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Ajibawo T, Okunowo O. Prevalence and Factors Associated With Palliative Care Utilization Among Hospitalized Patients With Gallbladder Cancer- A National Inpatient Sample Analysis. Am J Hosp Palliat Care 2024:10499091241262968. [PMID: 38881223 DOI: 10.1177/10499091241262968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVES Various factors have been associated with palliative utilization in different cancers. However, literature is still lacking on the prevalence and factors associated with palliative care use in gallbladder cancer (GBC). This study aims to determine the prevalence of palliative care utilization and examine the factors associated with palliative care utilization among patients with GBC. METHODS We conducted a retrospective analysis using the National Inpatient Sample between 2016 and 2018. Descriptive statistics were used to characterize the study population. We explored factors associated with palliative care utilization among hospitalized GBC patients using logistic regression. RESULTS Of the 20280 GBC hospitalizations, 18.0 % utilized palliative care. Multivariable analysis revealed that treatment at urban teaching hospitals, or treatment at urban nonteaching hospitals, Medicare insurance, other insurance coverage, transfer to a facility/discharge with home health, and death during hospital stay were associated with higher utilization of palliative care. In contrast, non-elective admissions were associated with decreased odds of palliative care utilization. CONCLUSION Palliative care use among GBC patients is still low at 18.0%. Palliative care use was associated with insurance disparities, discharge disposition, hospital location, and type of admission. Therefore, concerted efforts to address these disparities in palliative care utilization are needed to improve the quality of care for this population.
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Affiliation(s)
| | - Oluwatimilehin Okunowo
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, CA, USA
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Bischoff KE, Vanegas G, O'Riordan DL, Sumser B, Long J, Lin J, Berkey AR, Kobayashi E, Zapata C, Rabow MW, Pantilat SZ. A Systematic Approach to Assessing and Addressing Palliative Care Needs in an Outpatient Population. J Pain Symptom Manage 2023; 66:270-280.e8. [PMID: 37380147 DOI: 10.1016/j.jpainsymman.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
CONTEXT/OBJECTIVES A critical frontier for palliative medicine is to develop systems to routinely and equitably address the palliative care (PC) needs of seriously ill populations. METHODS An automated screen identified Medicare primary care patients who had serious illness based on diagnosis codes and utilization patterns. A stepped-wedge design was used to evaluate a six-month intervention through which a healthcare navigator assessed these seriously ill patients and their care partners for PC needs in the domains of 1) physical symptoms, 2) emotional distress, 3) practical concerns, and 4) advance care planning (ACP) via telephone surveys. Identified needs were addressed with tailored PC interventions. RESULTS A total of 292/2175 (13.4%) patients screened positive for serious illness. A total of 145 completed an intervention phase; 83 completed a control phase. Severe physical symptoms were identified in 27.6%, emotional distress in 57.2%, practical concerns in 37.2%, and ACP needs in 56.6%. Twenty-five intervention patients (17.2%) were referred to specialty PC compared to six control patients (7.2%). Prevalence of ACP notes increased 45.5%-71.7% (p = 0.001) during the intervention and remained stable during the control phase. Quality of life remained stable during the intervention and declined 7.4/10-6.5/10 (P =0.04) during the control phase. CONCLUSION Through an innovative program, patients with serious illness were identified from a primary care population, assessed for PC needs, and offered specific services to meet those needs. While some patients were appropriate for specialty PC, even more needs were addressed without specialty PC. The program resulted in increased ACP and preserved quality of life.
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Affiliation(s)
- Kara E Bischoff
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA.
| | - Gabriela Vanegas
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - David L O'Riordan
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Bridget Sumser
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Judy Long
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Jessica Lin
- University Medical Partners (J.L.), Stanford Healthcare, Stanford, California, USA
| | - Ann R Berkey
- The Berkey Group (A.R.B.), San Francisco, California, USA
| | - Edward Kobayashi
- Department of Family and Community Medicine (E.K.), University of California, San Francisco, San Francisco, California, USA
| | - Carly Zapata
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Michael W Rabow
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine (K.E.B., G.V., D.L.O-R., B.S., J.L., C.Z., M.W.R., S.Z.P.), University of California, San Francisco, California, USA
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Amare N, Gintamo B, Tukeni KN, Gebremichael EH, Abera EG. The Prevalence of Cancer Patients Requiring Palliative Care and Its Associated Factors at St. Paul Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study. Risk Manag Healthc Policy 2023; 16:1203-1214. [PMID: 37404288 PMCID: PMC10315136 DOI: 10.2147/rmhp.s415532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/24/2023] [Indexed: 07/06/2023] Open
Abstract
Background Cancer has been the leading cause of death worldwide with its various enormous socio-economic impacts. Hence, early palliative care implementation is a potent addition to oncology for the treatment of physical, mental, and psychological pain in cancer patients. Therefore, this article aims to assess the prevalence of patients requiring palliative care and its associated factors among admitted cancer patients. Methods A cross-sectional study was conducted among cancer patients who were admitted to oncology wards during the data collection period at St. Paul Hospital, Ethiopia. The Palliative Care Indicators Tool in Low-Income Settings (SPICT-LIS) was used to determine the need for palliative care. The collected data was entered into EpiData version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 26 for analysis. A multivariable logistic regression was used to analyze the predictors of palliative care need. Results A total of 301 cancer patients were included in this study, with a mean age of 42 years (SD=1.38). The prevalence of palliative care needs among the patients in this study was 10.6% (n=32). The study revealed that the need for palliative care increases as the age of the patient increases and suggested that cancer patients who were above 61 years old were two times (AOR=2.39 95% CI=0.34-16.55) more likely to need palliative care than others. Male patients had a significantly higher requirement for palliative care compared to female patients (AOR=5.31, 95% CI=1.68-11.79). Conclusion The manuscript describes the palliative care needs of patients with cancer admitted to St. Paul Hospital in Ethiopia. The study revealed that the health status of a significant number of cancer patients in the hospital was deteriorating. Hence, the hospital administrators and the oncology ward staff are recommended to pay attention to the identified factors.
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Affiliation(s)
- Nigist Amare
- Department of Gynecology and Obstetrics, St. Paul Hospital, Addis Ababa, Ethiopia
| | - Biniyam Gintamo
- Department of Public Health, Addis Ababa Medical and Business College, Addis Ababa, Ethiopia
| | | | | | - Eyob Girma Abera
- Department of Public Health, Jimma University, Jimma, Oromia, Ethiopia
- Clinical Trial Unit, Jimma University, Jimma, Oromia, Ethiopia
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Khan NN, Evans SM, Ioannou LJ, Pilgrim CHC, Blanchard M, Daveson B, Philip J, Zalcberg JR, Te Marvelde L. Characteristics of patients diagnosed with pancreatic cancer who access palliative care: An observational study. Qual Life Res 2023:10.1007/s11136-023-03425-x. [PMID: 37133625 PMCID: PMC10393853 DOI: 10.1007/s11136-023-03425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE Despite the benefits of palliative care (PC) in pancreatic cancer, little is known about patients who access PC. This observational study examines the characteristics of patients with pancreatic cancer at their first episode of PC. METHODS First-time, specialist PC episodes captured through the Palliative Care Outcomes Collaboration (PCOC), in Victoria, Australia between 2014 and 2020, for pancreatic cancer, were identified. Multivariable logistic regression analyses examined the impact of patient- and service-level characteristics on symptom burden (measured through patient-reported outcome measures and clinician-rated scores) at first PC episode. RESULTS Of 2890 eligible episodes, 45% began when the patient was deteriorating and 32% ended in death. High fatigue and appetite-related distress were most common. Generally, increasing age, higher performance status and more recent year of diagnosis predicted lower symptom burden. No significant differences were noted between symptom burden of regional/remote versus major city dwellers; however, only 11% of episodes recorded the patient as a regional/remote resident. A greater proportion of first episodes for non-English-speaking patients began when the patient was unstable, deteriorating or terminal, ended in death and were more likely to be associated with high family/carer problems. Community PC setting predicted high symptom burden, with the exception of pain. CONCLUSION A large proportion of first-time specialist PC episodes in pancreatic cancer begin at a deteriorating phase and end in death, suggesting late access to PC. Timely referrals to community-based specialist PC, access in regional/remote areas, as well as development of culturally diverse support systems require further investigation.
