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Fereydooni S, Valdez C, William L, Malik D, Mehra S, Judson B. Predisposing, Enabling, and Need Factors Driving Palliative Care Use in Head and Neck Cancer. Otolaryngol Head Neck Surg 2024; 171:1069-1082. [PMID: 38796734 DOI: 10.1002/ohn.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/10/2024] [Accepted: 04/27/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Characterizing factors associated with palliative care (PC) use in patients with stage III and VI head and neck cancer using Anderson's behavioral model of health service use. STUDY DESIGN A retrospective study of the 2004 to 2020 National Cancer Database.gg METHODS: We used multivariate logistic regression to assess the association of predisposing, enabling, and need factors with PC use. We also investigated the association of these factors with interventional PC type (chemotherapy, radiotherapy, surgery) and refusal of curative treatment in the last 6 months of life. RESULTS Five percent of patients received PC. "Predisposing factors" associated with less PC use include Hispanic ethnicity (adjusted odds ratio [aOR], 086; 95% confidence interval [CI], 0.76-0.97) and white and black race (vs white: aOR, 1.14; 95% CI, 1.07-1.22). "Enabling factors" associated with lower PC include private insurance (vs uninsured: aOR, 064; 95% CI, 0.53-0.77) and high-income (aOR, 078; 95% CI, 0.71-0.85). "Need factors" associated with higher PC use include stage IV (vs stage III cancer: aOR, 2.25; 95% CI, 2.11-2.40) and higher comorbidity index (vs Index 1: aOR, 1.58; 95% CI, 1.42-1.75). High-income (aOR, 0.78; 95% CI, 0.71-0.85) and private insurance (aOR, 0.6; 95% CI, 0.53, 0.77) were associated with higher interventional PC use and lower curative treatment refusal (insurance: aOR, 0.82; 95% CI, 0.55, 0.67; income aOR, 0.48; 95% CI, 0.44, 0.52). CONCLUSION Low PC uptake is attributed to patients' race/culture, financial capabilities, and disease severity. Culturally informed counseling, clear guidelines on PC indication, and increasing financial accessibility of PC may increase timely and appropriate use of this service.
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Affiliation(s)
- Soraya Fereydooni
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline Valdez
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Devesh Malik
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Judson
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
- Otolaryngology Surgery, New Haven, Connecticut, USA
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2
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Fischer C, Dirschmid K, Masel EK. Examining Variability in Intra-Hospital Patient Referrals to Specialized Palliative Care: A Comprehensive Analysis of Disciplines and Mortality. J Clin Med 2024; 13:2653. [PMID: 38731181 PMCID: PMC11084376 DOI: 10.3390/jcm13092653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Background: In Austria, specialized palliative care (SPC) access is limited, with unclear referral criteria, making it challenging to identify hospitalized patients requiring SPC and determine referral timing and mortality at the palliative care unit (PCU). Methods: This retrospective cohort study analyzed patients who underwent a palliative care (PC) needs assessment between March 2016 and November 2021 and were subsequently admitted to the PCU of Austria's largest academic hospital. Demographic, clinical, and standardized referral form data were used for analysis, employing descriptive statistics and logistic regression. Results: Out of the 903 assessed patients, 19% were admitted to the PCU, primarily cancer patients (94.7%), with lung (19%) and breast cancer (13%) being most prevalent. Common referral reasons included pain (61%) and nutritional problems (46%). Despite no significant differences in referral times, most patients (78.4%) died in the PCU, with varying outcomes based on cancer type. Referral reasons like pain (OR = 2.3), nutritional problems (OR = 2.4), and end-of-life care (OR = 6.5) were significantly associated with the outcome PCU mortality. Conclusions: This study underscores Austria's SPC access imbalance and emphasizes timely PC integration across disciplines for effective advance care planning and dignified end-of-life experiences in PCUs.
