at end of life. Clinicians (N = 152) read a detailed case study about a patient self-identifying as Black and American Indian who describes mistrust of the healthcare system. Participants then responded to three open-ended questions about communication strategies and approaches they would employ in providing care. We conducted a thematic analysis of participants' responses to questions using an iterative, inductive approach. Interdisciplinary clinicians from nursing (48%), social work (36%), and chaplaincy (16%), responded to the study survey. A total of four themes emerged: (1) person-centered, authentic, and culturally-sensitive care; (2) pain control; (3) approaches to build trust and connection; and (4) understanding communication challenges related to racial differences. Significant efforts have been made to train clinicians in culturally inclusive communication, yet we know little about how clinicians approach "real world" scenarios during which patients from structurally minoritized groups describe care concerns. We outline implications for identifying unconscious bias, informing educational interventions to support culturally inclusive communication, and improving the quality of end-of-life care for patients with cancer from minoritized groups.
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Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA;
| | - Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA;
| | - Haley Buller
- City of Hope, Duarte, CA 91010, USA; (H.B.); (B.R.F.)
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Wahyuni S, Gautama MSN, Simamora TY. A Literature Review of Nurses Challenges and Barriers in Assisting Patients and Families Facing Breaking Bad News. Indian J Palliat Care 2023; 29:243-249. [PMID: 37700890 PMCID: PMC10493690 DOI: 10.25259/ijpc_128_2023] [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: 05/21/2023] [Accepted: 07/22/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Breaking bad news (BBN) is a challenging task for healthcare professionals, including nurses. The manner in which bad news is delivered can have a significant impact on patients and their families, either positive or negative. Understanding the roles, methods, obstacles, and challenges that nurses face in the process of delivering bad news is crucial for improving the quality of the delivery process. Material and Methods This narrative review synthesises related studies. The search was conducted through PubMed, Scopus, ScienceDirect and Sage, with no restriction on publication year. The main keywords were 'nurse's challenge', 'nurse's barrier', 'bad news', 'breaking bad news', and 'communicating bad news.' A total of 12 articles were selected from 1075 articles. Results Nurses play a key role in BBN before, during and after the process. Their activities include preparing patients to receive bad news, supporting patients and families when doctors deliver bad news and clarifying information obtained by patients and families regarding the prognosis of their illness. Nurses should possess skills such as building interpersonal relationships, therapeutic communication and providing emotional care for patients and their families. The main challenges and barriers for nurses in implementing BBN are due to a lack of skills and unpreparedness for patient and family reactions. After BBN, the most reported roles of nurses were supporting patients and families and helping them understand the information received from doctors. It is essential for nurses to have the necessary skills and preparedness to effectively deliver bad news to patients and their families. Conclusion Nurses play a crucial role in delivering bad news to patients and their families. They should be equipped with the necessary skills to effectively communicate with patients and their families during this difficult time. Further training for nurses in therapeutic communication, emotional care for patients and their families, and building interpersonal relationships could help to improve the quality of the delivery process.
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Affiliation(s)
- Surya Wahyuni
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Made Satya Nugraha Gautama
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tiur Yulianta Simamora
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Lee JB, McIlfatrick S, Fitzpatrick L. Examining the Range and Scope of Artists' Professional Practices With Individuals With Palliative Care Needs: An International, Cross-Sectional Online Survey. Front Psychol 2021; 12:773451. [PMID: 34955991 PMCID: PMC8696005 DOI: 10.3389/fpsyg.2021.773451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Internationally, it is recognized that artists facilitate arts engagement with individuals with palliative care needs. There is a gap in the literature describing the range and scope of artists' professional practices in palliative care. The aim of this study was to examine an international range of professional practices among artists who work in palliative care including key professionals' perceptions of these practices. Methods: An international, cross-sectional, online survey was conducted with health professionals, artists, and program coordinators with experience with artists working in palliative care. This survey was part of a larger mixed methods study. An instrument was systematically developed to examine artists' professional practices. Descriptive statistics were reported for the total sample including frequencies, means and standard deviations and open-ended items were analyzed thematically. Results: 101 valid surveys were analyzed. Findings outlined: (1) who delivers the arts; (2) where and with whom; (3) practice descriptors; and (4) perceptions of practice. Themes identified from open-ended items on benefits and risks of practice revealed impacts on patients and artists alike, including: (1) enhanced well-being; (2) vulnerabilities; and (3) facilitators and barriers. Conclusion: Findings demonstrated a wide range of artists' practices in palliative and end-of-life care, featuring notable consistencies in international practice worth further exploration. Ongoing and international efforts examining artists' practices in palliative care contribute to the development of future research, policy and practice.
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Affiliation(s)
- Jenny Baxley Lee
- Institute of Nursing and Health Sciences Research, Ulster University, Coleraine, Northern Ireland
- Center for Arts in Medicine, College of the Arts, University of Florida, Gainesville, FL, United States
- School of Arts and Humanities, Ulster University, Coleraine, Northern Ireland
| | - Sonja McIlfatrick
- Institute of Nursing and Health Sciences Research, Ulster University, Coleraine, Northern Ireland
| | - Lisa Fitzpatrick
- School of Arts and Humanities, Ulster University, Coleraine, Northern Ireland
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Lee JB, McIlfatrick S, Fitzpatrick L. Arts engagement facilitated by artists with individuals with life-limiting illness: A systematic integrative review of the literature. Palliat Med 2021; 35:1815-1831. [PMID: 34781774 DOI: 10.1177/02692163211045895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Living with life-limiting illness significantly impacts quality of life. A growing body of evidence suggests that arts engagement facilitated by artists promotes well-being. However, no synthesis of the literature exists to describe arts engagement delivered by artists with individuals receiving palliative care. AIM To systematically review and synthesize evidence to identify outcomes and key knowledge gaps to inform future research and practice. DESIGN A systematic integrative literature review was conducted using a pre-defined search strategy and reported using PRISMA guidelines. Analysis was conducted iteratively and synthesis achieved using constant comparison to generate themes. DATA SOURCES PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase were searched for studies published between database inception and August 2020. Search terms included variations on arts/artists; patients/service users; and palliative or end-of-life care. Eligibility criteria was applied and study quality assessed. RESULTS Seven reviewed studies explored literary, performing, and visual arts engagement in hospitals, hospice and community settings in England, the United States, France, and Canada. Study designs, interventions and findings were discussed. Themes identified across studies associated arts engagement with (1) a sense of well-being, (2) a newly discovered, or re-framed, sense of self, (3) connection with others, and (4) challenges associated with practice. CONCLUSION Recommendations for future research were offered in order to maximize benefits, minimize risks and address complexity of artists' engagement in palliative care including: (1) consistency in methods and reporting; (2) inclusion of wider perspectives; and (3) key considerations for adapting the arts by health condition and art form.