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Affiliation(s)
- Nadia N Khan
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sue M Evans
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Liane J Ioannou
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Charles H C Pilgrim
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Megan Blanchard
- Palliative Care Outcomes Collaboration, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Barbara Daveson
- Palliative Care Outcomes Collaboration, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Jennifer Philip
- Department of Medicine, University of Melbourne, St Vincent's Hospital Campus, Victoria Pde, Fitzroy, VIC, 3000, Australia
| | - John R Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Luc Te Marvelde
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.
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Jackson I, Etuk A, Jackson N. Prevalence and Predictors of Palliative Care Utilization among Hospitalized Patients with Diffuse Large B-Cell Lymphoma. J Palliat Care 2023; 38:167-174. [PMID: 35006019 DOI: 10.1177/08258597211073226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Research has shown that palliative care improves the quality of life of cancer patients; however, there is no literature on specific factors that predict its use in diffuse large b-cell lymphoma (DLBCL) patients. Therefore, the prevalence of palliative care utilization and predictors of palliative care utilization among patients with DLBCL were examined. Methods: Data from the National Inpatient Sample (NIS) collected between 2016 to 2018 were used for all analyses. Multivariable logistic regression models were used to examine the predictors of palliative care utilization among hospitalized patients with DLBCL. Descriptive analyses were used to explore the overall prevalence of palliative care receipt in this population. Results: Of the 41,789 hospitalizations, 7.1% of patients used palliative care during hospitalization, while 4.8% utilized palliative care and were discharged alive. DLBCL patients aged 70 and older had 1.3 times (95% CI: 1.14-1.41) higher odds of utilizing palliative care compared to those less than 70 years. Relative to Medicare/Medicaid patients, those with other types of insurance were 1.7 times (95% CI: 1.34-2.05) more likely to receive palliative care. Those who were either transferred to a facility/discharged with home health (AOR: 6.23; 95% CI: 5.21-7.44) or died during hospitalization (AOR: 45.17; 95% CI: 36.98-55.17) had higher odds of receiving palliative care when relative to those with a routine hospital discharge. Other associated factors were type of admission, length of stay, chemotherapy receipt, and number of comorbidities. Conclusions: The prevalence of palliative care utilization was low and factors predicting utilization in our population were identified. Our findings highlight the need to increase awareness among medical oncologists on the need to involve the palliative care team early in the management of hospitalized patients with DLBCL.
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Affiliation(s)
| | - Aniekeme Etuk
- University of Texas School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nsikak Jackson
- University of Texas School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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6
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Jackson I, Jackson N, Etuk A. Prevalence and Factors Associated with Palliative Care Utilization among Hospitalized Patients with Esophageal Cancer in the United States. J Palliat Care 2023; 38:192-199. [PMID: 35837723 DOI: 10.1177/08258597221113716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Due to poor 5-year survival and high symptom burden, esophageal cancer (EC) patients benefit markedly from palliative care utilization. However, there is scant literature exploring factors associated with receipt of palliative care in this population. The prevalence of palliative care consultations among hospitalized EC patients was assessed. Furthermore, we examined the factors associated with palliative care utilization among hospitalized patients with EC. Methods: Retrospective analyses were conducted using the National Inpatient Sample data collected between 2016 and 2018. Descriptive analyses were used to explore the overall prevalence of palliative care utilization. Univariate and multivariable regression models were used to examine factors associated with palliative care utilization among hospitalized EC patients. Results: The overall prevalence of palliative care utilization was 15.97%. Non-Hispanic Blacks had 1.16 times (95% CI: 1.00-1.34) higher odds of palliative care utilization compared to non-Hispanic Whites. Compared to patients on Medicare, those on Medicaid (AOR: 1.21; 95% CI: 1.02-1.45), private (AOR: 1.19; 95% CI: 1.06-1.35) and other insurance types (AOR: 1.68; 95% CI: 1.39-2.02) were more likely to utilize palliative care. Relative to patients hospitalized in the Northeast, those in Midwest (AOR: 1.34; 95% CI: 1.17-1.53), south (AOR: 1.28; 95% CI: 1.12-1.45), and west (AOR: 1.41; 95% CI: 1.22-1.61) were more likely to receive palliative care. Patients admitted to urban teaching hospitals (AOR: 1.28; 95% CI: 1.07-1.52) had higher odds of having palliative care consultations when compared to their counterparts in rural hospitals. Also, patients who were either discharged to a facility/with home health (OR: 5.39; 95% CI: 4.76-6.10) or died during hospitalization (OR: 26.93; 95% CI: 23.31-31.11) had higher odds of utilizing palliative care when compared to those with a routine discharge. Other factors identified were median household income quartiles, admission type, chemotherapy receipt, and the number of comorbidities. Conclusions: Our findings highlight the need to further analyze and address factors that may hinder palliative care utilization among hospitalized EC patients to decrease disparities and improve their quality of life. Hospital physicians and health systems need to be more proactive about palliative care consultations to maximize the benefits to these sick cancer patients.
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Affiliation(s)
- Inimfon Jackson
- Department of Medicine, Einstein Medical Center, Philadelphia, USA
| | - Nsikak Jackson
- Department of Management, Policy and Community Health, University of Texas School of Public Health, 12340University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Aniekeme Etuk
- Department of Internal Medicine, Thomas Hospital Infirmary Health, Fairhope, Alabama, USA
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Shamieh O, Alarjeh G, Li H, Abu Naser M, Abu Farsakh F, Abdel-Razeq R, Edilbi A, Al-Ani R, Harding R, Guo P. Care Needs and Symptoms Burden of Breast Cancer Patients in Jordan: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10787. [PMID: 36078504 PMCID: PMC9517868 DOI: 10.3390/ijerph191710787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
Breast cancer is the most common malignancy in Jordan. Rigorous needs assessment for breast cancer patients can prioritize both cancer care and palliative care to propose the appropriate services effectively. We conducted a cross-sectional study of breast cancer patients in a cancer center in Jordan. We assessed symptom burden, comorbidities, and performance using the Edmonton Symptom Assessment System (ESAS), the Charlson Comorbidity Index (CCI), and the Australia-modified Karnofsky performance scale (AKPS). Descriptive analysis and regression models to predict the highest symptom burden were used. A total of 233 participants were enrolled: curative vs. palliative intent groups (147 (63%) vs. 86 (37%) patients), respectively. Tiredness was the most reported symptom in 189 patients (81%), while nausea was the least in 61 patients (26.2%). A relationship between the AKPS score and total ESAS was seen (correlation coefficient of -0.487; p < 0.0001). The prevalence of anxiety (p = 0.014), lack of appetite (p = 0.002), poor well-being (p < 0.001), and sleep disorder (p = 0.035) was higher in the palliative care intent group than in the curative one. We identified unmet needs in breast cancer patients. Both groups showed a prevalence of distressing symptoms suggesting that even those with non-palliative intent have high needs and should receive integrated palliative care.
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Affiliation(s)
- Omar Shamieh
- Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdulla St., Amman 11941, Jordan
- Center for Palliative & Cancer Care in Conflict, King Hussein Cancer Center, Amman 11941, Jordan
- Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Ghadeer Alarjeh
- Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdulla St., Amman 11941, Jordan
- Center for Palliative & Cancer Care in Conflict, King Hussein Cancer Center, Amman 11941, Jordan
| | - Houshen Li
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE5 9PJ, UK
| | - Mahmoud Abu Naser
- Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdulla St., Amman 11941, Jordan
- Department of Medicine, King Hussein Cancer Center, Amman 11941, Jordan
| | - Fadi Abu Farsakh
- Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdulla St., Amman 11941, Jordan
| | | | - Adib Edilbi
- Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdulla St., Amman 11941, Jordan
| | - Ruba Al-Ani
- Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdulla St., Amman 11941, Jordan
| | - Richard Harding
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE5 9PJ, UK
| | - Ping Guo
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE5 9PJ, UK
- School of Nursing & Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Baguley SI, Pavlova A, Consedine NS. More than a feeling? What does compassion in healthcare 'look like' to patients? Health Expect 2022; 25:1691-1702. [PMID: 35661516 PMCID: PMC9327826 DOI: 10.1111/hex.13512] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Compassion is important to patients and their families, predicts positive patient and practitioner outcomes, and is a professional requirement of physicians around the globe. Yet, despite the value placed on compassion, the empirical study of compassion remains in its infancy and little is known regarding what compassion 'looks like' to patients. The current study addresses limitations in prior work by asking patients what physicians do that helps them feel cared for. METHODS Topic modelling analysis was employed to identify empirical commonalities in the text responses of 767 patients describing physician behaviours that led to their feeling cared for. RESULTS Descriptively, seven meaningful groupings of physician actions experienced as compassion emerged: listening and paying attention (71% of responses), following-up and running tests (11%), continuity and holistic care (8%), respecting preferences (4%), genuine understanding (2%), body language and empathy (2%) and counselling and advocacy (1%). CONCLUSION These findings supplement prior work by identifying concrete actions that are experienced as caring by patients. These early data may provide clinicians with useful information to enhance their ability to customize care, strengthen patient-physician relationships and, ultimately, practice medicine in a way that is experienced as compassionate by patients. PUBLIC CONTRIBUTION This study involves the analysis of data provided by a diverse sample of patients from the general community population of New Zealand.