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Affiliation(s)
- Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Katharina Dirschmid
- Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Eva Katharina Masel
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, 1090 Vienna, Austria;
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3
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Rezende G, Gomes-Ferraz CA, Bacon IGFI, De Carlo MMRDP. The importance of a continuum of rehabilitation from diagnosis of advanced cancer to palliative care. Disabil Rehabil 2023; 45:3978-3988. [PMID: 36404719 DOI: 10.1080/09638288.2022.2140456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 10/22/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Identifying the evidence found in the international scientific literature, referring to the concept of rehabilitation in the setting of oncologic palliative care. METHODS Integrative literature review based on articles published in indexed journals on the electronic databases: LILACS, CINAHL and PubMed/MEDLINE, WEB OF SCIENCE, OTSEEKER and PEDRO, following the PRISMA criteria. The quantitative articles were evaluated using the McMaster form for quantitative studies and the qualitative studies were assessed by the Critical Appraisal Skills Program. The studies were inserted in the Rayyan™ application. RESULTS The final sample was composed of 21 qualitative and quantitative articles published in the period from 2004 to 2021, in nine different countries. Three thematic units were defined addressing the interface between palliative care and rehabilitation, the concept of palliative rehabilitation and the barriers to its implementation. The quality of the articles reviewed varied from 31% to 100% of the criteria met. CONCLUSION The international scientific production reinforces the importance of including rehabilitation in care in oncologic palliative care, highlighting the concept of palliative rehabilitation, but there is a need for expanding and divulging new research on the theme and the results.IMPLICATIONS FOR REHABILITATIONPalliative care services and rehabilitation services should take and create opportunities to promote rehabilitation for people living with incurable cancer.Palliative rehabilitation has an important role in the treatment of people with advanced cancer, helping increase the quality of life, relief of pain, symptoms, and distress.It is considered an integral part of palliative care, given that rehabilitation and palliative care are related to the continuum of care.It is important to understand this gap in the international literature on the continuum between rehabilitation and palliative rehabilitation to improve the provision of this approach in both rehabilitation and palliative care services.
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Affiliation(s)
- Gabriela Rezende
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Faculty of Health Social Care and Education, Kingston and St George's, University of London, London, UK
| | - Cristiane Aparecida Gomes-Ferraz
- Master of Health Sciences. Nursing Program on Public Health, Nursing School of Ribeirão Preto, University of São Paulo (EERP/USP), Ribeirão Preto, Brazil
| | | | - Marysia Mara Rodrigues do Prado De Carlo
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Postgraduate Program, Public Health Nursing, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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4
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McPherson S, Mitchell AK, Sletten I, Kvande ME, Steindal SA. Haematological nurses' experiences about palliative care trajectories of patients with life-threatening haematological malignancies: A qualitative study. Nurs Open 2022; 10:3094-3103. [PMID: 36539384 PMCID: PMC10077405 DOI: 10.1002/nop2.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/12/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS To explore haematological nurses' experiences about the palliative care trajectories of patients with life-threatening haematological malignancies. DESIGN A qualitative study with a descriptive and explorative design. METHODS Data were collected through 12 individual semi-structured interviews of nurses who work with patients with haematological malignancies from four hospitals in Norway. The data were analysed using systematic text condensation. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. RESULTS Three categories emerged from the data analysis: focus on a cure delays integration of palliative care, dialogue with patients facilitates palliative care and the need for enhanced interdisciplinary understanding. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution since nurses' experiences were explored.
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Affiliation(s)
- Siobhan McPherson
- Lovisenberg Diaconal University College, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Ann-Kristin Mitchell
- Lovisenberg Diaconal University College, Oslo, Norway.,Oslo Myeloma Center, Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Ida Sletten
- Lovisenberg Diaconal University College, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Monica Evelyn Kvande
- Lovisenberg Diaconal University College, Oslo, Norway.,Department of Anaesthesiology and Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Simen Alexander Steindal
- Lovisenberg Diaconal University College, Oslo, Norway.,Faculty of Health Studies, VID Specialized University, Oslo, Norway
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5
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Pigni A, Alfieri S, Caraceni AT, Zecca E, Fusetti V, Tallarita A, Brunelli C. Development of the palliative care referral system: proposal of a tool for the referral of cancer patients to specialized palliative care. BMC Palliat Care 2022; 21:209. [PMID: 36443700 PMCID: PMC9816370 DOI: 10.1186/s12904-022-01094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/02/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Early palliative care (PC) has shown beneficial effects for advanced cancer patients. However, it is still debated what criteria to use to identify patients for PC referral. AIM To document the initial steps of the development of the Palliative Care Referral System (PCRS), a tool to be used by oncologists in clinical practice. METHODS A multiprofessional working group developed the PCRS based on the results of a scoping literature review on PC referral criteria. PCRS criteria were evaluated by experts via a nominal group technique (NGT). Descriptive statistics were used to summarize expert scores on relevance, appropriateness and perceived feasibility of the criteria proposed. Quotations of participants during the discussion were also reported. RESULTS Sixteen studies, including PC referral criteria/tools, emerged from the scoping review. Severe symptoms, poor performance status, comorbidities and prognosis were the most commonly used criteria. The PCRS included nine major criteria and nine assessment methods; a scoring procedure was also proposed. Answers to the questionnaire during the NGT showed that five criteria reached full agreement on all items, while four did not, and were then discussed within the group. Participants agreed on the relevance of all criteria and on the appropriateness of methods proposed to assess most of them, while issues were raised about potential feasibility of the overall assessment of the PCRS in clinical practice. CONCLUSION The PCRS has been developed as an help for oncologists to timely identify patients for specialized PC referral. Since feasibility emerged as the main concern, implementation strategies have to be tested in subsequent studies.