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Affiliation(s)
- Jenny Baxley Lee
- Institute of Nursing and Health Sciences Research, Ulster University, Northern Ireland, UK.,Center for Arts in Medicine, College of the Arts, University of Florida, Gainesville, FL, USA
| | - Sonja McIlfatrick
- Institute of Nursing and Health Sciences Research, Ulster University, Northern Ireland, UK
| | - Lisa Fitzpatrick
- School of Arts and Humanities, Ulster University, Northern Ireland, UK
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Hamdan Alshehri H, Olausson S, Öhlén J, Wolf A. Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review. BMC Palliat Care 2020; 19:113. [PMID: 32698809 PMCID: PMC7375204 DOI: 10.1186/s12904-020-00616-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background While a palliative approach is generally perceived to be an integral part of the intensive care unit (ICU), the provision of palliative care in this setting is challenging. This review aims to identify factors (barriers and facilitators) influencing a palliative approach in intensive care settings, as perceived by health care professionals. Method A systematic mixed-methods review was conducted. Multiple electronic databases were used, and the following search terms were utilized: implementation, palliative care, and intensive care unit. In total, 1843 articles were screened, of which 24 met the research inclusion/exclusion criteria. A thematic synthesis method was used for both qualitative and quantitative studies. Results Four key prerequisite factors were identified: (a) organizational structure in facilitating policies, unappropriated resources, multi-disciplinary team involvement, and knowledge and skills; (b) work environment, including physical and psychosocial factors; (c) interpersonal factors/barriers, including family and patients’ involvement in communication and participation; and (d) decision-making, e.g., decision and transition, goal conflict, multidisciplinary team communication, and prognostication. Conclusion Factors hindering the integration of a palliative approach in an intensive care context constitute a complex interplay among organizational structure, the care environment and clinicians’ perceptions and attitudes. While patient and family involvement was identified as an important facilitator of palliative care, it was also recognized as a barrier for clinicians due to challenges in shared goal setting and communication.
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Affiliation(s)
- Hanan Hamdan Alshehri
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sepideh Olausson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Anaesthesiology and Intensive Care Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
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The Contribution of Spanish Science to Patents: Medicine as Case of Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103638. [PMID: 32455806 PMCID: PMC7277902 DOI: 10.3390/ijerph17103638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 12/04/2022]
Abstract
Investments in research and development (R&D) and innovation are expensive, and one wishes to be assured that there is positive feedback and to receive guidance on how to direct investments in the future. The social or economic benefits of investments in R&D are of particular interest to policymakers. In this regard, public expense in research, especially through universities, is sometimes being questioned. This paper establishes a measure of how research in Spain, and specifically in its universities, is involved. In this study, we have analyzed all the literature cited in the period 1998–2018 produced by Spanish institutions and which has been cited in at least one international patent, obtaining more than 40,000 publications from more than 160,000 different authors. The data have been surprisingly positive, showing that practically all public universities contribute to this subject and that there is a great deal of international collaboration, both in terms of the number of countries with which they collaborate and the prestige of the institutions involved. Regarding the specific scientific fields in which this collaboration is most relevant, biochemistry, genetics and molecular biology, and medicine together account for almost 40% of the total works. The topics most used by these publications were those of diseases or medical problems such as: Neoplams, Carcinoma, Alzheimer Disease, or human immunodeficiency virus (HIV-1). Oncology was according to the All Science Journal Classification (ASJC) the leading and central issue. Therefore, although the result of basic research is difficult to quantify, when it is observed that there is a return in fields such as medicine or global health, it can be said that it is well employed. In terms of journals from a purely bibliometric point of view, it has been observed that some journals do not have a great impact or relative position within their categories, but they do have a great relevance in this area of patent support. Therefore, it would be worthwhile to set up a rank for scientific journals based on the citations of patents, so the percentage of articles cited in patents with Field-Weighted Citation Impact (FWCI) >1, and as an indicator of scientific transfer from universities or research centres, the transference index in patents (TIP) is also proposed.
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Frett Utter B, Parham GP, Mershon CH, Sikombe K, Musonda A, Matambo J, Kapambwe S, Msadabwe SC, Katundu K, Bateman A, Lishimpi K, Mwanahamuntu M, Chibwesha CJ. Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey. J Cancer Policy 2019. [DOI: 10.1016/j.jcpo.2019.100185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Relyea E, MacDonald B, Cattaruzza C, Marshall D. On the Margins of Death: A Scoping Review on Palliative Care and Schizophrenia. J Palliat Care 2018; 34:62-69. [PMID: 30301428 DOI: 10.1177/0825859718804108] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Schizophrenia is a serious chronic mental illness that results in marginalization and stigma for sufferers. It is the seventh leading cause for disability worldwide. The symptoms of the illness, including hallucinations, delusions, and extremely disordered thinking and behavior, may also introduce barriers to accessing treatment, education, housing, and employment. Little is known about end-of-life care for individuals with schizophrenia. To address this gap, a scoping review was conducted to enhance understanding of hospice and palliative care for patients with schizophrenia. From this scoping review, 342 unique titles and abstracts were identified through a search of 20 databases, including 11 social science databases, 6 medical databases, and 3 gray literature databases. A total of 32 articles met the inclusion criteria and the following 4 themes were identified: Stigma affecting quality of care and access to care; Issues related to consent and capacity for the patient's end-of-life care decisions and to appoint substitute decision makers; Best practices for psychosocial interventions, pharmacology, family and health-care collaborations, goals of care, setting, and smoking; and Barriers to care, including setting, communication, provider education, and access to care. The review suggests the importance of mandatory interdisciplinary training practices and policy standards outlining cooperative communication across health-care providers. It highlights gaps in evidence-based research on psychosocial interventions and collaborative frameworks to enable the provision of quality end-of-life care for individuals with schizophrenia.
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Affiliation(s)
- Erin Relyea
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Brooke MacDonald
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Christina Cattaruzza
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Denise Marshall
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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Thrift-Perry M, Cabanes A, Cardoso F, Hunt KM, Cruz TA, Faircloth K. Global analysis of metastatic breast cancer policy gaps and advocacy efforts across the patient journey. Breast 2018; 41:93-106. [PMID: 30025274 DOI: 10.1016/j.breast.2018.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 12/11/2022] Open
Abstract
Metastatic breast cancer (mBC) is an area with high unmet need across the world. Despite significant progress to meet patient need, current breast cancer (BC) policies fail to recognize the unique challenges of patients who are further along the cancer patient journey. This analysis aims to understand BC/mBC policy development at a global level and identify opportunities for further development. A comprehensive analysis of National Cancer Control Plans (NCCPs) policies and programs was conducted across 16 countries, which represent a diverse range of healthcare systems, economies and geographic regions. Examples of promising practices, implemented or initiated by civil society, are provided to demonstrate successful methods to address the identified policy gaps. The analysis finds that disparities in BC policy development exist across and within countries. Progress in BC policy is fragmented and skewed towards the early part of the patient journey e.g. awareness and stakeholder education, with key gaps remaining in diagnosis and patient identification. In addition, access to innovative mBC treatments, ongoing support and palliative care remain a challenge, while care coordination is limited due to inefficient referrals. Although government and policymaker action is fundamental, collaboration between different stakeholders is imperative to address unmet needs of BC/mBC patients alike. Policy initiatives and promising practices that demonstrate successful multi-stakeholder engagement can be replicated or used to inform further advocacy and policy development with the aim to address patient unmet needs.
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Affiliation(s)
- Maia Thrift-Perry
- International Public Affairs, Pfizer Inc., 235 East 42nd Street, New York, NY 10017, USA
| | - Anna Cabanes
- Global Programs, Susan G. Komen, 5005 LBJ Freeway, Suite 526, Dallas, TX 75244, USA.