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Affiliation(s)
- Sofie I. Baguley
- Department of Psychological Medicine, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Alina Pavlova
- Department of Psychological Medicine, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Nathan S. Consedine
- Department of Psychological Medicine, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
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Koenig Kellas J, Castle KM, Johnson AZ, Cohen MZ. Cancer as Communal: Understanding Communication and Relationships from the Perspectives of Survivors, Family Caregivers, and Health Care Providers. HEALTH COMMUNICATION 2021; 36:280-292. [PMID: 31665940 DOI: 10.1080/10410236.2019.1683952] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
With cancer increasing in prevalence and high priorities placed on concurrent oncological and palliative care to help meet the familial, spiritual, and individual needs of stakeholders in cancer, research is needed that assesses the factors that facilitate coping across stakeholders in cancer care. We were interested in synthesizing our understanding of communication and relationships among patients, caregivers, and providers based on the reasoning that illness is relational, but often conceptualized and researched from the individual perspectives of various stakeholders. The current study examined the experiences of relational and communication opportunities and challenges during cancer for current and former family caregivers, cancer survivors, and palliative and oncology health care practitioners. The thematic analysis of 30 semi-structured interviews revealed an overarching theme on the benefits of orienting toward cancer as communal, which was, in turn, facilitated or impeded by four additional themes/sets of behaviors: support, presence, perspective-taking, and reframing hope. Results of a cross-case data matrix analysis reveal that stakeholders in different roles experience qualitative differences in their experience of cancer as communal, isolated, or ambivalent. Implications for education, palliative care, and interventions are discussed.
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Affiliation(s)
| | | | - Alexis Z Johnson
- Department of Communication and Journalism, Arkansas Tech University
| | - Marlene Z Cohen
- Department of Nursing, VA Nebraska Western Iowa Healthcare System, College of Nursing, University of Nebraska Medical Center
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10
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Lau N, Parsa AG, Walsh C, Yi-Frazier JP, Weiner BJ, Curtis JR, McCauley E, Rosenberg AR, Barton K. Facilitators and Barriers to Utilization of Psychosocial Care in Adolescents and Young Adults with Advanced Cancer: Integrating Mobile Health Perspectives. J Adolesc Young Adult Oncol 2020; 10:476-482. [PMID: 32985937 DOI: 10.1089/jayao.2020.0129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose: Although targeted psychosocial programming for adolescents and young adults (AYAs) with advanced cancer is a well-described priority, how best to engage AYAs in that programming is less clear. We aimed to examine AYA perspectives on facilitators and barriers to utilization of psychosocial programs and preferred mode of delivery. Methods: In this nested cohort study, AYAs participated in semistructured 1:1 interviews on communication needs. The present analysis focused on questions regarding psychosocial program delivery. Data were analyzed using directed content analysis followed by thematic content analysis to further organize and refine identified global themes and organizational themes. Results: We interviewed 32 patients (Mage = 18, range 14-25, 41% female). Key facilitators to utilization of psychosocial services by AYAs were to (1) align in importance of coping skills, (2) emphasize AYA self-motivation and agency in approach and introduction to services, and (3) offer services to everyone and at multiple timepoints. Key AYA barriers included (1) considering themselves an exception to the rule when discussing the psychosocial needs of AYAs with cancer, (2) the challenge of starting something new, and (3) reluctance to share emotional problems with psychosocial clinicians. Regarding the mode of delivery, some preferred in-person delivery due to opportunities for developing a close relationship and therapeutic rapport-building. Mobile app-based delivery was universally appealing. Conclusion: We provide a potential framework to increase uptake of psychosocial services in the high needs population of AYAs with advanced cancer. Future research will explore implementation strategies for increasing AYA engagement in psychosocial intervention programs.
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Affiliation(s)
- Nancy Lau
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Arta Gharib Parsa
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,UC Davis School of Medicine, Davis, California, USA
| | - Casey Walsh
- Department of Health Services, University of Washington, Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Abby R Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Krysta Barton
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
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Zanatta F, Maffoni M, Giardini A. Resilience in palliative healthcare professionals: a systematic review. Support Care Cancer 2019; 28:971-978. [PMID: 31811483 PMCID: PMC7223999 DOI: 10.1007/s00520-019-05194-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/20/2019] [Indexed: 11/07/2022]
Abstract
Purpose Exposure to end-of-life and chronic illness on a daily basis may put palliative healthcare professionals’ well-being at risk. Resilience may represent a protective factor against stressful and demanding challenges. Therefore, the aim is to systematically review the quantitative studies on resilience in healthcare professionals providing palliative care to adult patients. Methods A literature search on PubMed, Scopus, Web of Science and PsycINFO databases was performed. The review process has followed the international PRISMA statement guidelines. Results At the initial search, a total of 381 records were identified. Twelve articles were assessed for eligibility and, finally, 6 studies met all the inclusion criteria. Of these, four researches were observational and two interventional pilot studies. From the systematic synthesis, palliative care providers’ resilience revealed to be related to other psychological constructs, including secondary traumatic stress, vicarious posttraumatic growth, death anxiety, burnout, compassion satisfaction, hope and perspective taking. Conclusions The current systematic review reported informative data leading to consider resilience as a process modulator and facilitator among palliative care professionals. A model on palliative healthcare providers’ experience and the role of resilience was proposed. Further studies may lead to its validation and implementation in assessment and intervention contributing to foster palliative healthcare professionals’ well-being.
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Affiliation(s)
- Francesco Zanatta
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marina Maffoni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Anna Giardini
- Psychology Unit - Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, 27040, Montescano, PV, Italy.
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Curing Opioid Toxicity with Intrathecal Targeted Drug Delivery. Case Rep Med 2019; 2019:3428576. [PMID: 31223311 PMCID: PMC6541971 DOI: 10.1155/2019/3428576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/16/2019] [Accepted: 05/02/2019] [Indexed: 11/24/2022] Open
Abstract
Pain is one of the most feared symptoms that concern cancer patients and their families. Despite well-established guidelines set forth by the World Health Organization (WHO) on the treatment of cancer pain, nearly half of cancer patients report poorly controlled pain. One of the most serious side effects of systemic oral opioid use is neurotoxicity, which is characterized by altered mental status and systemic neurologic impairments. Treatment strategies are supportive in nature and focused on reducing or changing the offending opioid and correcting any metabolic deficiencies. Herein, we discuss a case of opioid-induced neurotoxicity treated with intrathecal targeted drug delivery (TDD). The timing and implementation of advanced therapies such as intrathecal TDD is not well delineated. More importantly, patients and their oncologic providers are often unaware of this useful tool in treating challenging cancer-associated pain and significantly minimizing systemic opioid side effects. To ensure that patients have comprehensive oncologic care, best-practice guidelines suggest involvement of an interdisciplinary team and coordinated care. Early referral to a pain and palliative specialist may allow for improved patient outcomes and removal of unnecessary barriers to optimal patient care.
