Palliative care from the perspective of cancer physicians: a qualitative semistructured interviews study

2020 ◽  
pp. bmjspcare-2020-002455
Author(s):  
Guillaume Economos ◽  
Alice Bonneville-Levard ◽  
Ines Djebari ◽  
Kevin Van Thuynes ◽  
Colombe Tricou ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Care ◽  
Symptom Management ◽  
Terminal Care ◽  
Qualitative Methodology ◽  
Psychosocial Support ◽  
Specialist Palliative Care ◽  
Palliative Care Teams ◽  
Semistructured Interviews ◽  
Data Saturation

ObjectiveIntegrated palliative care for populations with cancer is now highly recommended. However, numerous physicians working in cancer care are still reluctant to refer patients to specialist palliative care teams. This study explores their perceptions of palliative care and factors influencing reasons to refer to specialist palliative care.MethodsWe used a qualitative methodology based on semistructured interviews with physicians working in cancer care, in two tertiary hospitals and one comprehensive cancer centre with access to a specialist palliative care team. Forty-six physicians were invited and 18 interviews were performed until data saturation. Participants were mainly men, licensed in cancer care, 37.9 years old on average and had 13 years of professional experience. The length of interviews was on average 34 min (SD=3). Analysis was performed accordingly with the thematic analysis.ResultsThe data analysis found four themes: symptom management as a trigger, psychosocial support, mediation provided by interventions, and the association with terminal care or death. Palliative care integrated interventions were mainly perceived as holistic approaches that offered symptom management expertise and time. They were valued for helping in consolidating decision-making from a different or external perspective, or an ‘outside look’. Several barriers were identified, often due to the confusion between terminal care and palliative care. This was further highlighted by the avoidance of the words ‘palliative care’, which were associated with death.ConclusionsNational policies for promoting palliative care seemed to have failed in switching oncologists' perception of palliative care, which they still consider as terminal care.

Retrospective assessment of quality of cancer care in last 6 months of life.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 234-234
Author(s):  
Brian Cassel ◽  
Nevena Skoro ◽  
Kathleen Kerr ◽  
Lisa Shickle ◽  
Patrick J. Coyne ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Cancer Care ◽  
Specialist Palliative Care ◽  
Retrospective Assessment ◽  
Palliative Care Teams ◽  
Social Security Death Index ◽  
National Quality ◽  
National Organizations

234 Background: National organizations such as the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum (NQF) have developed metrics that assess the quality of cancer care. These metrics include consensus standards by the NQF for management of symptoms and end-of-life-care. Cancer centers need feasible methods for self-evaluating their performance on such metrics. Methods: Claims for our cancer patients were matched to Social Security Death Index data to determine date of death.3,128 adult cancer patients died between January 2009 and July 2011 and had at least 1 contact with our center in their last six month of life. All inpatient and outpatient claims data generated in the last six months of life at our hospital were analyzed. Results: 32% of patients had an admission in their last 30 days of life, with 15% dying in the hospital. 19% had at least one 30-day readmission in their last six months of life. 6.7% had chemotherapy in the 2 weeks prior to death, and 11.4% in the last month. 27.5% had some contact with the specialist palliative care (SPC) team. Solid tumor patients with SPC earlier than 1 month until death had fewer in-hospital deaths (15.6%) versus those with later or no SPC (19.5%), p=.041. There was no SPC difference for 30-day mortality, or 14- or 30-day chemotherapy metrics. Conclusions: Hospitals can self-evaluate their own performance on NQF endorsed measures, and CMS outcome measures. These data provide additional impetus for earlier integration of specialist palliative care teams. SPC in the last 1-3 weeks of life did not improve most utilization metrics.[Table: see text]

Acceptance and Benefits of Two Different Strategies to Timely Integrate Specialist Palliative Care into Routine Cancer Care – a Randomized Pilot Study

2021 ◽  
Author(s):  
Anneke Ullrich ◽  
Svenja Wilde ◽  
Volkmar Müller ◽  
Marianne Sinn ◽  
Christoffer Gebhardt ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Directives ◽  
Cancer Care ◽  
Psychosocial Support ◽  
Information Provision ◽  
Specialist Palliative Care ◽  
Incurable Cancer ◽  
Advance Care ◽  
Integration Strategies ◽  
Qualitative Part

