E10-B Palliative Care Needs at Different Phases in the Illness Trajectory: A Survey Study in Patients with Cancer

ObjectivesPatients with chronic respiratory disease have significant palliative care needs, but low utilisation of specialist palliative care (SPC) services. Decreased access to SPC results in unmet palliative care needs among this patient population. We sought to determine the referral practices to SPC among respirologists in Canada.MethodsRespirologists across Canada were invited to participate in a survey about their referral practices to SPC. Associations between referral practices and demographic, professional and attitudinal factors were analysed using regression analyses.ResultsThe response rate was 64.7% (438/677). Fifty-nine per cent of respondents believed that their patients have negative perceptions of palliative care and 39% were more likely to refer to SPC earlier if it was renamed supportive care. While only 2.7% never referred to SPC, referral was late in 52.6% of referring physicians. Lower frequency of referral was associated with equating palliative care to end-of-life care (p<0.001), male sex of respirologist (p=0.019), not knowing referral criteria of SPC services (p=0.015) and agreement that SPC services prioritise patients with cancer (p=0.025); higher referral frequency was associated with satisfaction with SPC services (p=0.001). Late referral was associated with equating palliative care to end-of-life care (p<0.001) and agreement that SPC services prioritise patients with cancer (p=0.013).ConclusionsPossible barriers to respirologists’ timely SPC referral include misperceptions about palliative care, lack of awareness of referral criteria and the belief that SPC services prioritise patients with cancer. Future studies should confirm these barriers and evaluate the effectiveness of strategies to overcome them.

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1-2-3 Project: A Quality Improvement Initiative to Normalize and Systematize Palliative Care for All Patients With Cancer in the Outpatient Clinic Setting

Journal of Oncology Practice ◽

10.1200/jop.18.00346 ◽

2018 ◽

Vol 14 (12) ◽

pp. e775-e785 ◽

Cited By ~ 7

Author(s):

Anjali V. Desai ◽

Virginia M. Klimek ◽

Kimberly Chow ◽

Andrew S. Epstein ◽

Camila Bernal ◽

...

Keyword(s):

Decision Making ◽

Palliative Care ◽

Outpatient Clinic ◽

Core Values ◽

Newly Diagnosed ◽

Care Needs ◽

Patients With Cancer ◽

Palliative Care Consultation ◽

Care Consultation ◽

Palliative Care Needs

Background: Prior work to integrate early palliative care in oncology has focused on patients with advanced cancer and primarily on palliative care consultation. We developed this outpatient clinic initiative for newly diagnosed patients at any stage, emphasizing primary (nonspecialist) palliative care by oncology teams, with enhanced access to palliative care specialists. Methods: We piloted the project in two medical oncology specialty clinics (for patients with myelodysplastic syndrome and GI cancer, respectively) to establish feasibility. On a visit-based schedule, patients systematically reported symptoms, information/decision-making preferences, and illness understanding. They also participated in discussions of their core values with their oncology nurse. Oncology teams were first responders to palliative care needs, whereas specialists were available for clinician support and direct patient consultation. Results: All 58 eligible patients were enrolled. In both clinics, patient self-reports documented a heavy symptom burden. Information/decision-making preferences and illness understanding levels varied across patients. Patients prepared new advance directives. Oncology nurses documented discussions of core values. Requests for palliative care consultation decreased over time as oncology teams embraced their primary palliative care role with coaching from the specialists. Clinic workflow and patient volume were maintained. Conclusion: Our pilot experience suggests that in outpatient oncology clinics, a structured, scheduled, and systematic approach is feasible to deliver palliative care to newly diagnosed patients with cancer at any stage and throughout their illness trajectory. This novel approach identified important, actionable palliative care needs, relying primarily on oncology teams to respond to these needs, while enhancing access to palliative care specialist input. Expansion to additional clinics will allow evaluation of scalability and generalizability, along with measurement of a broader range of important outcomes.

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Health professionals' views on services for patients with cancer-related palliative care needs

International Journal of Therapy and Rehabilitation ◽

10.12968/ijtr.2006.13.1.21347 ◽

2006 ◽

Vol 13 (1) ◽

pp. 15-21

Author(s):

Margaret Thomson ◽

Paula Hourston ◽

Jo Ladley ◽

Leigh Findlay ◽

Aileen Kelly

Keyword(s):

Palliative Care ◽

Health Professionals ◽

Care Needs ◽

Patients With Cancer ◽

Palliative Care Needs

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The Role of Palliative Care in Oncology

Seminars in Interventional Radiology ◽

10.1055/s-0037-1608702 ◽

2017 ◽

Vol 34 (04) ◽

pp. 307-312 ◽

Cited By ~ 1

Author(s):

Rajiv Agarwal ◽

Andrew Epstein

Keyword(s):

Palliative Care ◽

Symptom Burden ◽

Well Being ◽

Care Needs ◽

Patients With Cancer ◽

Living With Cancer ◽

Palliative Care Needs ◽

Shed Light

AbstractPalliative care is a powerful adjunct to oncology that adds distinct value to the physical, mental, and psychosocial well-being of patients living with cancer. Its expanding role and integration with standard oncologic care has proven clinical benefit, as the practice of palliative care can help alleviate symptom burden, enhance illness and prognostic understanding, and improve both the quality of life and overall survival for patients. The primary aim of this review article is to highlight the significant interplay between palliative care and oncology and, in doing so, shed light on the areas for improvement and modern challenges that exist to meet the complex palliative care needs of patients with cancer.