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DiMartino LD, Weiner BJ, Hanson LC, Weinberger M, Birken SA, Reeder-Hayes K, Trogdon JG. The impact of two triggered palliative care consultation approaches on consult implementation in oncology. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2019; 7:38-43. [PMID: 29273303 PMCID: PMC6008181 DOI: 10.1016/j.hjdsi.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/31/2017] [Accepted: 12/05/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Studies show palliative care delivered concurrently with cancer treatment improves outcomes, yet palliative care integration with inpatient oncology is underused. A promising approach to improve integration is a triggered palliative care consultation (TPCC). This study evaluated the impact of two TPCC approaches on consistency and quality of consult implementation, operationalized as uptake and timeliness, on solid tumor medical and gynecologic oncology services at an academic hospital. METHODS The study timeframe was 2010-2016. TPCC in gynecologic oncology began in 2014 and was supported by a single strategy (written guideline); TPCC in medical oncology began in 2015 and was supported by multiple strategies (e.g. training, chart review). Palliative care consult information was chart abstracted and linked to hospital encounter data. We compared the effect of a single strategy vs. usual care, and multiple strategies vs. a single strategy on implementation. Difference-in-differences modified Poisson regression models evaluated whether implementation differed after TPCC; we estimated adjusted relative risk (aRR), controlling for patient demographic and clinical characteristics. RESULTS Overall, 8.8% of medical oncology and 11.0% of gynecologic oncology inpatient encounters involved palliative care consultation. In regression analyses, TPCC supported by a single strategy in gynecologic oncology was associated with greater uptake vs. usual care (aRR: 1.45, p < .05), and TPCC supported by multiple strategies in medical oncology was associated with greater uptake vs. a single strategy (aRR: 2.34, p < .001). CONCLUSION Across two inpatient oncology services, TPCC supported by multiple strategies had the greatest impact on uptake. How strategies affect sustained use of palliative care consults remains to be investigated.
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Affiliation(s)
- Lisa D DiMartino
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC 27599-7411, USA; RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, USA.
| | - Bryan J Weiner
- Department of Global Health, Department of Health Services, Box 357965, University of Washington, Seattle, WA 98195-7965, USA.
| | - Laura C Hanson
- Division of Geriatric Medicine Center for Aging and Health, UNC Palliative Care Program, 5003 Old Clinic Building, Campus Box 7550, Chapel Hill, NC 27599-7550, USA.
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC 27599-7411, USA.
| | - Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC 27599-7411, USA.
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC 27599-7411, USA.
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Boucher NA, Bull JH, Cross SH, Kirby C, Davis JK, Taylor DH. Patient, Caregiver, and Taxpayer Knowledge of Palliative Care and Views on a Model of Community-Based Palliative Care. J Pain Symptom Manage 2018; 56:951-956. [PMID: 30149059 DOI: 10.1016/j.jpainsymman.2018.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 11/21/2022]
Abstract
CONTEXT Palliative care (PC) model delivered by two large hospices and PC providers. OBJECTIVES To understand study participants' knowledge of PC and acceptability of a new community-based PC model. METHODS Semistructured interview with patients and caregivers; focus groups with taxpayers. Descriptive content analysis with an inductive approach. RESULTS Across 10 interviews and four focus groups (n = 4-10 per group), there was varying knowledge of PC. Gaps in interview and focus group participants' knowledge related to knowing the services available in PC, how PC is paid for, how to initiate PC, and how PC affects the patient's relationship with existing providers. Regarding the model, negative feedback from interview participants included not having PC explained adequately and PC providers seen as consultants and not as full-time providers. Focus group participants indicated that the model sounded promising but noted the likely difficulty in enacting it in our current health care system. Positive feedback from interview participants included the perception that clinicians spent more time and provided more support for patients and families and the developing ability of PC services to provide care more broadly than at the very end of life. Focus group participants had similar observations related to perceived attention to care and broader application of PC. Perceptions of time-constrained care delivery and suboptimal provider-patient communication persist for some patients getting PC services. CONCLUSION Education for patients, caregivers, and community members about the roles and benefits of PC will be needed to successfully expand community-based PC.
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Affiliation(s)
- Nathan A Boucher
- Durham Veteran Affairs Medical Center, Durham, North Carolina, USA; Duke University Sanford School of Public Policy, Durham, North Carolina, USA; Duke-Margolis Center for Public Policy, Durham, North Carolina, USA.
| | - Janet H Bull
- Four Seasons Hospice and Palliative Care, Flat Rock, North Carolina, USA
| | - Sarah H Cross
- Duke University Sanford School of Public Policy, Durham, North Carolina, USA
| | - Christine Kirby
- Duke-Margolis Center for Public Policy, Durham, North Carolina, USA
| | - J Kelly Davis
- Duke-Margolis Center for Public Policy, Durham, North Carolina, USA
| | - Donald H Taylor
- Duke University Sanford School of Public Policy, Durham, North Carolina, USA; Duke-Margolis Center for Public Policy, Durham, North Carolina, USA
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Dudley N, Ritchie CS, Rehm RS, Chapman SA, Wallhagen MI. Facilitators and Barriers to Interdisciplinary Communication between Providers in Primary Care and Palliative Care. J Palliat Med 2018; 22:243-249. [PMID: 30383468 DOI: 10.1089/jpm.2018.0231] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Community-based palliative care (CBPC) plays an integral role in addressing the complex care needs of older adults with serious chronic illnesses, but is premised on effective communication and collaboration between primary care providers (PCPs) and the providers of specialty palliative care (SPC). Optimal strategies to achieve the goal of coordinated care are ill-defined. OBJECTIVE The objective of this study was to understand the facilitators and barriers to optimal, coordinated interdisciplinary provision of CBPC. METHODS This was a qualitative study using a constructivist grounded theory approach. Thirty semistructured interviews were conducted with primary and palliative care interdisciplinary team members in academic and community settings. RESULTS Major categories emerging from the data that positively or negatively influence optimal provision of coordinated care included feedback loops and interactions; clarity of roles; knowledge of palliative care, and workforce and structural constraints. Facilitators were frequent in-person, e-mail, or electronic medical record-based communication; defined role boundaries; and education of PCPs to distinguish elements of generalist palliative care (GPC) and more complex elements or situations requiring SPC. Barriers included inadequate communication that prevented a shared understanding of patients' needs and goals of care, limited time in primary care to provide GPC, and limited workforce in SPC. CONCLUSIONS Our findings suggest that processes are needed that promote communication, including structured communication strategies between PCPs and SPC providers, clarification of role boundaries, enrichment of nonspecialty providers' competence in GPC, and enhanced access to CBPC.
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Affiliation(s)
- Nancy Dudley
- 1 Department of Social and Behavioral Sciences, School of Nursing, University of California , San Francisco, California.,2 San Francisco Veterans Affairs Medical Center , Geriatrics, Palliative, and Extended Care, San Francisco, California
| | - Christine S Ritchie
- 3 Division of Geriatrics, Department of Medicine, University of California , San Francisco, California
| | - Roberta S Rehm
- 4 Department of Family Health Care Nursing and School of Nursing, University of California , San Francisco, California
| | - Susan A Chapman
- 1 Department of Social and Behavioral Sciences, School of Nursing, University of California , San Francisco, California
| | - Margaret I Wallhagen
- 5 Department of Physiological Nursing, School of Nursing, University of California , San Francisco, California
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Kienle GS, Mussler M, Fuchs D, Kiene H. The Subjective Dimension of Integrative Cancer Care: A Qualitative Study Exploring the Perspectives, Themes, and Observations of Experienced Doctors from the Area of Anthroposophic Medicine. Explore (NY) 2018; 14:342-351. [PMID: 30181043 DOI: 10.1016/j.explore.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/06/2018] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Integrative cancer care (ICC) is used by approximately 50% of cancer patients to complement oncologic treatments and to address unmet needs. One ICC practice is anthroposophic medicine, integrating conventional and complementary cancer care. It specifically provides mistletoe therapy (MT), but also intensive counselling, natural remedies, creative and movement therapies, nursing procedures, nutrition, and others. The objective of this study was to explore perceptions, themes, goals, procedures, and observations of experienced AM doctors with regard to the subjective dimensions of ICC. METHOD A guideline-based qualitative interview study was conducted with 35 AM doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Triangulation was done with published studies investigating patients' perspectives on AM and MT. RESULTS The interviewed doctors integrated conventional and holistic cancer concepts. Overarching therapeutic themes were: to enable patients to live with or overcome their disease, to find their own way through their disease, and to possibly reframe their situation. A broad variety of therapeutic goals were pursued, depending on the situation and priorities of the particular patient. Doctors described varying levels of patients' improved strength; increased vitality, thermal comfort, and recovery; relief from suffering, particularly in the areas of fatigue, appetite, sleep, pain, infections, and reactions to toxic anti-cancer therapies. The doctors also described how they perceived changes of patients' emotional level, their coping, autonomy, functional abilities, and finding their own way to deal with the disease. This is consistent with patients' perspectives described in published studies. CONCLUSION Themes, goals, and described benefit of ICC from doctors' and patients' perspective may be an important complementation of conventional cancer care, as it meets important needs, distresses and conditions of patients which often stay unmet and unrelieved. Further research should investigate these goals and procedures.