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Av Brasilia, s/n Lisbon, Lisbon 1400-038, Portugal; European School of Oncology, Via Filippo Turati, 29, 20121 Milan, Italy
| | - Katherine Moose Hunt
- Global Programs, Susan G. Komen, 5005 LBJ Freeway, Suite 526, Dallas, TX 75244, USA
| | - Tauane Araújo Cruz
- Global Programs, Susan G. Komen, 5005 LBJ Freeway, Suite 526, Dallas, TX 75244, USA
| | - Kyra Faircloth
- International Public Affairs, Pfizer Inc., 235 East 42nd Street, New York, NY 10017, USA
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13
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Cain CL, Surbone A, Elk R, Kagawa-Singer M. Culture and Palliative Care: Preferences, Communication, Meaning, and Mutual Decision Making. J Pain Symptom Manage 2018; 55:1408-1419. [PMID: 29366913 DOI: 10.1016/j.jpainsymman.2018.01.007] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 01/11/2023]
Abstract
Palliative care is gaining acceptance across the world. However, even when palliative care resources exist, both the delivery and distribution of services too often are neither equitably nor acceptably provided to diverse population groups. The goal of this study was to illustrate tensions in the delivery of palliative care for diverse patient populations to help clinicians to improve care for all. We begin by defining and differentiating culture, race, and ethnicity, so that these terms-often used interchangeably-are not conflated and are more effectively used in caring for diverse populations. We then present examples from an integrative literature review of recent research on culture and palliative care to illustrate both how and why varied responses to pain and suffering occur in different patterns, focusing on four areas of palliative care: the formation of care preferences, communication patterns, different meanings of suffering, and decision-making processes about care. For each area, we provide international and multiethnic examples of variations that emphasize the need for personalization of care and the avoidance of stereotyping beliefs and practices without considering individual circumstances and life histories. We conclude with recommendations for improving palliative care research and practice with cultural perspectives, emphasizing the need to work in partnerships with patients, their family members, and communities to identify and negotiate culturally meaningful care, promote quality of life, and ensure the highest quality palliative care for all, both domestically and internationally.
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Affiliation(s)
- Cindy L Cain
- Department of Health Policy and Management, University of California-Los Angeles, Los Angeles, California.
| | - Antonella Surbone
- Department of Medicine, Division of Haematology and Medical Oncology, New York University Medical School, New York, New York
| | - Ronit Elk
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Marjorie Kagawa-Singer
- Department of Community Health Sciences and Asian American Studies Center, University of California-Los Angeles, Los Angeles, California
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Grunauer M, Mikesell C. A Review of the Integrated Model of Care: An Opportunity to Respond to Extensive Palliative Care Needs in Pediatric Intensive Care Units in Under-Resourced Settings. Front Pediatr 2018; 6:3. [PMID: 29410951 PMCID: PMC5787068 DOI: 10.3389/fped.2018.00003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/08/2018] [Indexed: 01/27/2023] Open
Abstract
It is estimated that 6.3 million children who die annually need pediatric palliative care (PPC) and that only about 10% of them receive the attention they need because about 98% of them live in under-resourced settings where PPC is not accessible. The consultative model and the integrated model of care (IMOC) are the most common strategies used to make PPC available to critically ill children. In the consultative model, the pediatric intensive care unit (PICU) team, the patient, or their family must request a palliative care (PC) consultation with the external PC team for a PICU patient to be evaluated for special care needs. While the consultation model has historically been more popular, issues related to specialist availability, referral timing, staff's personal biases, misconceptions about PC, and other factors may impede excellent candidates from receiving the attention they need in a timely manner. Contrastingly, in the IMOC, family-centered care, PC tasks, and/or PC are a standard part of the treatment automatically available to all patients. In the IMOC, the PICU team is trained to complete critical and PC tasks as a part of normal daily operations. This review investigates the claim that the IMOC is the best model to meet extensive PPC needs in PICUs, especially in low-resource settings; based on an extensive review of the literature, we have identified five reasons why this model may be superior. The IMOC appears to: (1) improve the delivery of PPC and pediatric critical care, (2) allow clinicians to better respond to the care needs of patients and the epidemiological realities of their settings in ways that are consistent with evidence-based recommendations, (3) facilitate the universal delivery of care to all patients with special care needs, (4) maximize available resources, and (5) build local capacity; each of these areas should be further researched to develop a model of care that enables clinicians to provide pediatric patients with the highest attainable standard of health care. The IMOC lays out a pathway to provide the world's sickest, most vulnerable children with access to PPC, a human right to which they are entitled by international legal conventions.
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Affiliation(s)
- Michelle Grunauer
- Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
- Pediatric Intensive Care Unit, Hospital de los Valles, Quito, Ecuador
| | - Caley Mikesell
- Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
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Khatib AH, Hamdan-Mansour AM, Bani Hani MA. Theoretical Perspectives of Hospitalized Older Patients and Their Health-Related Problems and Quality of Care: Systematic Literature Review. ACTA ACUST UNITED AC 2017. [DOI: 10.2174/1874944501710010215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Introduction:The proportion of aged people is growing worldwide. Older persons are affected by a number of physical, psychological and social factors that influence their health and quality of life. These factors are usually multiple and are often masked by sensory and cognitive impairments.Purpose:The purpose of this study was to examine the available literature emphasizing older persons’ care, care-related problems, and older persons’ quality of healthcare. Also, the paper aimed at exploring the future direction of research needs.Results:Good quality older patients’ care involves safety, professional interventions, recognition and management of physical and emotional wellbeing. Care of older patients requires addressing the aging process itself, the expected decrease in functionality, and diminished cognitive ability. Little statistical data were found to address the quality of hospitalized elderly patients in particular as well as study on healthcare facilities and nursing homes. Literature does not provide much guidance to the effectiveness of care strategies.Conclusion:The results assert that elderly health care is a priority. However, health care systems are not specific about elderly patients’ needs, leading to low quality of elderly care. There is a need to use an integrated model of care to improve the quality of life and quality of care provided to hospitalized older patients.
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16
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ABR Subspecialty Certifications in Hospice and Palliative Medicine and Pain Medicine. J Am Coll Radiol 2017; 14:1069-1073. [DOI: 10.1016/j.jacr.2017.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 11/18/2022]
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17
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Pimentel LE, De La Cruz M, Wong A, Castro D, Bruera E. Snapshot of an Outpatient Supportive Care Center at a Comprehensive Cancer Center. J Palliat Med 2017; 20:433-436. [DOI: 10.1089/jpm.2016.0370] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lindsey E. Pimentel
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maxine De La Cruz
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Angelique Wong
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra Castro
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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18
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Abstract
The United States has 1332 critical access hospitals. These hospitals have fewer than 25 beds each and a mean daily census of 4.2 patients. Critical access hospitals are located in rural areas and provide acute inpatient services, ambulatory care, labor and delivery services, and general surgery. Some, but not all, critical access hospitals offer home care services; a few have palliative care programs. Because of the millions of patients living with serious and life-threatening conditions, the need for palliative care is increasing. As expert generalists, rural nurses are well positioned to provide care close to home for patients of all ages and the patients' families. A case report illustrates the role that nurses and critical access hospitals play in meeting the need for high-quality palliative care in rural settings. Working together, rural nurses and their urban nursing colleagues can provide palliative care across all health care settings.