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Palliative Care Needs of Patients With Cancer Living in the Community

Journal of Oncology Practice ◽

10.1200/jop.2011.000455 ◽

2011 ◽

Vol 7 (6) ◽

pp. 382-388 ◽

Cited By ~ 31

Author(s):

Arif H. Kamal ◽

Janet Bull ◽

Dio Kavalieratos ◽

Donald H. Taylor ◽

William Downey ◽

...

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Community Dwelling ◽

Care Needs ◽

Patients With Cancer ◽

Palliative Care Needs

The authors describe the current palliative care needs of a population of community-dwelling patients with advanced cancer who are not yet ready for transition to hospice.

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Comparing the physical, psychological, social, and spiritual needs of patients with non-cancer and cancer diagnoses in a tertiary palliative care setting

Palliative & Supportive Care ◽

10.1017/s1478951519001020 ◽

2019 ◽

Vol 18 (5) ◽

pp. 513-518 ◽

Cited By ~ 2

Author(s):

Suhair Bandeali ◽

Amanda Roze des Ordons ◽

Aynharan Sinnarajah

Keyword(s):

Palliative Care ◽

Retrospective Chart Review ◽

Spiritual Needs ◽

Primary Concern ◽

List Type ◽

Care Needs ◽

Serious Illness ◽

Patients With Cancer ◽

Palliative Care Setting ◽

Palliative Care Needs

AbstractObjectiveThe purpose was to describe the physical, psychological, social, and spiritual needs of patients with non-cancer serious illness diagnoses compared to those of patients with cancer.MethodWe conducted a retrospective chart review of all patients with a non-cancer diagnosis admitted to a tertiary palliative care unit between January 2008 and December 2017 and compared their needs to those of a matched cohort of patients with cancer diagnoses. The prevalence of needs within the following four main concerns was recorded and the data analyzed using descriptive statistics and content analysis: •Physical: pain, dyspnea, fatigue, anorexia, edema, and delirium•Psychological: depression, anxiety, prognosis, and dignity•Social: caregiver burden, isolation, and financial•Spiritual: spiritual distressResultsThe prevalence of the four main concerns was similar among patients with non-cancer and cancer diagnoses. Pain, nausea/vomiting, fatigue, and anorexia were more prevalent among patients with cancer. Dyspnea was more commonly the primary concern in patients with non-cancer diagnoses (39%), who also had a higher prevalence of anxiety and concerns about dignity. Spirituality was addressed more often in patients with cancer.Significance of resultsThe majority of patients admitted to tertiary palliative care settings have historically been those with cancer. The tertiary palliative care needs of patients with non-cancer diagnoses have not been well described, despite the increasing prevalence of this population. Our description of the palliative care needs of patients with non-cancer diagnoses will help guide future palliative care for the increasing population of patients with non-cancer serious illness diagnoses.

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RELIEF: A Digital Health Tool for the Remote Self-Reporting of Symptoms in Patients with Cancer to Address Palliative Care Needs and Minimize Emergency Department Visits

Current Oncology ◽

10.3390/curroncol28060363 ◽

2021 ◽

Vol 28 (6) ◽

pp. 4273-4280

Author(s):

Ravi Bhargava ◽

Bonnie Keating ◽

Sarina R. Isenberg ◽

Saranjah Subramaniam ◽

Pete Wegier ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Symptom Management ◽

Digital Health ◽

Clinical Intervention ◽

Emergency Department Visits ◽

Self Report ◽

Care Needs ◽

Patients With Cancer ◽

Palliative Care Needs

The lack of timely symptom reporting remains a barrier to effective symptom management and comfort for patients with cancer-related palliative care needs. Poor symptom management at home can lead to unwanted outcomes, such as emergency department visits and death in hospital. We developed and evaluated RELIEF, a remote symptom self-reporting app for community patients with palliative care needs. A pilot feasibility study was conducted at a large, community hospital in Ontario, Canada. Patients self-reported their symptoms each morning using validated clinical symptom measures and RELIEF would alert for worsening or severe symptoms. RELIEF alerts were monitored by palliative care nurses who would then contact patients to determine if appropriate clinical intervention could be initiated to avoid unnecessary emergency department visits. A total of 20 patients were recruited to use RELIEF for two months. Patients completed 80% of daily self-report assessments; 133 alerts were trigged, half of which required clinical intervention. No patient visited the emergency department for symptom management during the study. Clinical staff estimated five emergency department visits were avoided because of RELIEF—saving an estimated cost of over CAD 60,000. RELIEF is a feasible and acceptable method for the remote monitoring of patients with palliative care needs through regular symptom self-reporting.

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Validation of a Simple Screening Tool for Identifying Unmet Palliative Care Needs in Patients With Cancer

Journal of Oncology Practice ◽

10.1200/jop.2014.001487 ◽

2015 ◽

Vol 11 (1) ◽

pp. e81-e86 ◽

Cited By ~ 29

Author(s):

Paul A. Glare ◽

Kimberly Chow

Keyword(s):

Palliative Care ◽

Screening Tool ◽

Care Needs ◽

Patients With Cancer ◽

Valid Method ◽

Palliative Care Needs ◽

Simple Screening

The authors conclude an 11-item screening tool seems to be a valid method for identifying patients with cancer who have complex PC needs and could benefit from a PC consult.

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