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Affiliation(s)
- Gunver S Kienle
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany; Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Breisacher Str. 115B, 79106 Freiburg, Germany.
| | - Milena Mussler
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany.
| | - Dieter Fuchs
- Department of Theology, Caritas Sciences, University of Freiburg, Werthmannplatz 3, D-79098 Freiburg, Germany.
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany.
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Social Inequalities in Palliative Care for Cancer Patients in the United States: A Structured Review. Semin Oncol Nurs 2018; 34:303-315. [PMID: 30146346 DOI: 10.1016/j.soncn.2018.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To identify patterns of access to and use or provision of palliative care services in medically underserved and vulnerable groups diagnosed with cancer. DATA SOURCES Google Scholar, PubMed, MEDLINE, and Web of Science were searched to identify peer-reviewed studies that described palliative care in medically underserved or vulnerable populations diagnosed with cancer. CONCLUSION Disparities in both access and referral to palliative care are evident in many underserved groups. There is evidence that some groups received poorer quality of such care. IMPLICATIONS FOR NURSING PRACTICE Achieving health equity in access to and receipt of quality palliative care requires prioritization of this area in clinical practice and in research funding.
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Narsavage GL, Chen YJ, Korn B, Elk R. The potential of palliative care for patients with respiratory diseases. Breathe (Sheff) 2017; 13:278-289. [PMID: 29209422 PMCID: PMC5709801 DOI: 10.1183/20734735.014217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians. Early palliative care can relieve suffering and provide support for people with respiratory diseaseshttp://ow.ly/z0Hd30jpsb4
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Affiliation(s)
- Georgia L Narsavage
- Dept of Nursing, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Yea-Jyh Chen
- Kent State University - College of Nursing, Kent, OH, USA
| | - Bettina Korn
- End-of-Life Care Programme, St. James's Hospital, Dublin, Ireland
| | - Ronit Elk
- University of South Carolina - College of Nursing, Columbia, SC, USA
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Communicatively Constructing the Bright and Dark Sides of Hope: Family Caregivers' Experiences during End of Life Cancer Care. Behav Sci (Basel) 2017; 7:bs7020033. [PMID: 28505118 PMCID: PMC5485463 DOI: 10.3390/bs7020033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/22/2017] [Accepted: 05/09/2017] [Indexed: 11/30/2022] Open
Abstract
(1) Background: The communication of hope is complicated, particularly for family caregivers in the context of cancer who struggle to maintain hope for themselves and their loved ones in the face of terminality. In order to understand these complexities, the current study examines the bright and dark sides of how hope is communicated across the cancer journey from the vantage point of bereaved family caregivers; (2) Methods: We analyzed interviews with bereaved family caregivers using qualitative thematic and case oriented strategies to identify patterns in the positive and negative lived experiences when communicating about hope at the end of life; (3) Results: Two overarching patterns of hope emerged. Those who experienced hope as particularized (focused on cure) cited communication about false hope, performing (faking it), and avoidance. Those who transitioned from particularized to generalized hope (hope for a good death) reported acceptance, the communication of hope as social support, prioritizing family, and balancing hope and honesty; (4) Conclusion: Family caregivers face myriad complexities in managing the bright and dark sides of hope. Interventions should encourage concurrent oncological and palliative care, increased perspective-taking among family members, and encourage the transition from particularized to generalized hope.
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McMullen S, Szabo S, Halbert R, Lai C, Parikh A, Bunce M, Khoury R, Small A, Masaquel A. Tools for Communication: Novel Infrastructure to Address Patient-Perceived Gaps in Oncology Care. Clin J Oncol Nurs 2017; 21:E38-E48. [DOI: 10.1188/17.cjon.e38-e48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Da Rocha Rodrigues MG, Colin S, Shaha M, Pautex S. [The acceptability of the intervention Revie ⊕ : the nurses’ perceptions and experiences]. Rech Soins Infirm 2017:55-70. [PMID: 28186482 DOI: 10.3917/rsi.127.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Persons with advanced cancer experience high levels of existential distress due to being confronted with their mortality, which leads to feelings of lack of sense, or discouragement. It is important to develop interventions to relieve existential distress to promote the dignity of persons with advanced cancer in order to help them live this difficult experience in the best possible way. A new intervention, called Revie ⊕ and conducted by nurses, was developed. A feasibility study was conducted with 41 patients with advanced cancer in the ambulatory and hospital sector of a university hospital in Switzerland to determine the acceptability of Revie ⊕. The purpose of this article is to present the intervention’s acceptability from the perspective of the nurses. Nurses conducting the intervention were asked to complete a questionnaire, maintain personal notes, and to participate in one focus group. Descriptive statistics were used to analyze the questionnaire. Thematic analysis was applied to analyze the nurses’ personal notes and focus group data. Results indicate that nurses consider Revie ⊕ to be a beneficial intervention for the patients and also for their professional posture. As a consequence, the nurses wish for its implementation into practice. Recommendations are proposed to promote further implementation.
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22
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Kienle GS, Mussler M, Fuchs D, Kiene H. Individualized Integrative Cancer Care in Anthroposophic Medicine: A Qualitative Study of the Concepts and Procedures of Expert Doctors. Integr Cancer Ther 2016; 15:478-494. [PMID: 27151589 PMCID: PMC5739166 DOI: 10.1177/1534735416640091] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/20/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022] Open
Abstract
Background Cancer patients widely seek integrative oncology which embraces a wide variety of treatments and system approaches. Objective To investigate the concepts, therapeutic goals, procedures, and working conditions of integrative oncology doctors in the field of anthroposophic medicine. Methods This qualitative study was based on in-depth interviews with 35 highly experienced doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Results The doctors integrated conventional and holistic cancer concepts. Their treatments aimed at both tumor and symptom control and at strengthening the patient on different levels: living with the disease, overcoming the disease, enabling emotional and cognitive development, and addressing spiritual or transcendental issues according to the patient's wishes and initiatives. Therapeutic procedures were conventional anticancer and symptom-relieving treatments, herbal and mineral remedies, mistletoe therapy, art therapies, massages and other external applications, nutrition and lifestyle advice, psychological support, and multiple forms of empowerment. The approach emphasised good patient-doctor relationships and sufficient time for patient encounters and decision-making. Individualization appeared in several dimensions and was interwoven with standards and mindlines. The doctors often worked in teams and cooperated with other cancer care-related specialists. Conclusion Integrative cancer care pursues an individualized and patient-centered approach, encompassing conventional and multimodal complementary interventions, and addressing, along with physical and functional needs, the emotional and spiritual needs of patients. This seems to be important for tumor and symptom control, and addresses major challenges and important goals of modern cancer care.
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Affiliation(s)
- Gunver S Kienle
- University of Witten Herdecke, Freiburg, Germany
- University Medical Center Freiburg, Freiburg, Germany
| | | | | | - Helmut Kiene
- University of Witten Herdecke, Freiburg, Germany
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23
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Kamal AH, Bull J, Kavalieratos D, Nicolla JM, Roe L, Adams M, Abernethy AP. Development of the Quality Data Collection Tool for Prospective Quality Assessment and Reporting in Palliative Care. J Palliat Med 2016; 19:1148-1155. [PMID: 27348507 DOI: 10.1089/jpm.2016.0036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Assessing and reporting the quality of care provided are increasingly important in palliative care, but we currently lack practical, efficient approaches for collection and reporting. OBJECTIVE In response, the Global Palliative Care Quality Alliance ("Alliance") sought to create a Quality Data Collection Tool for Palliative Care (QDACT-PC). METHODS We collaboratively and iteratively developed QDACT-PC, an electronic, point-of-care quality monitoring system for palliative care that supports prospective quality assessment and reporting in any clinical setting. QDACT-PC is the web-based data collection and reporting interface. Quality measures selected to be used in QDACT-PC were derived from a systematic review summarizing all published palliative care quality measure sets; Alliance clinical providers prioritized measures to be included in QDACT-PC to ensure maximal clinical relevance. Data elements and variables required to ascertain conformance to all selected quality measures were included in the QDACT-PC data dictionary. Whenever possible, variables collected in QDACT-PC align with validated surveys and/or nationally recognized common data elements. QDACT-PC data elements and software programmed business rules inform real-time assessments of conformance to selected quality measures. Data are deposited into a centralized registry for future analyses. RESULTS QDACT-PC can be used to report on >80% of all published palliative care quality measures and 100% of high-priority measure. CONCLUSION Electronic methods for collecting point-of-care quality monitoring data can be developed using collaborative partnerships between community and academic palliative care providers. Feasibility testing and creation of feedback reports are ongoing.