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Affiliation(s)
- Dorothy Dale M Mayer
- Dorothy "Dale" M. Mayer is an assistant professor, College of Nursing, Montana State University, Missoula, Montana.Charlene A. Winters is a professor, College of Nursing, Montana State University.
| | - Charlene A Winters
- Dorothy "Dale" M. Mayer is an assistant professor, College of Nursing, Montana State University, Missoula, Montana.Charlene A. Winters is a professor, College of Nursing, Montana State University
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Evans BC, Coon DW. The "Reckoning Point" as a Marker for Formal Palliative and End-of-Life Care in Mexican American Families. JOURNAL OF FAMILY NURSING 2016; 22:606-630. [PMID: 27903942 DOI: 10.1177/1074840716677994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Palliative and end-of-life care (PEOLC) in Mexican American (MA) caregiving families remains unexplored. Its onset was uncovered in our mixed methods, multisite, interdisciplinary, qualitative descriptive study of 116 caregivers, most of whom had provided long-term informal home care for chronically ill, disabled older family members. This subanalysis used Life Course Perspective to examine the "point of reckoning" in these families, where an older person is taken in for care, or care escalates until one recognizes oneself as the primary caregiver. Ninety-three of 116 caregivers recognized and spontaneously reported a "reckoning point" that initiated the caregiving trajectory, while eight cited "gradual decline" into caregiving for elders in their homes. This "reckoning point," which marks the assumption of this role, may afford a fertile opportunity for referral to community resources or initiation of formal PEOLC, thereby improving the quality of life for these older individuals and their families.
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Assi T, El Rassy E, Ibrahim T, Moussa T, Tohme A, El Karak F, Farhat F, Faddoul S, Ghosn M, Kattan J. The role of palliative care in the last month of life in elderly cancer patients. Support Care Cancer 2016; 25:599-605. [PMID: 27738795 DOI: 10.1007/s00520-016-3444-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/03/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION One major health care issue encountered in elderly cancer patients is the alteration of the quality of life. The purpose of our study is to evaluate the administration of chemotherapy in the last month of life (CLML) and to evaluate the impact of the palliative care consult (PCC) in the elderly patients. METHODS We conducted a retrospective observational study that included elderly patients diagnosed with an end-stage cancer and who were deceased between the 1st of January 2012 and the 31st of December 2015. Patient medical records were reviewed for patients' characteristics and management during the last month of life. RESULTS This study enrolled 231 patients that fulfilled the eligibility criteria. CLML was administered in 91 patients (39.4 %) among which 43 patients (47.3 %) had their treatment within the last 2 weeks of life. Seventy-seven patients (33.3 %) had a palliative care consult (PCC) with a median duration of follow up of 13 days (range 2-56 days). Overall, PCC failed to decrease CLML administration, the duration of hospitalization, and ICU admissions. However, CLML administration decreased by 69 % among patients that had their PCC before receiving treatment (OR = 0.31; 95 % CI 0.15-0.63). PCC also led to a change in the pattern of treatment administered in the last month of life with less cytotoxic therapy (OR = 0.27 CI 95 % 0.09-0.9, p = 0.02) and higher rates of oral agents being prescribed (OR = 3.8; 95 % CI 1.3-11.3, p = 0.014). CONCLUSION Our elderly patients seem to receive aggressive management similar to the general oncology population. Early PCC was shown throughout our results to decrease the aggressiveness of cancer treatment in elderly patients which seems to improve the quality of care of our patients.
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Affiliation(s)
- Tarek Assi
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Elie El Rassy
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tony Ibrahim
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tania Moussa
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Aline Tohme
- Department of Palliative Care, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fadi El Karak
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fadi Farhat
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Salma Faddoul
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marwan Ghosn
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Roos V, Wheeler A. Older people’s experiences of giving and receiving empathy in relation to middle adolescents in rural South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/0081246316638563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Viewed in the context of an older-growing population, pressure on health-care and social (family and community) resources, and a perceived changed intergenerational ‘care contract’, relationships are often the only avenue open to address the care needs of both older and younger generations in economically deprived environments. This study explored how empathy manifested in the care experiences of older people (8 women and 1 man, aged between 60 and 85 years) in relation to middle adolescents (aged 16 years and younger). Empathy is proposed as an essential quality that can benefit care in any relationship, and indications of this were obtained by applying the Mmogo-method®, a projective visual data collection method. Textual data were analysed thematically, and visual data were analysed using Roos and Redelinghuys’ method of analysis. Findings indicated that older people viewed the relational interactions from a self-centred perspective and in a linear manner, referred to mid-adolescents in judgemental terms, and expressed conditional acceptance of these younger people. The findings indicated the antithesis (the opposite) of empathy, with the implication that older people might not give or elicit empathy in relation to younger people, particularly when the latter reach independence and exercise their autonomy. A lack of giving and receiving empathy holds serious implications for the future care needs of older people.
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Affiliation(s)
- Vera Roos
- AUTHeR, North-West University, Potchefstroom Campus, South Africa
| | - Anri Wheeler
- AUTHeR, North-West University, Potchefstroom Campus, South Africa
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Abstract
Palliative care is given to improve the quality of life of patients who have a serious or life-threatening disease. The role of the advanced practice nurse (APN) has significant value in this speciality. APNs provide holistic care, along with diagnostic and treatment expertise, and at the same time evaluate cost-effective use of resources. Palliative care APNs are specialists and leaders in disease-modifying care, pain and symptom management, giving attention to highest quality of life possible, and compassionate end-of-life care. The role of the APN has been highly recognised in the US and the aim of this article is to investigate this role. The article explores background, significance and a review of the literature. It concludes by emphasising the importance of APNs.
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Affiliation(s)
- Tintu George
- Adult Acute Nurse Practitioner, Thomas Jefferson College of Nursing, Philadelphia, US
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23
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Aldridge MD, Hasselaar J, Garralda E, van der Eerden M, Stevenson D, McKendrick K, Centeno C, Meier DE. Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliat Med 2016; 30:224-39. [PMID: 26405109 DOI: 10.1177/0269216315606645] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early integration of palliative care into the management of patients with serious disease has the potential to both improve quality of life of patients and families and reduce healthcare costs. Despite these benefits, significant barriers exist in the United States to the early integration of palliative care in the disease trajectory of individuals with serious illness. AIM To provide an overview of the barriers to more widespread palliative care integration in the United States. DESIGN AND DATA SOURCES A literature review using PubMed from 2005 to March 2015 augmented by primary data collected from 405 hospitals included in the Center to Advance Palliative Care's National Palliative Care Registry for years 2012 and 2013. We use the World Health Organization's Public Health Strategy for Palliative Care as a framework for analyzing barriers to palliative care integration. RESULTS We identified key barriers to palliative care integration across three World Health Organization domains: (1) education domain: lack of adequate education/training and perception of palliative care as end-of-life care; (2) implementation domain: inadequate size of palliative medicine-trained workforce, challenge of identifying patients appropriate for palliative care referral, and need for culture change across settings; (3) policy domain: fragmented healthcare system, need for greater funding for research, lack of adequate reimbursement for palliative care, and regulatory barriers. CONCLUSION We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness.