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Affiliation(s)
- Alessandra Pigni
- grid.417893.00000 0001 0807 2568Palliative care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Alfieri
- grid.417893.00000 0001 0807 2568Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Tommaso Caraceni
- grid.417893.00000 0001 0807 2568Palliative care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy ,grid.4708.b0000 0004 1757 2822Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Ernesto Zecca
- grid.417893.00000 0001 0807 2568Palliative care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Viviana Fusetti
- grid.417893.00000 0001 0807 2568Palliative care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy ,grid.6530.00000 0001 2300 0941Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - Antonino Tallarita
- grid.417893.00000 0001 0807 2568Palliative care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cinzia Brunelli
- grid.417893.00000 0001 0807 2568Palliative care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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6
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Pasquarella AV, Islam S, Ramdhanny A, Gendy M, Pinto P, Braunstein MJ. Outcomes of Patients With Hematologic Malignancies Who Received Inpatient Palliative Care Consultation. JCO Oncol Pract 2022; 18:e688-e696. [PMID: 34986010 DOI: 10.1200/op.21.00502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Palliative care (PC) plays an established role in improving outcomes in patients with solid tumors, yet these services are underutilized in hematologic malignancies (HMs). We reviewed records of hospitalized patients with active HM to determine associations between PC consultation and length of stay, intensive care unit stay, 30-day readmission, and 6-month mortality compared with those who were not seen by PC. METHODS We reviewed all oncology admissions at our institution between 2013 and 2019 and included patients with HM actively on treatment, stratified by those seen by PC to controls not seen by PC. Groups were compared using Wilcoxon rank-sum, chi-square, and Fisher's exact tests on the basis of the type and distribution of data. Multiple logistic regression models with stepwise variable selection methods were used to find predictors of outcomes. RESULTS Three thousand six hundred fifty-four admissions were reviewed, among which 370 unique patients with HM were included. Among these, 102 (28%) patients saw PC, whereas the remaining 268 were controls with similar comorbidities. When compared with controls, PC consultation was associated with a statistically significant reduction in 30-day readmissions (16% v 27%; P = .024), increased length of stay (11.5 v 6 days; P < .001), increased intensive care unit admission (28% v 9%; P < .001), and increased 6-month mortality (67% v 15%; P < .001). These data were confirmed in multivariable models. CONCLUSION In this retrospective study, more than two thirds of patients with HM did not receive PC consultation despite having similar comorbidities, suggesting that inpatient PC consultation is underutilized in patients with HM, despite the potential for decreased readmission rates.
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Affiliation(s)
- Anthony V Pasquarella
- Department of Medicine, Division of Oncology-Hematology, NYU Long Island School of Medicine, NYU Perlmutter Cancer Center, Mineola, NY
| | - Shahidul Islam
- Department of Biostatistics, NYU Long Island School of Medicine, Mineola, NY
| | - Angela Ramdhanny
- Department of Medicine, Division of Oncology-Hematology, NYU Long Island School of Medicine, NYU Perlmutter Cancer Center, Mineola, NY
| | - Mina Gendy
- Department of Medicine, Division of Oncology-Hematology, NYU Long Island School of Medicine, NYU Perlmutter Cancer Center, Mineola, NY
| | - Priya Pinto
- Department of Medicine, Division of Palliative Care, NYU Long Island School of Medicine, Mineola, NY
| | - Marc J Braunstein
- Department of Medicine, Division of Oncology-Hematology, NYU Long Island School of Medicine, NYU Perlmutter Cancer Center, Mineola, NY
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7
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Formagini T, Poague C, O'Neal A, Brooks JV. "When I Heard the Word Palliative": Obscuring and Clarifying Factors Affecting the Stigma Around Palliative Care Referral in Oncology. JCO Oncol Pract 2022; 18:e72-e79. [PMID: 34310185 PMCID: PMC8758121 DOI: 10.1200/op.21.00088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Palliative care (PC) can help patients with cancer manage symptoms and achieve a greater quality of life. However, there are many barriers to patients with cancer receiving referrals to PC, including the stigmatizing association of PC with end of life. This study explores factors that obscure or clarify the stigma around PC referrals and its associations with end of life in cancer care. METHODS A qualitative descriptive design using grounded theory components was designed to investigate barriers to PC referrals for patients receiving treatment at an outpatient cancer center. Interviews with patients, caregivers, and oncology professionals were audio-recorded, transcribed, and independently coded by three investigators to ensure rigor. Participants were asked about their perceptions of PC and PC referral experiences. RESULTS Interviews with 44 participants revealed both obscuring and clarifying factors surrounding the association of PC as end of life. Prognostic uncertainty, confusion about PC's role, and social network influence all perpetuated an inaccurate and stigmatizing association of PC with end of life. Contrarily, familiarity with PC, prognostic confidence, and clear referral communication helped delineate PC as distinct from end of life. CONCLUSION To reduce the stigmatizing association of PC with end of life, referring clinicians should clearly communicate prognosis, PC's role, and the reason for referral within the context of each patient and his or her unique cancer trajectory. The oncology team plays a vital role in framing the messaging surrounding referrals to PC.