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Affiliation(s)
| | - Janet Bull
- 2 Four Seasons , Flat Rock, North Carolina
| | - Dio Kavalieratos
- 3 Division of General Internal Medicine, Department of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | | | - Laura Roe
- 1 Duke University , Durham, North Carolina
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Hochman MJ, Wolf S, Zafar SY, Portman D, Bull J, Kamal AH. Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations. J Pain Symptom Manage 2016; 51:1033-1039.e3. [PMID: 27046299 DOI: 10.1016/j.jpainsymman.2015.12.338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/11/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022]
Abstract
CONTEXT Palliative care (PC) consultation services are available in most hospitals; outpatient services are rapidly growing to meet the needs of patients at earlier stages of the disease trajectory. OBJECTIVES We aimed to compare the unmet needs of PC patients by location of care to better characterize these populations. METHODS This cross-sectional secondary analysis examined patients receiving hospital and outpatient-based PC across 10 community and academic organizations in the Global Palliative Care Quality Alliance. We identified unmet symptom, advance care planning, and functional needs within our database from October 23, 2012 to January 22, 2015. Kruskal-Wallis, chi-square, and Fisher exact tests were performed. RESULTS We evaluated 633 unique patients. Inpatients (n = 216) were older than outpatients (n = 417; 73 vs. 64 years, P < 0.0001). Seventy-six inpatients (38%) had a Palliative Performance Scale score ≤30%; no outpatients did (P < 0.0001). More inpatients rated their quality of life as poor compared with outpatients (39% vs. 21%, P = 0.0001). We found that outpatients presented with more unresolved pain than inpatients (58.5% vs. 4.1%, P < 0.0001). Conversely, more inpatients presented with unresolved anorexia (52.3% vs. 35.8%, P = 0.002) and dysphagia (28.1% vs. 5.4%, P < 0.0001) than outpatients. We found that inpatient setting was independently associated with lower performance status (odds ratio = 0.068, 95% confidence interval = 0.038-0.120, P < 0.0001). CONCLUSION Compared with inpatients, outpatients are more burdened by pain at first PC encounter yet experience higher quality of life and better performance status. These findings suggest different clinician skillsets, and assessments are needed depending on the setting of PC consultation.
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Affiliation(s)
| | - Steven Wolf
- Duke Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Syed Yousuf Zafar
- Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Diane Portman
- Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Janet Bull
- Four Seasons Compassion for Life, Hendersonville, North Carolina, USA
| | - Arif H Kamal
- Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
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Hui D, Meng YC, Bruera S, Geng Y, Hutchins R, Mori M, Strasser F, Bruera E. Referral Criteria for Outpatient Palliative Cancer Care: A Systematic Review. Oncologist 2016; 21:895-901. [PMID: 27185614 PMCID: PMC4943399 DOI: 10.1634/theoncologist.2016-0006] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/18/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Outpatient palliative care clinics facilitate early referral and are associated with improved outcomes in cancer patients. However, appropriate candidates for outpatient palliative care referral and optimal timing remain unclear. We conducted a systematic review of the literature to identify criteria that are considered when an outpatient palliative cancer care referral is initiated. METHODS We searched Ovid MEDLINE (1948-2013 citations) and Ovid Embase (1947-2015 citations) for articles related to outpatient palliative cancer care. Two researchers independently reviewed each citation for inclusion and extracted the referral criteria. The interrater agreement was high (κ = 0.96). RESULTS Of the 186 publications in our initial search, 21 were included in the final sample. We identified 20 unique referral criteria. Among these, 6 were recurrent themes, which included physical symptoms (n = 13 [62%]), cancer trajectory (n = 13 [62%]), prognosis (n = 7 [33%]), performance status (n = 7 [33%]), psychosocial distress (n = 6 [29%]), and end-of-life care planning (n = 5 [24%]). We found significant variations among the articles regarding the definition of advanced cancer and the assessment tools for symptom/distress screening. The Edmonton Symptom Assessment Scale (n = 7 [33%]) and the distress thermometer (n = 2 [10%]) were used most often. Furthermore, there was a lack of consensus in the cutoffs in symptom assessment tools and timing for outpatient palliative care referral. CONCLUSION This systematic review identified 20 criteria including 6 recurrent themes for outpatient cancer palliative care referral. It highlights the significant heterogeneity regarding the timing and process for referral and the need for further research to develop standardized referral criteria. IMPLICATIONS FOR PRACTICE Outpatient palliative care clinics improve patient outcomes; however, it remains unclear who is appropriate for referral and what is the optimal timing. A better understanding of the referral criteria would help (a) referring clinicians to identify appropriate patients for palliative care interventions, (b) administrators to assess their programs with set benchmarks for quality improvement, (c) researchers to standardize inclusion criteria, and (d) policymakers to develop clinical care pathways and allocate appropriate resources. This systematic review identified 20 criteria including 6 recurrent themes for outpatient palliative cancer care referral. It represents the first step toward developing standardized referral criteria.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yee-Choon Meng
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Palliative Care, Tan Tock Seng Hospital, Singapore
| | - Sebastian Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yimin Geng
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ron Hutchins
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Masanori Mori
- Department of Palliative Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Florian Strasser
- Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Kienle GS, Mussler M, Fuchs D, Kiene H. Intravenous Mistletoe Treatment in Integrative Cancer Care: A Qualitative Study Exploring the Procedures, Concepts, and Observations of Expert Doctors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:4628287. [PMID: 27239209 PMCID: PMC4860234 DOI: 10.1155/2016/4628287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/07/2016] [Indexed: 11/20/2022]
Abstract
Background. Mistletoe therapy (MT) is widely used in patient-centered integrative cancer care. The objective of this study was to explore the concepts, procedures, and observations of expert doctors, with a focus on intravenous MT. Method. A qualitative interview study was conducted with 35 highly experienced doctors specialized in integrative and anthroposophic medicine. Structured qualitative content analysis was applied. For triangulation, the results were compared with external evidence that was systematically collected, reviewed, and presented. Results. Doctors perform individualized patient assessments that lead to multimodal treatment approaches. The underlying goal is to help patients to live with and overcome disease. Mistletoe infusions are a means of accomplishing this goal. They are applied to stabilize disease, achieve responsiveness, induce fever, improve quality of life, and improve the tolerability of conventional cancer treatments. The doctors reported long-term disease stability and improvements in patients' general condition, vitality, strength, thermal comfort, appetite, sleep, pain from bone metastases, dyspnea in pulmonary lymphangitis carcinomatosa, fatigue, and cachexia; chemotherapy was better tolerated. Also patients' emotional and mental condition was reported to have improved. Conclusion. Individualized integrative cancer treatment including MT aims to help cancer patients to live well with their disease. Further research should investigate the reported observations.