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Affiliation(s)
- Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Eduardo Garralda
- ATLANTES Research Programme, Institute for Culture and Society, University of Navarra, Pamplona, Spain and Palliative Medicine Group, Area of Oncology and Haematology, Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | | | - David Stevenson
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Karen McKendrick
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlos Centeno
- ATLANTES Research Programme, Institute for Culture and Society, University of Navarra, Pamplona, Spain and Palliative Medicine Group, Area of Oncology and Haematology, Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Diane E Meier
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Center to Advance Palliative Care, New York, NY, USA
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Bharadwaj P, Helfen KM, Deleon LJ, Thompson DM, Ward JR, Patterson J, Yennurajalingam S, Kim JB, Zimbro KS, Cassel JB, Bleznak AD. Making the Case for Palliative Care at the System Level: Outcomes Data. J Palliat Med 2016; 19:255-8. [PMID: 26849002 DOI: 10.1089/jpm.2015.0234] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A recent trend in health care is to integrate palliative care (PC) programs across multiple hospitals to reduce variation, improve quality, and reduce cost. OBJECTIVE The study objective was to demonstrate the benefits of PC for a system. METHODS The study was a descriptive study using retrospective medical records in seven federated hospitals where PC developed differently before system integration. Measured were length of stay (LOS), mortality, readmissions, saved intensive care unit (ICU) days, cost avoidance, and hospice referrals. RESULTS PC services within the first 48 hours of admission demonstrate a shorter LOS (5.08 days), reduced costs 40% ($2,362 per day), and decreased mortality (1.01 versus 1.10) for one hospital. Readmissions at 30, 60, and 90 days after a PC consult decreased (61.5%, 47.0%, and 42.1%, respectively). Annual pre- and postprogram referrals to hospice increased (65 to 107). Using modified matched pairs, LOS of PC patients seen within 48 hours of admission average 1.67 days less compared to non-PC patients. LOS for ICU patients with PC services in the ICU within the first 48 hours decreased by 1.12 days. Overall cost avoidance was 1.5 times total cost for PC programs systemwide. One pilot project using a full-time physician in the ICU reduced cost more than $600,000, with 315 saved ICU days, annualized. Systemwide, 69.3% of all referrals to hospice were made by the PC service. CONCLUSION Early involvement of PC services emerged as advantageous to the net benefit. Given that health care's changing landscape will increasingly include bundled payment and risk holding strategies to improve quality and reduce cost in health care systems, systemwide PC will play a vital role.
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Affiliation(s)
- Parag Bharadwaj
- 1 Palliative Care, Sentara Healthcare , Norfolk, Virginia.,2 Department of Internal Medicine, Eastern Virginia Medical School , Norfolk, Virginia
| | | | - Leo J Deleon
- 4 Sentara Princess Anne Hospital , Virginia Beach, Virginia
| | | | | | | | | | - Joe B Kim
- 8 Cedars-Sinai Medical Center , Los Angeles, California
| | | | - J Brian Cassel
- 9 Massey Cancer Center, Virginia Commonwealth University , Richmond, Virginia
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Larjow E, Papavasiliou E, Payne S, Scholten W, Radbruch L. A Systematic Content Analysis of Policy Barriers Impeding Access to Opioid Medication in Central and Eastern Europe: Results of ATOME. J Pain Symptom Manage 2016; 51:99-107. [PMID: 26386186 DOI: 10.1016/j.jpainsymman.2015.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/08/2015] [Accepted: 08/20/2015] [Indexed: 11/28/2022]
Abstract
CONTEXT Reliable access to opioid medication is critical to delivering effective pain management, adequate treatment of opioid dependence, and quality palliative care. However, more than 80% of the world population is estimated to be inadequately treated for pain because of difficulties in accessing opioids. Although barriers to opioid access are primarily associated with restrictive laws, regulations, and licensing requirements, a key problem that significantly limits opioid access relates to policy constraints. OBJECTIVES To identify and explore policy barriers to opioid access in 12 Eastern and Central European countries involved in the Access to Opioid Medication in Europe project, funded by the European Community's Seventh Framework (FP7/2007-2013, no. 222994) Programme. METHODS A systematic content analysis of texts retrieved from documents (e.g., protocols of national problem analyses, strategic planning worksheets, and executive summaries) compiled, reviewed, approved, and submitted by either the Access to Opioid Medication in Europe consortium or the national country teams (comprising experts in pain management, harm reduction, and palliative care) between September 2011 and April 2014 was performed. RESULTS Twenty-five policy barriers were identified (e.g., economic crisis, bureaucratic issues, lack of training initiatives, stigma, and discrimination), classified under four predetermined categories (financial/economic aspects and governmental support, formularies, education and training, and societal attitudes). Key barriers related to issues of funding allocation, affordability, knowledge, and fears associated with opioids. CONCLUSION Reducing barriers and improving access to opioids require policy reform at the governmental level with a set of action plans being formulated and concurrently implemented and aimed at different levels of social, education, and economic policy change.
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Affiliation(s)
- Eugenia Larjow
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Evangelia Papavasiliou
- International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom.
| | | | - Lukas Radbruch
- Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
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Walbert T, Glantz M, Schultz L, Puduvalli VK. Impact of provider level, training and gender on the utilization of palliative care and hospice in neuro-oncology: a North-American survey. J Neurooncol 2016; 126:337-45. [PMID: 26518539 PMCID: PMC5557051 DOI: 10.1007/s11060-015-1973-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/25/2015] [Indexed: 10/22/2022]
Abstract
Specialized palliative care (PC) services have emerged to address symptoms and provide end-of-life management for patients with brain tumors. The utilization patterns of PC in neuro-oncology are unknown. A 22-question survey was distributed to participants of the society for neuro-oncology annual meeting 2012 (n = 4487). Nonparametric methods including Wilcoxon two-sample and Kruskal-Wallis tests were used to assess differences in responses. 239 (5.3 %) evaluable responses were received; 79 % of respondents were physicians, and 17 % were nurses or midlevel providers. Forty-seven percent were medical or neuro-oncologists, 31 % neurosurgeons and 11 % radiation oncologists. Forty percent had no formal training in PC, 57 % had some formal training and 3 % completed a PC fellowship. Seventy-nine percent practiced in an academic setting. Of the respondents, 57 % referred patients to PC when symptoms required treatment and 18 % at end of life. Only 51 % of all providers felt comfortable dealing with end-of-life issues and symptoms, while 33 % did not. Fifty-one percent preferred a service named "Supportive Care" rather than "Palliative Care" (MDs > midlevel providers, p < 0.001), and 32 % felt that patient expectations for ongoing therapy hindered their ability to make PC referrals. Female gender, formal training in neuro-oncology and PC, and medical versus surgical neuro-oncology training were significantly associated with hospice referral, comfort in dealing with end-of-life issues, and ease of access to PC services. Provider level, specialty, gender, training in PC and neuro-oncology have significant impact on the utilization of PC and hospice in neuro-oncology.
