Implementing a Standardized Care Pathway Integrating Oncology, Palliative Care and Community Care in a Rural Region of Mid-Norway

73 Background: Palliative care early in the cancer disease trajectory may improve health related quality of life for patients and their families. Collaboration between community and specialist health care professionals is paramount to achieve optimal cancer care. The objective of this study is to develop and to implement this model into our health care system.The target population is cancer patients with metastatic and/ or loco-regional disease. Methods: The study takes place in a rural district of 13 municipalities with a local hospital (Orkdal) in Mid Norway. It is designed as a prospective controlled observational pre- post cohort study with four main interventions: 1. Development and implementation of a standardized care pathway across health care levels, 2. Educational programme for health care professionals, 3. Information about cancer and palliative care to the public, 4.Information,education and support to family members.Outcomes are patient’s time spent at home, family member’s health related quality of life, improvement of health care providers’ knowledge and skills and distribution of health care service use. Results: A standardized care pathway for all palliative cancer patients including home care, care in nursing homes, and specialist care in hospitals (in- and outpatients) is developed. It focuses on access to palliative care services, transfer of medical data, and symptom assessment. The educational program consists of two parts; one to inform about the project and the standardized care pathway, and one to improve competence and skills in cancer palliative care. To the general public, information regarding chemo- and radiotherapy, symptom diagnosis and treatment and palliative care services in general is given. Conclusions: A total integrated model to improve care for cancer patients was developed focusing on collaboration between community and specialist health care, and on early integration of palliative care in the traditional cancer care trajectory. Improved care for cancer patients and their families in the Orkdal region to equal costs is expected. The Orkdal Model may be applied in other regions and for other chronic diseases. Clinical trial information: NCT02170168.

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Palliative care and complex chronic conditions since the perspective of healthcare professionals

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1095 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Doñate-Martínez ◽

L Llop ◽

J Garcés

Keyword(s):

Primary Care ◽

Palliative Care ◽

Early Identification ◽

Chronic Conditions ◽

Healthcare Professionals ◽

Care Pathway ◽

Holistic View ◽

Complex Chronic Conditions ◽

Symptom Intensity

Abstract Background According to the WHO, palliative care (PC) is applicable early in the course of illness together with other curative therapies. Early PC has demonstrated beneficial effects on quality of life and symptom intensity among cancer patients. However, PC is not as early integrated on the care pathway of complex chronic conditions (CCC). This abstract presents barriers and needs identified to effectively implement early PC on CCC performed under the EU-funded InAdvance project (ref.: 825750). Methods Semi-structured interviews were performed with 16 healthcare professionals (HPs) from primary care and hospital settings working with older patients with CCC in Valencia (Spain). Results Interviews reported that main needs identified to provide early PC are: (a) coordinated strategies between multi-setting HPs to an early identification of CCC patients in need of PC; (b) adequate resources to attend patients' PC needs from a holistic view, i.e. psychosocial and spiritual needs; and (c) early integration of basic PC at primary care teams. The main barriers identified were: (a) stereotypes associated to the traditional PC approach; (b) poor knowledge from HPs of the PC holistic approach; and (c) lack of specific protocols or pathways for CCC in need of PC. Conclusions Specific skills and resources are the most relevant needs to effectively provide early PC among patients with CCC. First, it is urgent to demystify the negative culture-related vision of PC that is commonly associated to sedation and last days of a person's life. Also, multidisciplinary HPs require specific training to identify and provide early PC tailored to CCC. And, it is required a strategic and multi-setting organizational approach with fluent information flow and coordinated roles. Key messages Healthcare expenditure would be considerably reduced, especially at hospital and emergency units, with an early identification of patients with CCC in need of PC. Empowering primary HPs in PC would improve the quality of care of patients with CCC.

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Community nurses' participation in palliative care research: The Dignity Care Pathway

British Journal of Community Nursing ◽

10.12968/bjcn.2013.18.7.326 ◽

2013 ◽

Vol 18 (7) ◽

pp. 326-331 ◽

Cited By ~ 3

Author(s):

Jane Andrew ◽

Bridget Johnston ◽

Constantina Papadopoulou

Keyword(s):

Palliative Care ◽

Care Pathway ◽

Care Research

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PP41 British columbia emergency health services assess, see treat and refer palliative clinical pathway

Emergency Medicine Journal ◽

10.1136/emermed-2021-999.41 ◽

2021 ◽

Vol 38 (9) ◽

pp. A17-A17

Author(s):

Jennie Helmer ◽

Leon Baranowski ◽

Richard Armour ◽

John Tallon ◽

David Williscroft ◽

...