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Affiliation(s)
- Taynara Formagini
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Claire Poague
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Alicia O'Neal
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS,University of Kansas Cancer Center, Kansas City, KS,Joanna Veazey Brooks, MBE, PhD, 3901 Rainbow Blvd, Mail Stop 3044, Kansas City, KS 66106; e-mail:
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8
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Ocak S, Tournoy K, Berghmans T, Demedts I, Durieux R, Janssens A, Moretti L, Nackaerts K, Pieters T, Surmont V, Van Eycken L, Vrijens F, Weynand B, van Meerbeeck JP. Lung Cancer in Belgium. J Thorac Oncol 2021; 16:1610-1621. [PMID: 34561034 DOI: 10.1016/j.jtho.2021.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Sebahat Ocak
- Division of Pneumology, CHU UCL Namur (Godinne Site), Université catholique de Louvain (UCLouvain), Yvoir, Belgium; Pole of Pneumology, ENT, and Dermatology (PNEU), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Brussels, Belgium.
| | - Kurt Tournoy
- Division of Pneumology, Onze-Lieve-Vrouw Ziekenhuis (OLV) Aalst and Faculty of Medicine and Life Sciences, Ghent University, Ghent, Belgium
| | - Thierry Berghmans
- Thoracic Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Ingel Demedts
- Division of Pneumology, AZ Delta Roeselare, Roeselare, Belgium
| | - Rodolphe Durieux
- Division of Cardiovascular and Thoracic Surgery, CHU Liège, Liège, Belgium
| | | | - Luigi Moretti
- Department of Radiation Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Kristiaan Nackaerts
- Division of Respiratory Oncology/Pneumology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Thierry Pieters
- Cliniques Universitaires St-Luc, UCLouvain, Brussels, Belgium; Pole of Pneumology, ENT, and Dermatology (PNEU), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Brussels, Belgium
| | | | | | - France Vrijens
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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9
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Hidalgo-Andrade P, Mascialino G. Beliefs About Morphine in Palliative Care: Results From an Ecuadorian Sample. J Palliat Care 2021; 37:73-76. [PMID: 34128421 DOI: 10.1177/08258597211026398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous research unambiguously establishes the importance of knowledge and education about opioids and pain management in medical care. This article aimed at describing the perception of the general public on the uses and the risks of morphine in palliative care in an Ecuadorian sample, where training and access to those services is limited. METHODS We used an online recruited sample of 257 participants for this cross-sectional descriptive study. Participants responded to an online self-report survey regarding morphine's effects and its relationship with addiction and death in a palliative care context. RESULTS Analyses indicate that there is a lack of understanding about the effectiveness of morphine and that, overall, participants did not associate morphine with death and dying. Results also show that people in health-related occupations did not differ from the general public in beliefs about the addiction and the effectiveness of morphine. However, occupation and education effects were noted for several other items, as well as whether the participants had direct experiences with palliative care as either a patient or a caregiver. CONCLUSIONS There is still misinformation about opioids such as morphine in the general public and health professionals in Ecuador. Although personal experiences with pain control and palliative care are linked to better knowledge about opioids, education is still necessary to overcome the myths around them. Future research could address the found misconceptions to increase health literacy through education policies and interventions.