Background / Aims: To investigate the acceptance and benefits of two different strategies to timely integrate specialist palliative care (SPC) in routine cancer care: commonly recommended early SPC counselling versus an informational brochure plus SPC counselling upon patients’ request. Methods: Patients diagnosed with incurable cancer within the last 6-12 weeks were sequentially randomized. Endpoints were acceptance of the two strategies after 3 months as well as use of SPC counselling and psychosocial support, presence of advance directives, palliative care outcome (IPOS), psychosocial distress (DT) and after 3 and 6 months. In a qualitative part, SPC consultations were analyzed using content analysis. Results: Overall, 43 patients received SPC counselling and 37 a brochure with SPC counselling on demand. In the brochure group, only one patient later registered for SPC counselling from own initiative. SPC timing was appropriate in 70% of patients (75% counselling / 61% brochure, n.s.). Sufficiency, helpfulness and relevance of information, provision of security and help with finding contacts for specific support were perceived adequate in both groups. No significant differences were found regarding potential effects of the interventions on IPOS or DT after 3 and 6 months. Use of psychosocial support was comparable between the groups and 4 patients had new advance directives (3 counselling / 1 brochure). Five key themes of SPC consultations were identified: symptoms, rapport, coping, illness understanding, and advance care planning. Conclusions: Both SPC integration strategies were well accepted. However, patients seem not to benefit from a brochure in terms of initiating SPC counselling timely after a palliative cancer diagnosis.

Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness

2021 ◽  
pp. 104990912110107
Author(s):  
Kate L. M. Hinrichs ◽  
Cindy B. Woolverton ◽  
Jordana L. Meyerson
Keyword(s):  
Mental Illness ◽  
Palliative Care ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Psychosocial Support ◽  
Life Care ◽  
Case Examples ◽  
Increased Risk ◽  
Palliative Care Teams

Individuals with serious mental illness (SMI) have shortened life expectancy with increased risk of developing comorbid medical illnesses. They might have difficulty accessing care and can be lost to follow-up due to complex socioeconomic factors, placing them at greater risk of dying from chronic or undiagnosed conditions. This, in combination with stigma associated with SMI, can result in lower quality end-of-life care. Interdisciplinary palliative care teams are in a unique position to lend assistance to those with SMI given their expertise in serious illness communication, values-based care, and psychosocial support. However, palliative care teams might be unfamiliar with the hallmark features of the various SMI diagnoses. Consequently, recognizing and managing exacerbations of SMI while delivering concurrent palliative or end-of-life care can feel challenging. The goal of this narrative review is to describe the benefits of providing palliative care to individuals with SMI with concrete suggestions for communication and use of recovery-oriented language in the treatment of individuals with SMI. The salient features of 3 SMI diagnoses—Bipolar Disorders, Major Depressive Disorder, and Schizophrenia—are outlined through case examples. Recommendations for working with individuals who have SMI and other life-limiting illness are provided, including strategies to effectively manage SMI exacerbations.

scholarly journals Shared electronic care coordination systems following referral to hospice

2021 ◽  
Vol 26 (2) ◽  
pp. 58-62
Author(s):  
Libby Sampey ◽  
Anne M Finucane ◽  
Juliet Spiller
Keyword(s):  
Palliative Care ◽  
Service Evaluation ◽  
Health Providers ◽  
Specialist Palliative Care ◽  
Community Nurse ◽  
Structured Interviews ◽  
Out Of Hours ◽  
Care Community ◽  
Palliative Care Teams ◽  
Coordination Systems

In Scotland, the Key Information Summary (KIS) enables health providers to access key patient information to guide decision-making out-of-hours. KISs are generated in primary care and rely on information from other teams, such as community specialist palliative care teams (CSPCTs), to keep them up-to-date. This study involved a service evaluation consisting of case note reviews of new referrals to a CSPCT and semi-structured interviews with palliative care community nurse specialists (CNSs) regarding their perspectives on KISs. Some 44 case notes were examined, and 77% of patients had a KIS on CSPCT referral. One-month post-referral, all those re-examined (n=17) had a KIS, and 59% KISs had been updated following CNS assessments. CNSs cited anticipatory care planning (ACP) as the most useful aspect of KIS, and the majority of CNSs said they would appreciate KIS editing access. A system allowing CNSs to update KISs would be acceptable to CNSs, as it could facilitate care co-ordination and potentially improve comprehensiveness of ACP information held in KISs.