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Affiliation(s)
- Tobias Walbert
- Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
| | - Michael Glantz
- Department of Neurosurgery, Penn State Hershey, Hershey, PA, USA
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Vinay K Puduvalli
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Henoch I, Carlander I, Holm M, James I, Kenne Sarenmalm E, Lundh Hagelin C, Lind S, Sandgren A, Öhlén J. Palliative Care Research - A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 2012. Scand J Caring Sci 2015; 30:5-25. [DOI: 10.1111/scs.12253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Ingela Henoch
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
| | - Ida Carlander
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Maja Holm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Inger James
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Elisabeth Kenne Sarenmalm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Research and Development Centre; Skaraborg Hospital; Skövde Sweden
| | - Carina Lundh Hagelin
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
- Research and Development Unit in Palliative care; Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Susanne Lind
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Anna Sandgren
- School of Health Sciences; Jönköping University; Jönköping Sweden
- Center for Collaborative Palliative Care; Department of Health and Caring Sciences; Linneaus University; Kalmar/Växjö Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
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Walbert T, Puduvalli VK, Taphoorn MJB, Taylor AR, Jalali R. International patterns of palliative care in neuro-oncology: a survey of physician members of the Asian Society for Neuro-Oncology, the European Association of Neuro-Oncology, and the Society for Neuro-Oncology. Neurooncol Pract 2015; 2:62-69. [PMID: 31386064 DOI: 10.1093/nop/npu037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/01/2014] [Indexed: 11/12/2022] Open
Abstract
Background Brain tumor patients have limited survival and suffer from high morbidity requiring specific symptom management. Specialized palliative care (PC) services have been developed to address these symptoms and provide end-of-life treatment. Global utilization patterns of PC in neuro-oncology are unknown. Methods In a collaborative effort between the Society for Neuro-Oncology (SNO), the European Association of Neuro-Oncology (EANO), and the Asian Society for Neuro-Oncology (ASNO), a 22-question survey was distributed. Wilcoxon 2-sample and Kruskal-Wallis tests were used to assess differences in responses. Results Five hundred fifty-two evaluable responses were received. The most significant differences were found between Asia-Oceania (AO) and Europe as well as AO and United States/Canada (USA-C). USA-C providers had more subspecialty training in neuro-oncology, but most providers had received no or minimal training in palliative care independent of region. Providers in all 3 regions reported referring patients at the onset of symptoms requiring palliation, but USA-C and European responders refer a larger total proportion of patients to PC (P < .001). Physicians in AO and Europe (both 46%) as well as 29% of USA-C providers did not feel comfortable dealing with end-of-life issues. Most USA-C patients (63%) are referred to hospice compared with only 8% and 19% in AO and Europe (P < .001), respectively. Conclusion This is the first report describing global differences of PC utilization in neuro-oncology. Significant differences in provider training, culture, access, and utilization were mainly found between AO and USA-C or AO and Europe. PC patterns are more similar in Europe and USA-C.
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Affiliation(s)
- Tobias Walbert
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan (T.W., A.R.T.); The Ohio State University Comprehensive Cancer Center, Columbus, Ohio (V.K.P.); VU University Medical Center, Amsterdam, Netherlands (M.J.B.T.); Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Tata Memorial Centre, Mumbai, India (R.J.)
| | - Vinay K Puduvalli
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan (T.W., A.R.T.); The Ohio State University Comprehensive Cancer Center, Columbus, Ohio (V.K.P.); VU University Medical Center, Amsterdam, Netherlands (M.J.B.T.); Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Tata Memorial Centre, Mumbai, India (R.J.)
| | - Martin J B Taphoorn
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan (T.W., A.R.T.); The Ohio State University Comprehensive Cancer Center, Columbus, Ohio (V.K.P.); VU University Medical Center, Amsterdam, Netherlands (M.J.B.T.); Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Tata Memorial Centre, Mumbai, India (R.J.)
| | - Andrew R Taylor
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan (T.W., A.R.T.); The Ohio State University Comprehensive Cancer Center, Columbus, Ohio (V.K.P.); VU University Medical Center, Amsterdam, Netherlands (M.J.B.T.); Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Tata Memorial Centre, Mumbai, India (R.J.)
| | - Rakesh Jalali
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan (T.W., A.R.T.); The Ohio State University Comprehensive Cancer Center, Columbus, Ohio (V.K.P.); VU University Medical Center, Amsterdam, Netherlands (M.J.B.T.); Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Tata Memorial Centre, Mumbai, India (R.J.)
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Erdek M. Pain medicine and palliative care as an alternative to euthanasia in end-of-life cancer care. LINACRE QUARTERLY 2015; 82:128-34. [PMID: 25999611 DOI: 10.1179/2050854915y.0000000003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
There exists support for euthanasia or physician-assisted suicide (PAS) in cases of terminal cancer. One of the premises for this approach is the goal of the alleviation of suffering. Do current means of pain control in the greater overall setting of palliative care serve as a desirable alternative? A contrast comparison may be drawn between the above approaches using both theological and medical sources to show that the enlightened use of both interventional and non-interventional pain medicine approaches in an integrated palliative care setting are a theologically grounded and medically feasible alternative to euthanasia or PAS in this population. Lay summary: Patients suffering from terminal cancer often have pain. Some have advocated euthanasia or physician-assisted suicide as a potential way of alleviating this suffering. Further examination of this topic, however, shows this approach may be essentially utilitarian and fail to consider the inherent value of human life. There has been significant development in recent years in the fields of pain medicine and palliative care, which afford alternate means of addressing suffering in this patient population.
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Sountoulides P, Mykoniatis I, Dimasis N. Palliative management of malignant upper urinary tract obstruction. Hippokratia 2014; 18:292-297. [PMID: 26052193 PMCID: PMC4453800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Malignancies of the genitourinary tract are diagnosed with increased frequency compared to the past. Currently prostate and bladder cancer account for the majority of urological malignancies. While for prostate cancer recent developments in the management of local and metastatic disease are likely to lead the majority of patients to either cure from the disease or to longer survival time, for bladder cancer advanced disease will unfortunately lead to death within months. However, the common clinical scenario in both prostate and bladder cancer includes, in high incidence, upper urinary tract obstruction in the advanced stages of these malignancies. This coupled with the fact that average life expectancy in the western world is increasing, will result in a significant patient population with either advanced, non-curable disease or with problems related to the received therapeutic surgical or medical interventions. There is no doubt that in both circumstances the room and role of palliation therapy is increasing. The care of patients with advanced urologic malignancies requires a multi-disciplinary effort from physicians of many specialties under the guiding role of the treating urologist. This review focuses on currently available palliative therapeutic options for upper urinary tract obstruction in the setting of patients with advanced malignancies of the urinary tract, as recently significant advancements have been witnessed in this field.