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Affiliation(s)
| | - Guido Mascialino
- School of Psychology, Universidad de Las Américas, Quito, Ecuador
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10
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Hausner D, Tricou C, Mathews J, Wadhwa D, Pope A, Swami N, Hannon B, Rodin G, Krzyzanowska MK, Le LW, Zimmermann C. Timing of Palliative Care Referral Before and After Evidence from Trials Supporting Early Palliative Care. Oncologist 2021; 26:332-340. [PMID: 33284483 DOI: 10.1002/onco.13625] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/20/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evidence from randomized controlled trials has demonstrated benefits in quality of life outcomes from early palliative care concurrent with standard oncology care in patients with advanced cancer. We hypothesized that there would be earlier referral to outpatient palliative care at a comprehensive cancer center following this evidence. MATERIALS AND METHODS Administrative databases were reviewed for two cohorts of patients: the pre-evidence cohort was seen in outpatient palliative care between June and November 2006, and the post-evidence cohort was seen between June and November 2015. Timing of referral was categorized, according to time from referral to death, as early (>12 months), intermediate (>6 months to 12 months), and late (≤6 months from referral to death). Univariable and multivariable ordinal logistic regression analyses were used to determine demographic and medical factors associated with timing of referral. RESULTS Late referrals decreased from 68.8% pre-evidence to 44.8% post-evidence; early referrals increased from 13.4% to 31.1% (p < .0001). The median time from palliative care referral to death increased from 3.5 to 7.0 months (p < .0001); time from diagnosis to referral was also reduced (p < .05). On multivariable regression analysis, earlier referral to palliative care was associated with post-evidence group (p < .0001), adjusting for shorter time since diagnosis (p < .0001), referral for pain and symptom management (p = .002), and patient sex (p = .04). Late referrals were reduced to <50% in the breast, gynecological, genitourinary, lung, and gastrointestinal tumor sites. CONCLUSIONS Following robust evidence from trials supporting early palliative care for patients with advanced cancer, patients were referred substantially earlier to outpatient palliative care. IMPLICATIONS FOR PRACTICE Following published evidence demonstrating the benefit of early referral to palliative care for patients with advanced cancer, there was a substantial increase in early referrals to outpatient palliative care at a comprehensive cancer center. The increase in early referrals occurred mainly in tumor sites that have been included in trials of early palliative care. These results indicate that oncologists' referral practices can change if positive consequences of earlier referral are demonstrated. Future research should focus on demonstrating benefits of early palliative care for tumor sites that have tended to be omitted from early palliative care trials.
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Affiliation(s)
- David Hausner
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Palliative Care Service, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Colombe Tricou
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon Pierre-Bénite, France
| | - Jean Mathews
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Deepa Wadhwa
- BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - Ashley Pope
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Nadia Swami
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Breffni Hannon
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Gary Rodin
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology, University of Toronto, Toronto, Canada.,Department of Medical Oncology and Hematology, University Health Network, Toronto, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Camilla Zimmermann
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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11
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Abilkaiyr N, Sabyr N, Tazhiyeva A, Satybaldin A. Comparative analysis of primary health care indicators security standing in Belgium and Norway: Lessons from readiness to COVID-19. J Med Life 2021; 14:816-822. [PMID: 35126753 PMCID: PMC8811665 DOI: 10.25122/jml-2021-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
The research aims to suggest the most enabling indicator of COVID-19 resistance in Belgium and Norway by studying the dynamics of staff and bed security indicators of the primary health care sector. The research methodology comprises Organization for Economic Cooperation and Development (OECD) statistical analysis of staff and bed security indicators. The reason for choosing Belgium and Norway for comparative analysis regarding the readiness to face the COVID-19 pandemic in terms of staff and bed security is because Belgium is leading by the highest level and Norway is leading by the lowest level of morbidity and mortality per 1 million population. The study revealed that the greatest enabler of the primary health care system efficiency in terms of resistance to COVID-19 is primary health care staff security. The analysis clearly shows that the number of beds is not paramount for the effectiveness of the healthcare system and primary health care. The COVID-19 pandemic has exposed the deficiencies and weaknesses of primary health care systems of all countries of the world. The research results suggest that Belgium and other countries focus on the education of nurses and therapists. The significance of the research results is that they prove that the main factor of the effectiveness of the primary health care system is its human resources. This information is useful for improving health systems in many countries around the world.