Keyword(s):

Palliative Care ◽

Clinical Pathway ◽

Community Care ◽

Lessons Learned ◽

Symptom Improvement ◽

Retrospective Case ◽

Home And Community Care ◽

Palliative Care Teams ◽

Acute Crisis ◽

Palliative Patients

Background/Research ObjectivesParamedic services have experienced a steadily increasing demand from palliative patients accessing 911 during times of acute crisis, and not wishing subsequent conveyance to ED. Early data indicates that many of these patients are NOT already connected to palliative care teams.To address this demand and to connect patients to care, BCEHS introduced the Assess, See, Treat and Refer (ASTAR)-Palliative Clinical Pathway. Objectives are to reduce patient conveyance to ED, reduce hospitalizations and improve patient care through referral after non-conveyance.InterventionParamedic activation of the ASTaR Palliative Clinical Pathway results in referral of non-conveyed palliative patients to local Home and Community Care teams and BCEHS paramedics. The referral occurs within 1-6 hours of paramedic contact and follow up occurs over the next 24-48 hours by telephone. This referral action provides safe, effective, patient-centred care for non-conveyed patients, and also fills a gap for connecting patients to local palliative care teams.ImpactA retrospective case review of 183 cases was conducted. Symptom improvement was achieved in 70% of cases, the ED non-conveyance rate was 19%, and the time on task when palliative patients were treated at home and not conveyed was 37% less (52 minutes) than if palliative patients were transported (82 minutes). All 183 patients were connected to either the local home and community care team or BCEHS Rural Advanced Care Community Paramedics (RACCP).Lessons LearnedPalliative patients frequently call 911 for help during acute crisis events and many of these patients do not wish conveyance to ED. The introduction of the ASTaR palliative clinical pathway provided safety netting and referral to appropriate care teams.

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35 Online randomised controlled trial to improve clinical estimates of survival (ORACLES): study design

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-mariecurie.35 ◽

2018 ◽

Vol 8 (3) ◽

pp. 373.1-373 ◽

Cited By ~ 1

Author(s):

Linda Oostendorp ◽

Nicola White ◽

Priscilla Harries ◽

Sarah Yardley ◽

Christopher Tomlinson ◽

...

Keyword(s):

Palliative Care ◽

Medical Students ◽

Randomised Controlled Trial ◽

Care Pathway ◽

Low Cost ◽

Controlled Trial ◽

Online Training ◽

List Type ◽

More Care ◽

Randomised Controlled

IntroductionClinicians often struggle to recognise whether palliative care patients are imminently dying.1 2 A previous study identified the factors that expert palliative care doctors (with demonstrated prognostic skills) had used to judge the probability of patients dying within 72 hours.Aim and methodsTo evaluate whether an online training resource can teach medical students to formulate survival estimates for palliative care patients that are more similar to experts’ estimates. In this online randomised controlled trial we will recruit 128 students in the penultimate/final year of medical school. Participants are asked to review three series of vignettes describing patients referred to palliative care and provide estimates (0%–100%) about the probability that patients will die within 72 hours. After the first series of vignettes students in the intervention arm are given access to the training resource showing how experts weighted the various symptoms/signs. Participants are asked to complete a second series of vignettes and then a third series after two weeks to assess if any effect has been maintained.ResultsStudents’ survival estimates will be correlated with experts’ estimates to determine the baseline level of agreement and any changes following the intervention. The primary outcome will be the survival estimates provided in the second series of vignettes. Secondary outcomes include the estimates provided at the follow-up the weighting of symptoms/signs and levels of discrimination and consistency.ConclusionThis study will provide evidence about whether a brief low-cost online training resource can influence how medical students make prognostic decisions in an experimental setting.References. Neuberger J. More care less pathway: A review of the liverpool care pathway.Department of Health2013. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf [Accessed: 30thMay 2018]. White N, Reid F, Harris A, Harries P, Stone P. A systematic review of predictions of survival in palliative care: How accurate are clinicians and who are the experts?PLoS One25 August 2016;11(8):e0161407. Available from: http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0161407&type=printable [Accessed: 30th May 2018]

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Perinatal palliative care: a dedicated care pathway

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-001849 ◽

2019 ◽

pp. bmjspcare-2019-001849 ◽

Cited By ~ 4

Author(s):

Francesca Rusalen ◽

Maria Elena Cavicchiolo ◽

Paola Lago ◽

Sabrina Salvadori ◽

Franca Benini

Keyword(s):

Palliative Care ◽

Best Practice ◽

Work Group ◽

Care Pathway ◽

Shared Care ◽

University Hospital ◽

Grade Method ◽

Paediatric Palliative Care ◽

Extremely Preterm ◽

Perinatal Palliative Care

ObjectiveEnsure access to perinatal palliative care (PnPC) to all eligible fetuses/infants/parents.DesignDuring 12 meetings in 2016, a multidisciplinary work-group (WG) performed literature review (Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method was applied), including the ethical and legal references, in order to propose shared care pathway.SettingMaternal-Infant Department of Padua’s University Hospital.PatientsPnPC eligible population has been divided into three main groups: extremely preterm newborns (first group), newborns with prenatal/postnatal diagnosis of life-limiting and/or life-threatening disease and poor prognosis (second group) and newborns for whom a shift to PnPC is appropriate after the initial intensive care (third group).InterventionsThe multidisciplinary WG has shared care pathway for these three groups and defined roles and responsibilities.Main outcome measuresPrenatal and postnatal management, symptom’s treatment, end-of-life care.ResultsThe best care setting and the best practice for PnPC have been defined, as well as the indications for family support, corpse management and postmortem counselling, as well suggestion for conflicts’ mediation.ConclusionsPnPC represents an emerging field within the paediatric palliative care and calls for the development of dedicated shared pathways, in order to ensure accessibility and quality of care to this specific population of newborns.

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