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Affiliation(s)
| | - I Mykoniatis
- Urology Department, General Hospital of Veria, Greece
| | - N Dimasis
- Urology Department, "Theagenio" Anticancer Hospital, Thessaloniki, Greece
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Walbert T. Integration of palliative care into the neuro-oncology practice: patterns in the United States. Neurooncol Pract 2014; 1:3-7. [PMID: 26034608 DOI: 10.1093/nop/npt004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/02/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Between 80%-85 percent of all adult brain tumors are high-grade gliomas (HGGs). Despite aggressive treatment with surgical resection, radiotherapy and chemotherapy, the survival of patients with HGG is limited. Brain tumor patients develop unique symptoms and needs throughout their disease trajectory, and the majority lose the ability to communicate during the end-of-life phase. Palliative care (PC) is a proactive and systematic approach to manage issues that are important to patients and families affected by serious illness. The goal is to improve quality of life and symptom control and thereby reduce suffering. Most PC interventions take place during the end-of-life phase; however, newer data suggest that early PC interventions might improve symptom control and quality of life. METHODS A literature review focusing on PC, hospice care, and end-of-life care was performed with the aim to describe the integration of PC into neuro-oncology practice. RESULTS Recently there has been increased interest in the effects of PC and brain tumor patients. The origins, methodology, and conceptual models of delivering PC and how it might be applied to the field of neuro-oncology were reviewed. Patterns of referral and utilization in neuro-oncology are described based on the findings of a recent survey. CONCLUSIONS Despite a very high symptom burden, many HGG patients do not receive the same level of PC and have fewer interactions with PC services than other cancer populations. Early PC interventions and structured advance-care planning might improve symptom control and quality of life for brain tumor patients.
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Affiliation(s)
- Tobias Walbert
- Departments of Neurosurgery and Neurology , Henry Ford Health System, Detroit, Michigan
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McIlfatrick S, Noble H, McCorry NK, Roulston A, Hasson F, McLaughlin D, Johnston G, Rutherford L, Payne C, Kernohan G, Kelly S, Craig A. Exploring public awareness and perceptions of palliative care: a qualitative study. Palliat Med 2014; 28:273-80. [PMID: 24026003 DOI: 10.1177/0269216313502372] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research suggests that the public appear to be confused about the meaning of palliative care. Given the ageing population and associated increase in the number of patients requiring palliative care, it is vital to explore the public's understanding of this concept. Health-promoting palliative care seeks to translate hospice and palliative care ideals into broader public health practice. AIM To explore public perceptions of palliative care and identify strategies to raise awareness. DESIGN An exploratory qualitative approach. PARTICIPANTS Semi-structured telephone interviews were undertaken (N = 50) with members of the public who volunteered to participate in the study. The interviews focused on knowledge and perceptions of palliative care, expectations of palliative care services and the identification of strategies to raise public awareness of palliative care. The interviews were audio recorded and content analysed. RESULTS Most participants had a general knowledge of palliative care, largely influenced by their own personal experience. They identified that palliative care was about caring for people who were dying and maintaining comfort in the last days of life. Participant's expectations of services included the following: holistic support, symptom management, good communication and practical support to enable choice and carer support. Key aspects identified for promoting palliative care were the development of understanding and use of the term itself and targeted educational strategies. CONCLUSION Experience of palliative care generates understanding in the general public who also have ideas for increasing knowledge and awareness. The findings can inform policymakers about strategies to raise public awareness of palliative care.
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Affiliation(s)
- Sonja McIlfatrick
- 1Institute of Nursing and Health Research, School of Nursing, University of Ulster, Newtownabbey, UK
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Klinger CA, Howell D, Zakus D, Deber RB. Barriers and facilitators to care for the terminally ill: a cross-country case comparison study of Canada, England, Germany, and the United States. Palliat Med 2014; 28:111-20. [PMID: 23801462 DOI: 10.1177/0269216313493342] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Why do many patients not die at their preferred location? AIM Analyze system-level characteristics influencing the ability to implement best practices in delivering care for terminally ill adults (barriers and facilitators). DESIGN Cross-country comparison study from a "most similar-most different" perspective, triangulating evidence from a scoping review of the literature, document analyses, and semi-structured key informant interviews. SETTING Case study of Canada, England, Germany, and the United States. RESULTS While similar with regard to leading causes of death, patient needs, and potential avenues to care, different models of service provision were employed in the four countries studied. Although hospice and palliative care services were generally offered with standard care along the disease continuum and in various settings, and featured common elements such as physical, psycho-social, and spiritual care, outcomes (access, utilization, etc.) varied across jurisdictions. Barriers to best practice service provision included legislative (including jurisdictional), regulatory (e.g. education and training), and financial issues as well as public knowledge and perception ("giving up hope") challenges. Advance care planning, dedicated and stable funding toward hospice and palliative care, including caregiver benefits, population aging, and standards of practice and guidelines to hospice and palliative care, were identified as facilitators. CONCLUSION Successful implementation of effective and efficient best practice approaches to care for the terminally ill, such as shared care, requires concerted action to align these system-level characteristics; many factors were identified as being essential but not sufficient. Policy implementation needs to be tailored to the respective health-care system(s), monitored, and fine-tuned.
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Affiliation(s)
- Christopher A Klinger
- 1Institute of Health Policy, Management & Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
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Hardiman L. The Case for Early Palliative Care in the Treatment of Ovarian Cancer. J Adv Pract Oncol 2014; 5:290-3. [PMID: 26110073 PMCID: PMC4457184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Greer JA, Jackson VA, Meier DE, Temel JS. Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA Cancer J Clin 2013; 63:349-63. [PMID: 23856954 DOI: 10.3322/caac.21192] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/01/2013] [Accepted: 04/02/2013] [Indexed: 12/25/2022] Open
Abstract
Scientific advances in novel cancer therapeutics have led to remarkable changes in oncology practice and longer lives for patients diagnosed with incurable malignancies. However, the myriad options for treatment have established a culture of cancer care that has not been matched with a similar availability of efficacious supportive care interventions aimed at relieving debilitating symptoms due to progressive disease and treatment side effects. Accumulating data show that the introduction of palliative care services at the time of diagnosis of advanced cancer leads to meaningful improvement in the experiences of patients and family caregivers by emphasizing symptom management, quality of life, and treatment planning. In this review article, the rationale and evidence base for this model of early palliative care services integrated into standard oncology care are presented. In addition, the implications and limitations of the existing data to 1) elucidate the mechanisms by which early palliative care benefits patients and families; 2) guide the dissemination and application of this model in outpatient settings; and 3) inform health care policy regarding the delivery of high-quality, cost-effective, and comprehensive cancer care are discussed.
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Affiliation(s)
- Joseph A Greer
- Assistant Professor of Psychology, Harvard Medical School, and Assistant in Psychology, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Seow H, Bainbridge D, Bryant D. Palliative care programs for patients with breast cancer: the benefits of home-based care. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
SUMMARY Improving breast cancer care means enhancing end-of-life care with specialized palliative care services. Palliative care embodies a holistic approach to care that focuses on symptom management of individuals with incurable diseases, whereas end-of-life care specifically focuses on a period of time, such as the last 6 months of life, where a rapid state of decline is often evident. The purpose of this article is to explore the benefits and limitations of end-of-life care provided in the hospital and community settings, with an emphasis on the benefits of home-based care. A key strength of home-based palliative care is the ability to expand the reach of palliative care to more cancer patients beyond residential hospice or hospital settings, which are limited in bed availability. The essential features of quality end-of-life services, regardless of setting, are care that offers seamless transitions, around-the-clock access to the same providers and an interdisciplinary, whole-person approach.