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Affiliation(s)
- Nazerke Abilkaiyr
- Department of Epidemiology, Biostatistics and Evidence-Based Medicine, Al-Farabi Kazakh National University, Almaty, Republic of Kazakhstan,Corresponding Author: Nazerke Abilkaiyr, Department of Epidemiology, Biostatistics and Evidence-Based Medicine, Al-Farabi Kazakh National University, 050040, 71 Al-Farabi Ave., Almaty, Republic of Kazakhstan. E-mail:
| | - Nursymbat Sabyr
- Faculty of Economics, L.N. Gumilyov Eurasian National University, Nur-Sultan, Republic of Kazakhstan
| | | | - Azimkhan Satybaldin
- Institute of Economics, Science Committee of the Ministry of Education of the Republic of Kazakhstan, Almaty, Republic of Kazakhstan
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Salins N, Ghoshal A, Hughes S, Preston N. How views of oncologists and haematologists impacts palliative care referral: a systematic review. BMC Palliat Care 2020; 19:175. [PMID: 33228651 PMCID: PMC7686696 DOI: 10.1186/s12904-020-00671-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Worldwide, many patients with cancer, are infrequently referred to palliative care or are referred late. Oncologists and haematologists may act as gatekeepers, and their views may facilitate or hinder referrals to palliative care. This review aimed to identify, explore and synthesise their views on referrals systematically. METHODS Databases of MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science and Cochrane were searched for articles from 01/01/1990 to 31/12/2019. All studies were scored for their methodological rigour using Hawker's tool. Findings were synthesised using Popay's narrative synthesis method and interpreted using a critical realist lens and social exchange theory. RESULTS Out of 9336 initial database citations, 23 studies were included for synthesis. Five themes were developed during synthesis. 1. Presuppositions of oncologists and haematologists about palliative care referral: Role conflict, abandonment, rupture of therapeutic alliance and loss of hope were some of the presuppositions that hindered palliative care referral. Negative emotions and perception of self-efficacy to manage palliative care need also hindered referral. 2. Power relationships and trust issues: Oncologists and haematologists preferred to gatekeep the referral process and wished to control and coordinate the care process. They had diminished trust in the competency of palliative care providers. 3. Making a palliative care referral: A daunting task: The stigma associated with palliative care, navigating illness and treatment associated factors, addressing patient and family attitudes, and overcoming organisational challenges made referral a daunting task. Lack of referral criteria and limited palliative care resources made the referral process challenging. 4. Cost-benefit of palliative care referral: Pain and symptom management and psychosocial support were the perceived benefits, whereas inconsistencies in communication and curtailment of care were some of the costs associated with palliative care referral. 5. Strategies to facilitate palliative care referral: Developing an integrated model of care, renaming and augmenting palliative care resources were some of the strategies that could facilitate a referral. CONCLUSION Presuppositions, power relationships, trust issues and the challenges associated with the task of referrals hindered palliative care referral. Oncologists and haematologists appraised the cost-benefit of making a palliative care referral. They felt that an integrated model of care, changing the name of palliative care and augmenting palliative care resources might facilitate a referral.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, MB-G-75, DR E Borges Road, Parel, Mumbai, 400012, India
| | - Sean Hughes
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, C051, C - Floor, Bailrigg, LA1 4YW, UK
| | - Nancy Preston
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, C051, C - Floor, Bailrigg, LA1 4YW, UK.
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The Use of a Palliative Care Screening Tool to Improve Referrals to Palliative Care Services in Community-Based Hospitals: A Quality Improvement Initiative. J Hosp Palliat Nurs 2020; 22:327-334. [PMID: 32568941 DOI: 10.1097/njh.0000000000000664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite efforts to improve access to palliative care services, a significant number of patients still have unmet needs throughout their continuum of care. As such, this project was conducted to increase recognition of patients who could benefit from palliative care, increase referrals, and connect regional sites. This study utilized Plan-Do-Study-Act cycles through a quality improvement approach to develop and test the Palliative Care Screening Tool and aimed to screen 100% of patients within 24 hours who were admitted to selected units by February 2017. The intervention was implemented in 3 different units, each within community hospitals. Patients 18 years or older were screened if they were admitted to one of the selected units for the project, regardless of their diagnosis, age, or comorbidities. The percentage of newly admitted patients who were screened and the total number of palliative care consults were assessed as outcome measures. The tool was met with varying compliance among the 3 sites. However, there was an overall increase in consults across all hospital sites, and an increase in the proportion of noncancer patients was demonstrated. Although the aim was not reached, the tool helped to create a shift in the demographic of patients identified as palliative.
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