scholarly journals Proactive and systematic multidimensional needs assessment in patients with advanced cancer approaching palliative care: a study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e034413
Author(s):  
Denise Pergolizzi ◽  
Iris Crespo ◽  
Albert Balaguer ◽  
Cristina Monforte-Royo ◽  
Alberto Alonso-Babarro ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Phase I ◽  
Needs Assessment ◽  
Advanced Cancer ◽  
Phase Ii ◽  
Healthcare Professionals ◽  
Complex Interventions ◽  
Evidence Based ◽  
Delphi Consensus

IntroductionThe benefits of palliative care rely on how healthcare professionals assess patients’ needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients.Methods and analysisTo design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP’s acceptability, participation, practicality, adaptation and implementation. A nested qualitative study will purposively sample a subset of participants to add preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical practice.Ethics and disseminationEthical approval for this study has been granted by the university research ethics committee where the study will be carried out (approval reference MED-2018-10). Dissemination will be informed by the results obtained and communication will occur throughout.

scholarly journals Severe Asthma Toolkit: an online resource for multidisciplinary health professionals—needs assessment, development process and user analytics with survey feedback

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e032877
Author(s):  
Steven Maltby ◽  
Peter G Gibson ◽  
Helen K Reddel ◽  
Lorraine Smith ◽  
Peter A B Wark ◽  
...  
Keyword(s):  
Needs Assessment ◽  
Severe Asthma ◽  
Health Professionals ◽  
Healthcare Professionals ◽  
Reference Group ◽  
Asthma Management ◽  
Web Design ◽  
Skills Training ◽  
Evidence Based ◽  
Internet Resource

ObjectivesSevere asthma imposes a significant burden on individuals, families and the healthcare system. New treatment and management approaches are emerging as effective options for severe asthma. Translating new knowledge to multidisciplinary healthcare professionals is a priority. We developed ‘The Severe Asthma Toolkit’(https://toolkit.severeasthma.org.au) to increase awareness of severe asthma, provide evidence-based resources and support decisionmaking by healthcare providers.SettingRoundtable discussions and a survey of Australians clinicians were conducted to determine clinician preferences, format and content for a severe asthma resource.ParticipantsA reference group from stakeholder and consumer bodies and severe asthma experts provided advice and feedback. A multidisciplinary team of international experts was engaged to develop content. Written content was based on up-to-date literature. Peer and editorial review were performed to finalise content and inform web design. Website design focused on user experience, navigation, engagement, interactivity and tailoring of content for a clinical audience.ResultsA web-based resource was developed. Roundtable discussions and a needs assessment survey identified the need for dedicated severe asthma management resources to support skills training. The end-product, which launched 26 March 2018, includes an overview of severe asthma, diagnosis and assessment, management, medications, comorbidities, living with severe asthma, establishing a clinic, paediatrics/adolescents and clinical resources. Analytics indicate access by users worldwide (32 169 users from 169 countries). User survey results (n=394) confirm access by the target audience (72% health professionals), who agreed the toolkit increased their knowledge (73%) and confidence in managing severe asthma (66%), and 75% are likely to use the resource in clinic.ConclusionsThe Severe Asthma Toolkit is a unique, evidence-based internet resource to support healthcare professionals providing optimal care for people with severe asthma. It is a comprehensive, accessible and independent resource developed by leading severe asthma experts to improve clinician knowledge and skills in severe asthma management.

scholarly journals How do palliative care doctors recognise imminently dying patients? A judgement analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024996 ◽  
Author(s):  
Nicola White ◽  
Priscilla Harries ◽  
Adam JL Harris ◽  
Victoria Vickerstaff ◽  
Philip Lodge ◽  
...  
Keyword(s):  
Palliative Care ◽  
Observational Study ◽  
Phase I ◽  
Phase Ii ◽  
Prospective Observational Study ◽  
Clinical Signs ◽  
Brier Score ◽  
Prognostic Test ◽  
Probability Of Death ◽  
The Mean

ObjectivesTo identify a group of palliative care doctors who perform well on a prognostic test and to understand how they make their survival predictions.DesignProspective observational study and two cross-sectional online studies.SettingPhase I: an online prognostic test, developed from a prospective observational study of patients referred to palliative care. Phase II: an online judgement task consisting of 50 hypothetical vignettes.ParticipantsAll members of the Association of Palliative Medicine (APM) were eligible (n=~1100). 99 doctors completed the prognostic test and were included in the phase I analysis. The top 20% were invited to participate in phase II; 14/19 doctors completed the judgement task and were included in the phase II analysis.MeasuresPhase I: participants were asked to give a probability of death within 72 hours (0%–100%) for all 20 cases. Accuracy on the prognostic test was measured with the Brier score which was used to identify the ‘expert’ group (scale range: 0 (expert)–1 (non-expert)). Phase II: participants gave a probability of death within 72 hours (0%–100%). A mixed model regression analysis was completed using the percentage estimate as the outcome and the patient information included in the vignettes as the predictors.ResultsThe mean Brier score of all participants was 0.237 (95% CI 0.235 to 0.239). The mean Brier score of the ‘experts’ was 0.184 (95% CI 0.176 to 0.192). Six of the seven prognostic variables included in the hypothetical vignettes were significantly associated with clinician predictions of death. The Palliative Performance Score was identified as being the most influential in the doctors’ prognostic decision making (β=0.48, p<0.001).ConclusionsThis study identified six clinical signs and symptoms which influenced the judgement policies of palliative care doctors. These results may be used to teach novice doctors how to improve their prognostic skills.