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Affiliation(s)
- Hsien Seow
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, 699 Concession St, 4th Floor, Room 4-229, Hamilton, ON L8V 5C2, Canada
| | - Deanna Bryant
- Department of Oncology, McMaster University, 699 Concession St, 4th Floor, Room 4-229, Hamilton, ON L8V 5C2, Canada
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Adams JA, Bailey DE, Anderson RA, Thygeson M. Finding your way through EOL challenges in the ICU using Adaptive Leadership behaviours: A qualitative descriptive case study. Intensive Crit Care Nurs 2013; 29:329-36. [PMID: 23879936 DOI: 10.1016/j.iccn.2013.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Using the Adaptive Leadership framework, we describe behaviours that providers used while interacting with family members facing the challenges of recognising that their loved one was dying in the ICU. RESEARCH METHODOLOGY In this prospective pilot case study, we selected one ICU patient with end-stage illness who lacked decision-making capacity. Participants included four family members, one nurse and two physicians. The principle investigator observed and recorded three family conferences and conducted one in-depth interview with the family. Three members of the research team independently coded the transcripts using a priori codes to describe the Adaptive Leadership behaviours that providers used to facilitate the family's adaptive work, met to compare and discuss the codes and resolved all discrepancies. FINDINGS We identified behaviours used by nurses and physicians that facilitated the family's ability to adapt to the impending death of a loved one. Examples of these behaviours include defining the adaptive challenges for families and foreshadowing a poor prognosis. CONCLUSIONS Nurse and physician Adaptive Leadership behaviours can facilitate the transition from curative to palliative care by helping family members do the adaptive work of letting go. Further research is warranted to create knowledge for providers to help family members adapt.
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Affiliation(s)
- Judith A Adams
- Duke University School of Nursing (DUSON), Durham, NC, United States.
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Epstein AS, Morrison RS. Palliative oncology: identity, progress, and the path ahead. Ann Oncol 2012; 23 Suppl 3:43-8. [PMID: 22628415 DOI: 10.1093/annonc/mds087] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Palliative care is a rapidly growing subspecialty of medicine entailing expert and active assessment, evaluation and treatment of the physical, psychological, social and spiritual needs of patients and families with serious illnesses. It provides an added layer of support to the patient's regular medical care. As cancer is detected earlier and its treatments improve, palliative care is increasingly playing a vital role in the oncology population. Because of these advances in oncology, the role of palliative care services for such patients is actively evolving. Herein, we will highlight emerging paradigms in palliative care and attempt to delineate key education, research and policy areas that lie ahead for the field of palliative oncology. Despite the critical need for improving multi-faceted and multi-specialty symptom management and patient-physician communication, we will focus on the interface between palliative care and oncology specialists, a relationship that can lead to better overall patient care on all of these levels.
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Affiliation(s)
- A S Epstein
- The Lilian and Benjamin Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
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Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, Cooper D, Gansler T, Lerro C, Fedewa S, Lin C, Leach C, Cannady RS, Cho H, Scoppa S, Hachey M, Kirch R, Jemal A, Ward E. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 2012; 62:220-41. [PMID: 22700443 DOI: 10.3322/caac.21149] [Citation(s) in RCA: 2041] [Impact Index Per Article: 170.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although there has been considerable progress in reducing cancer incidence in the United States, the number of cancer survivors continues to increase due to the aging and growth of the population and improvements in survival rates. As a result, it is increasingly important to understand the unique medical and psychosocial needs of survivors and be aware of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship. To highlight the challenges and opportunities to serve these survivors, the American Cancer Society and the National Cancer Institute estimated the prevalence of cancer survivors on January 1, 2012 and January 1, 2022, by cancer site. Data from Surveillance, Epidemiology, and End Results (SEER) registries were used to describe median age and stage at diagnosis and survival; data from the National Cancer Data Base and the SEER-Medicare Database were used to describe patterns of cancer treatment. An estimated 13.7 million Americans with a history of cancer were alive on January 1, 2012, and by January 1, 2022, that number will increase to nearly 18 million. The 3 most prevalent cancers among males are prostate (43%), colorectal (9%), and melanoma of the skin (7%), and those among females are breast (41%), uterine corpus (8%), and colorectal (8%). This article summarizes common cancer treatments, survival rates, and posttreatment concerns and introduces the new National Cancer Survivorship Resource Center, which has engaged more than 100 volunteer survivorship experts nationwide to develop tools for cancer survivors, caregivers, health care professionals, advocates, and policy makers.
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Affiliation(s)
- Rebecca Siegel
- Surveillance Information, Surveillance Research, American Cancer Society, Atlanta, GA 30303, USA.
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Schulman-Green D, Ercolano E, Jeon S, Dixon J. Validation of the knowledge of care options instrument to measure knowledge of curative, palliative, and hospice care. J Palliat Med 2012; 15:1091-9. [PMID: 22694739 DOI: 10.1089/jpm.2011.0514] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Treatment decision-making may be hindered by a lack of knowledge about the care options of curative, palliative, and hospice care. Our purpose was to create and validate an instrument to measure knowledge of these care options, the Knowledge of Care Options (KOCO) instrument. METHODS We began by generating a pool of true-false items. Experts (n=32) evaluated items in two rounds of review. For each round, we calculated Content Validity Indexes for each item and for the total scale (S-CVI). Items were revised or dropped as indicated. The clarity and acceptability of KOCO were assessed through cognitive interviews with 10 men and women with cancer. We pilot-tested KOCO with a target population sample of 23 women with metastatic breast cancer as part of larger study testing self-management training materials that included a module on care options. RESULTS Following expert review, the S-CVI was 85.2%, and the KOCO consisted of 11 items. Cognitive interviews showed KOCO to be clear and acceptable. The KR-20 test revealed high internal consistency of 0.89. In the pilot test, the mean pre-test score was 9.3 items correct (SD 1.29). The mean post-test score was 10.21 items correct (SD 0.92). KOCO captured change in knowledge of care options (signed rank test=42.5, p<0.006). CONCLUSIONS KOCO is a brief, acceptable instrument capable of assessing knowledge of curative, palliative, and hospice care. Additional testing is needed with larger samples to assess the utility of KOCO for use with various patient populations, family caregivers, and clinicians.
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Kirch RA, Brawley O. Palliative care: a lifeline to quality of life. J Oncol Pract 2012; 8:128-9. [PMID: 23077441 DOI: 10.1200/jop.2011.000530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2012] [Indexed: 11/20/2022] Open
Abstract
ASCO's Provisional Clinical Opinion offers the opportunity to bring clinicians a significant step forward in delivering truly patient-centered, family-focused care that can make a difference.
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Arends J, Mross K, Pletschen L, Azémar M. Palliative Treatment: Anticancer, Antisymptom, or End-of-Life Care? J Clin Oncol 2011; 29:4591; author reply 4591-2. [DOI: 10.1200/jco.2011.38.9635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jann Arends
- Tumor Biology Center at Albert-Ludwigs University, Freiburg, Germany
| | - Klaus Mross
- Tumor Biology Center at Albert-Ludwigs University, Freiburg, Germany
| | - Lars Pletschen
- Tumor Biology Center at Albert-Ludwigs University, Freiburg, Germany
| | - Marc Azémar
- Tumor Biology Center at Albert-Ludwigs University, Freiburg, Germany
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