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Affiliation(s)
- Gunver S. Kienle
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Zechenweg 6, 79111 Freiburg, Germany
- Center for Complementary Medicine, Institute for Environmental Health Sciences and Hospital Infection Control, University Medical Center Freiburg, Breisacher Strasse 115B, 79106 Freiburg, Germany
| | - Milena Mussler
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Zechenweg 6, 79111 Freiburg, Germany
| | - Dieter Fuchs
- Department of Theology, Caritas Sciences, University of Freiburg, Werthmannplatz 3, 79098 Freiburg, Germany
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Zechenweg 6, 79111 Freiburg, Germany
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Mehta DH, Perez GK, Traeger L, Park ER, Goldman RE, Haime V, Chittenden EH, Denninger JW, Jackson VA. Building Resiliency in a Palliative Care Team: A Pilot Study. J Pain Symptom Manage 2016; 51:604-8. [PMID: 26550936 DOI: 10.1016/j.jpainsymman.2015.10.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 10/25/2015] [Accepted: 10/28/2015] [Indexed: 11/27/2022]
Abstract
CONTEXT Palliative care clinicians (PCCs) are vulnerable to burnout as a result of chronic stress related to working with seriously ill patients. Burnout can lead to absenteeism, ineffective communication, medical errors, and job turnover. Interventions that promote better coping with stress are needed in this population. OBJECTIVES This pilot study tested the feasibility of the Relaxation Response Resiliency Program for Palliative Care Clinicians, a program targeted to decrease stress and increase resiliency, in a multidisciplinary cohort of PCCs (N = 16) at a major academic medical center. METHODS A physician delivered the intervention over two months in five sessions (12 hours total). Data were collected the week before the program start and two months after completion. The main outcome was feasibility of the program. Changes in perceived stress, positive and negative affect, perspective taking, optimism, satisfaction with life, and self-efficacy were examined using nonparametric statistical tests. Effect size was quantified using Cohen's d. RESULTS The intervention was feasible; all participants attended at least four of the five sessions, and there was no attrition. After the intervention, participants showed reductions in perceived stress and improvements in perspective taking. CONCLUSION Our findings suggest that a novel team-based resiliency intervention based on elicitation of the relaxation response was feasible and may help promote resiliency and protect against the negative consequences of stress for PCCs.
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Affiliation(s)
- Darshan H Mehta
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Giselle K Perez
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elyse R Park
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Roberta E Goldman
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vivian Haime
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eva H Chittenden
- Division of Palliative Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John W Denninger
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Division of Palliative Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Beesley VL, Janda M, Goldstein D, Gooden H, Merrett ND, O'Connell DL, Rowlands IJ, Wyld D, Neale RE. A tsunami of unmet needs: pancreatic and ampullary cancer patients' supportive care needs and use of community and allied health services. Psychooncology 2016; 25:150-7. [PMID: 26123474 DOI: 10.1002/pon.3887] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/15/2015] [Accepted: 05/26/2015] [Indexed: 01/25/2023]
Abstract
OBJECTIVE People diagnosed with pancreatic cancer have the worst survival prognosis of any cancer. No previous research has documented the supportive care needs of this population. Our objective was to describe people's needs and use of support services and to examine whether these differed according to whether or not patients had undergone surgical resection. METHODS Queensland pancreatic or ampullary cancer patients (n = 136, 54% of those eligible) completed a survey, which assessed 34 needs across five domains (Supportive Care Needs Survey-Short Form) and use of health services. Differences by resection were compared with Chi-squared tests. RESULTS Overall, 96% of participants reported having some needs. More than half reported moderate-to-high unmet physical (54%) or psychological (52%) needs, whereas health system/information (32%), patient care (21%) and sexuality needs (16%) were described less frequently. The three most frequently reported moderate-to-high needs included 'not being able to do things they used to do' (41%), 'concerns about the worries of those close' (37%) and 'uncertainty about the future' (30%). Patients with non-resectable disease reported greater individual information needs, but their needs were otherwise similar to patients with resectable disease. Self-reported use of support was low; only 35% accessed information, 28%, 18% and 15% consulted a dietician, complementary medicine practitioner or mental health practitioner, respectively. Palliative care access was greater (59% vs 27%) among those with non-resectable disease. CONCLUSION Very high levels of needs were reported by people with pancreatic or ampullary cancer. Future work needs to elucidate why uptake of appropriate supportive care is low and which services are required.
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Affiliation(s)
- Vanessa L Beesley
- Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Monika Janda
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Helen Gooden
- Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Neil D Merrett
- Discipline of Surgery, University of Western Sydney, Sydney, Australia
- South Western Sydney Upper GI Surgical Unit, Bankstown Hospital, Sydney, Australia
| | | | - Ingrid J Rowlands
- School of Public Health, University of Queensland, Brisbane, Australia
| | - David Wyld
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Rachel E Neale
- Cancer Aetiology and Prevention Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Kamal AH, Gradison M, Maguire JM, Taylor D, Abernethy AP. Quality measures for palliative care in patients with cancer: a systematic review. J Oncol Pract 2014; 10:281-7. [PMID: 24917264 DOI: 10.1200/jop.2013.001212] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Quality assessment is a critical component of determining the value of medical services, including palliative care. Characterization of the current portfolio of measures that assess the quality of palliative care delivered in oncology is necessary to identify gaps and inform future measure development. METHODS We performed a systematic review of MEDLINE/PubMed and the gray literature for quality measures relevant to palliative care. Measures were categorized into National Quality Forum domains and reviewed for methodology of development and content. Measures were additionally analyzed to draw summative conclusions on scope and span. RESULTS Two hundred eighty-four quality measures within 13 measure sets were identified. The most common domains for measure content were Physical Aspects of Care (35%) and Structure and Processes of Care (22%). Of symptom-related measures, pain (36%) and dyspnea (26%) were the most commonly addressed. Spiritual (4%) and Cultural (1%) Aspects of Care were least represented domains. Generally, measures addressed processes of care, did not delineate benchmarks for success, and often did not specify intended interventions to address unmet needs. This was most evident regarding issues of psychosocial and spiritual assessment and management. CONCLUSION Within a large cohort of quality measures for palliative, care is often a focus on physical manifestations of disease and adverse effects of therapy; relatively little attention is given to the other aspects of suffering commonly observed among patients with advanced cancer, including psychological, social, and spiritual distress.
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Affiliation(s)
- Arif H Kamal
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Margaret Gradison
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Jennifer M Maguire
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Donald Taylor
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Amy P Abernethy
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
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Soelver L, Rydahl-Hansen S, Oestergaard B, Wagner L. Identifying factors significant to continuity in basic palliative hospital care-from the perspective of patients with advanced cancer. J Psychosoc Oncol 2014; 32:167-88. [PMID: 24364876 DOI: 10.1080/07347332.2013.873999] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Based on the research method grounded theory and semistructured patient interviews at home following hospitalization, the aim was to provide information on issues relating to the identification and alleviation of patients' physical and emotional problems, understood as continuity in palliative care. The interviews were based on selected problems that patients found significant. The results are distilled into the core category disheartening interactions and four categories: falling outside the professional framework, not being seen as a person, unidentified/unmet need for guidance and involvement, and patient strategy-minimizing conflict. The categories are significant in generating and maintaining continuity in basic palliative care.
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Affiliation(s)
- Lisbeth Soelver
- a Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark
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Kavalieratos D, Kamal AH, Abernethy AP, Biddle AK, Carey TS, Dev S, Reeve BB, Weinberger M. Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer. J Palliat Med 2014; 17:475-81. [PMID: 24588568 DOI: 10.1089/jpm.2013.0526] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND As the role of palliative care (PC) has yet to be clearly defined in patients with heart failure (HF), such patients may face barriers regarding PC referral. In order to maximally meet the needs of HF patients, it is necessary to understand how they compare to the classic PC population: patients with cancer. OBJECTIVE To characterize the unresolved symptom and treatment needs with which patients with HF and those with cancer present to PC. METHODS We used data from the Palliative Care Research Registry (PCRR), a repository of quality improvement data from three community-based PC organizations. We abstracted first PC visit data from the PCRR for patients with primary diagnoses of HF or cancer seen between 2008 and 2012. We assessed the association of primary diagnosis (i.e., HF or cancer) on three outcomes: unresolved symptoms, treatment gaps, and a composite indicator of symptom control and quality of life. Analyses included descriptive statistics and multivariate Poisson regression. RESULTS Our analytic sample comprised 334 patients with HF and 697 patients with cancer, the majority of whom were white and male. Compared to patients with cancer, patients with HF presented with fewer unresolved symptoms, both overall and at moderate/severe distress levels. Patients with HF more commonly reported moderately/severely distressful dyspnea (25% versus 18%, p=0.02), and more commonly experienced dyspnea-related treatment gaps (17% versus 8%, p<0.001). CONCLUSIONS Patients with HF possess care needs that are squarely within the purview of PC. Future work is needed to delineate how PC referral policies should be refined to optimize PC access for patients with HF.