scholarly journals Prognostic Factors in Advanced Cancer Patients: Evidence-Based Clinical Recommendations—A Study by the Steering Committee of the European Association for Palliative Care

2005 ◽  
Vol 23 (25) ◽  
pp. 6240-6248 ◽  
Author(s):  
Marco Maltoni ◽  
Augusto Caraceni ◽  
Cinzia Brunelli ◽  
Bert Broeckaert ◽  
Nicholas Christakis ◽  
...  
Keyword(s):  
Palliative Care ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
European Association ◽  
Prognostic Scores ◽  
Evidence Based ◽  
Advanced Cancer Patients ◽  
Clinical Recommendations ◽  
Biologic Factors

PurposeTo offer evidence-based clinical recommendations concerning prognosis in advanced cancer patients.MethodsA Working Group of the Research Network of the European Association for Palliative Care identified clinically significant topics, reviewed the studies, and assigned the level of evidence. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results. A systematic electronic literature search within the main available medical literature databases was performed for each of the following four areas identified: clinical prediction of survival (CPS), biologic factors, clinical signs and symptoms and psychosocial variables, and prognostic scores. Only studies on patients with advanced cancer and survival ≤ 90 days were included.ResultsA total of 38 studies were evaluated. Level A evidence-based recommendations of prognostic correlation could be formulated for CPS (albeit with a series of limitations of which clinicians must be aware) and prognostic scores. Recommendations on the use of other prognostic factors, such as performance status, symptoms associated with cancer anorexia-cachexia syndrome (weight loss, anorexia, dysphagia, and xerostomia), dyspnea, delirium, and some biologic factors (leukocytosis, lymphocytopenia, and C-reactive protein), reached level B.ConclusionPrognostication of life expectancy is a significant clinical commitment for clinicians involved in oncology and palliative care. More accurate prognostication is feasible and can be achieved by combining clinical experience and evidence from the literature. Using and communicating prognostic information should be part of a multidisciplinary palliative care approach.

Integration of specialty palliative care in a phase I ovarian cancer population.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 75-75
Author(s):  
Marisa R Moroney ◽  
Breana Hill ◽  
Jeanelle Sheeder ◽  
Jennifer Robinson Diamond ◽  
Melony Avella-Howell ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Palliative Care ◽  
Clinical Trials ◽  
Phase I ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Disease Stage ◽  
Phase I Clinical Trials ◽  
Care Services ◽  
Palliative Care Services

75 Background: ASCO guidelines recommend patients with advanced cancer receive early integrated specialty palliative care based on evidence of multiple clinical benefits. To our knowledge, there is no literature evaluating utilization of specialty palliative care in Phase I clinical trial patients, but there is limited data demonstrating underutilization of palliative care services in patients with life-threatening diseases including advanced cancer. Methods: A retrospective review of ovarian cancer patients enrolled in Phase I clinical trials at one institution from 2008 to 2018. Charts were reviewed for patient and disease characteristics including age, disease stage, number of chemotherapy regimens and date of death. Charts were also reviewed to determine if and when patients received specialty palliative care services. Results: A total of 121 patients with ovarian cancer were enrolled in Phase I clinical trials. Median age at time of Phase I enrollment was 59 years (range 33-88). 87% of patients had advanced stage disease: 60% Stage III and 27% Stage IV. Median number of chemotherapy regimens received prior to Phase I enrollment was 5 (range 1-13). Median survival was 311 days (95%CI 225.9-396.1). Of the 121 patients, 4 (3.3%) received specialty palliative care prior to Phase I enrollment, 7 (5.8%) within 30 days after enrollment, and 53 (43.8%) more than 30 days after enrollment. 57 patients (47.1%) never received specialty palliative care. Conclusions: Ovarian cancer patients enrolled in Phase I clinical trials have advanced cancer – defined by ASCO as disease that is late-stage and life limiting with a prognosis less than 24 months – and should therefore receive early integrated specialty palliative care. This study demonstrates that a significant portion of Phase I ovarian cancer patients are either receiving no or late integration of specialty palliative care. Further work needs to focus on increasing early integration of specialty palliative care in this population.

scholarly journals Managing Advanced Cancer Pain Together (MACPT) conversation tool: an evaluation of use in clinical practice

2021 ◽  
Author(s):  
Barry Quinn ◽  
Sophie Laurent ◽  
Susan Dargan ◽  
Maria Lapuente ◽  
Diana Lüftner ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cancer Pain ◽  
Advanced Cancer ◽  
Healthcare Professionals ◽  
Physical Pain ◽  
Before And After ◽  
Pain Descriptors

Aim: To investigate use of the ‘Managing Advanced Cancer Pain Together’ conversation tool between individuals with advanced cancer and healthcare professionals (HCPs) during routine consultations. Methods: Twenty-one patients and six HCPs completed questionnaires before and after use of the tool (at their routine consultation 1 and consecutive consultation 2, respectively). Results: Patients and HCPs were satisfied with communication during both consultations. When using the tool, patients most frequently selected physical pain descriptors (95.2%), followed by emotional (81.0%), social (28.6%) and spiritual (28.6%) descriptors. Patients found the tool useful, stating that it helped them describe their pain. HCPs considered the tool difficult to incorporate into consultations. Conclusion: The study highlighted the need to consider the various aspects of cancer pain.

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