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Affiliation(s)
- Dio Kavalieratos
- 1 Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
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Kamal AH, Bull J, Stinson CS, Blue DL, Abernethy AP. Conformance with supportive care quality measures is associated with better quality of life in patients with cancer receiving palliative care. J Oncol Pract 2014; 9:e73-6. [PMID: 23942504 DOI: 10.1200/jop.2013.000948] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE As palliative care further integrates into cancer care, descriptions of how supportive care quality measures improve patient outcomes are necessary to establish best practices. METHODS We assessed the relationship between conformance to 18 palliative care quality measures and quality of life from data obtained using our novel point-of-care, electronic quality monitoring system, the Quality Data Collection Tool for Palliative Care (QDACT-PC). All patients with cancer from January 2008 through March 2011 seen in the Carolinas Palliative Care Consortium were evaluated for demographic, disease, prognostic, performance status, and measure conformance variables. Using univariate and multivariate regression, we examined the relationship between these variable and high quality of life at the initial specialty palliative care consultation. RESULTS Our cohort included 459 patients, the majority of whom were over age 65 years (66%) and white (84%). Lung (29.1%) and GI (24.7%) cancers were most common. In univariate analyses, conformance to assessment of comprehensive symptoms, fatigue and constipation assessment, timely management of pain and constipation, and timely emotional well-being assessment were associated with highest levels of quality of life (all Ps < .05). In a multivariate model (C-stat = 0.66), performance status (odds ratio [OR], 5.21; P = .003), estimated life expectancy (OR, 22.6; P = .003), conformance to the measure related to emotional well-being assessment (OR, 1.60; P = .026), and comprehensive screening of symptoms (OR, 1.74, P = .008) remained significant. CONCLUSION Oncology care pathways that routinely incorporate supportive care principles, such as comprehensive symptom and emotional well-being assessments, may improve patient outcomes.
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Affiliation(s)
- Arif H Kamal
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA.
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Kavalieratos D, Mitchell EM, Carey TS, Dev S, Biddle AK, Reeve BB, Abernethy AP, Weinberger M. "Not the 'grim reaper service'": an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure. J Am Heart Assoc 2014; 3:e000544. [PMID: 24385453 PMCID: PMC3959712 DOI: 10.1161/jaha.113.000544] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/17/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although similar to cancer patients regarding symptom burden and prognosis, patients with heart failure (HF) tend to receive palliative care far less frequently. We sought to explore factors perceived by cardiology, primary care, and palliative care providers to impede palliative care referral for HF patients. METHODS AND RESULTS We conducted semistructured interviews regarding (1) perceived needs of patients with advanced HF; (2) knowledge, attitudes, and experiences with specialist palliative care; (3) perceived indications for and optimal timing of palliative care referral in HF; and (4) perceived barriers to palliative care referral. Two investigators analyzed data using template analysis, a qualitative technique. We interviewed 18 physician, nurse practitioner, and physician assistant providers from 3 specialties: cardiology, primary care, and palliative care. Providers had limited knowledge regarding what palliative care is, and how it can complement traditional HF therapy to decrease HF-related suffering. Interviews identified several potential barriers: the unpredictable course of HF; lack of clear referral triggers across the HF trajectory; and ambiguity regarding what differentiates standard HF therapy from palliative care. Nevertheless, providers expressed interest for integrating palliative care into traditional HF care, but were unsure of how to initiate collaboration. CONCLUSIONS Palliative care referral for HF patients may be suboptimal due to limited provider knowledge and misperceptions of palliative care as a service reserved for those near death. These factors represent potentially modifiable targets for provider education, which may help to improve palliative care referral for HF patients with unresolved disease-related burden.
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Affiliation(s)
- Dio Kavalieratos
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (D.K.)
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,
| | - Emma M. Mitchell
- School of Nursing and Health Studies, University of Miami, FL (E.M.M.)
| | - Timothy S. Carey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill,
| | - Sandesh Dev
- Phoenix Veterans Affairs Medical Center, Phoenix, AZ (S.D.)
| | - Andrea K. Biddle
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,
| | - Bryce B. Reeve
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,
| | - Amy P. Abernethy
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,
- Center for Learning Health Care, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.P.A.)
- Division of Medical Oncology, Duke University School of Medicine, Duke University, Durham, NC (A.P.A.)
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill,
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC (M.W.)
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Abernethy AP, Bull J, Whitten E, Shelby R, Wheeler JL, Taylor DH. Targeted investment improves access to hospice and palliative care. J Pain Symptom Manage 2013; 46:629-39. [PMID: 23669467 DOI: 10.1016/j.jpainsymman.2012.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 12/03/2012] [Accepted: 12/05/2012] [Indexed: 11/23/2022]
Abstract
CONTEXT Availability of hospice and palliative care is increasing, despite lack of a clear national strategy for developing and evaluating their penetration into and impact on the target population. OBJECTIVES To determine whether targeted investment (i.e., strategic grants made by one charitable foundation) in hospice and palliative care in one U.S. state (North Carolina [NC]) led to improved access to end-of-life care services as indicated by hospice utilization. METHODS Access was measured by the death service ratio (DSR), defined as the proportion of people who died and were served by hospice for at least one day before death. Calculation of the DSR is based on counts of patients accessing hospice by county in a given year (numerator) and U.S. Census projected population data for that county (denominator). Multilevel modeling was the primary analytic strategy used to generate two models: 1) comparison of the DSR in counties with vs. without philanthropic funding and 2) relationship between years since receipt of a philanthropic grant and DSR. RESULTS In NC, the average DSR increased from 20.7% in 2003 to 35.8% in 2009 (55% increase). In 2009, 82 of 100 NC counties had a DSR below the U.S. average (41.6%). In Model 1, significant associations were found between county population and DSR (P=0.03) and between receipt of philanthropic funding and DSR (P=0.01); on average, funded counties had a DSR that was 2.63 percentage points higher than unfunded counties. CONCLUSION Receipt of philanthropic funding appeared to be associated with improved access to palliative care and hospice services in NC.
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Affiliation(s)
- Amy P Abernethy
- Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina, USA; Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.
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Abernethy AP, Currow DC. Time for better integration of oncology and palliative care. J Oncol Pract 2013; 7:346-8. [PMID: 22379412 DOI: 10.1200/jop.2011.000467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2011] [Indexed: 11/20/2022] Open
Affiliation(s)
- Amy P Abernethy
- Duke University Medical Center, Durham, NC; Flinders University, Bedford Park, South Australia, Australia
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Woodside HM, Keats MR. Exploring the Role of Physical Activity During Palliative Care for Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2013. [DOI: 10.1089/jayao.2012.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Hillary M. Woodside
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melanie R. Keats
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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Rocque GB, Cleary JF. Palliative care reduces morbidity and mortality in cancer. Nat Rev Clin Oncol 2012; 10:80-9. [DOI: 10.1038/nrclinonc.2012.211] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bull JH, Whitten E, Morris J, Hooper RN, Wheeler JL, Kamal A, Abernethy AP. Demonstration of a sustainable community-based model of care across the palliative care continuum. J Pain Symptom Manage 2012; 44:797-809. [PMID: 22771124 DOI: 10.1016/j.jpainsymman.2011.12.278] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 12/03/2011] [Accepted: 12/14/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT In the U.S., the number of hospital-based palliative care programs has increased rapidly, but availability of outpatient palliative care remains limited. Multiple barriers impede the financial viability of these programs. Four Seasons, a nonprofit organization in western North Carolina, delivers a full spectrum of palliative care in hospitals, nursing homes, assisted living facilities, patients' homes, and outpatient clinics; its catchment area encompasses approximately 350,000 people. Initially focused on hospice care, Four Seasons added its palliative care program in 2003. Before the inquiry described herein, financial losses from outpatient palliative care (2003-2008) were escalating. OBJECTIVES We explored organizational and financial barriers to sustainability of palliative care, so as to 1) identify reasons for financial losses; 2) devise and implement solutions; and 3) develop a sustainable model for palliative care delivery across settings, including the outpatient setting. METHODS In 2008, Four Seasons's palliative care program served 305 patients per day (average) with 10.5 providers (physicians, nurse practitioners, and physician assistants); financial losses approached $400,000 per year. We used Quality Assessment and Performance Improvement cycles to identify challenges to and inefficiencies in service provision, developed targeted strategies for overcoming identified barriers to cost-efficiency, instituted these measures, and tracked results. RESULTS In 2011, Four Seasons served 620 palliative care patients per day (average) with 14 providers; financial losses decreased by 40%. CONCLUSION With health care reform promoting integration of care across settings, outpatient palliative care will gain importance in the health care continuum. Process changes can help reduce financial losses that currently impede outpatient palliative care programs.
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Affiliation(s)
- Janet H Bull
- Four Seasons, Flat Rock, North Carolina 28731, USA.
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