Acute palliative intervention: critical care outreach and hospital specialist palliative care teams collaboration

2020 ◽  
pp. bmjspcare-2019-002065
Author(s):  
Felicity Dewhurst ◽  
Alex Nicholson ◽  
Lindsay Garcia ◽  
Isabel Gonzalez ◽  
Martin Johnson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Specialist Palliative Care ◽  
Hospital Specialist ◽  
Palliative Care Teams ◽  
Critical Care Outreach

The Effect of Community-Based Specialist Palliative Care Teams on Place of Care

2016 ◽  
Vol 19 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Hsien Seow ◽  
Gagan Dhaliwal ◽  
Konrad Fassbender ◽  
Jagadish Rangrej ◽  
Kevin Brazil ◽  
...  
Keyword(s):  
Palliative Care ◽  
Specialist Palliative Care ◽  
Community Based ◽  
Palliative Care Teams

How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals

2015 ◽  
Vol 33 (6) ◽  
pp. 520-526 ◽  
Author(s):  
Akihiro Sakashita ◽  
Megumi Kishino ◽  
Yoko Nakazawa ◽  
Nobuyuki Yotani ◽  
Takashi Yamaguchi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Care ◽  
Full Time ◽  
Palliative Care Teams

scholarly journals Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

2020 ◽  
Author(s):  
Ellinor Christin Haukland ◽  
Christian von Plessen ◽  
Carsten Nieder ◽  
Barthold Vonen
Keyword(s):  
Palliative Care ◽  
Adverse Events ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Quality And Safety ◽  
Negative Consequences ◽  
Specialist Palliative Care ◽  
Early Integration ◽  
Anticancer Treatment

Abstract Background: Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer care Methods: Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life. Results: 30 % of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62 % more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1 000 patient days (p<0.001, OR 1.62 (1.23 – 2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18 % (p=0.045, OR 1.85 (1.01 – 3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1 000 patient days in both groups by 29 % (p= 0.02, IRR 0.71, CI 95% 0.53 – 0.96). Conclusions: Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.

scholarly journals ‘Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multi-national survey (CovPall)

2020 ◽  
Author(s):  
Lesley Dunleavy ◽  
Nancy Preston ◽  
Sabrina Bajwah ◽  
Andy Bradshaw ◽  
Rachel Cripps ◽  
...  
Keyword(s):  
Palliative Care ◽  
Resource Use ◽  
System Response ◽  
List Type ◽  
Specialist Palliative Care ◽  
It Infrastructure ◽  
Care Services ◽  
Palliative Care Teams ◽  
Palliative Care Services ◽  
Palliative Care Units

AbstractBackgroundSpecialist palliative care services have a key role in a whole system response to COVID-19. There is a need to understand service response to share good practice and prepare for future care.AimTo map and understand specialist palliative care services innovations and practice changes in response to COVID-19 (CovPall).DesignOnline survey of specialist palliative care providers, disseminated via key stakeholders. Data collected on service characteristics, innovations and changes in response to COVID-19. Statistical analysis included frequencies, proportions and means, and free-text comments were analysed using a qualitative framework approach.Setting/participantsInpatient palliative care units, home nursing services, hospital and home palliative care teams from any country.Results458 respondents: 277 UK, 85 Europe (except UK), 95 World (except UK and Europe), 1 missing country. 54.8% provided care across 2+ settings; 47.4% hospital palliative care teams, 57% in-patient palliative care units, and 57% home palliative care teams. The crisis context meant services implemented rapid changes. Changes involved streamlining, extending and increasing outreach of services, using technology to facilitate communication, and implementing staff wellbeing innovations. Barriers included; fear and anxiety, duplication of effort, information overload, funding, and IT infrastructure issues. Enablers included; collaborative teamwork, pooling of staffing resources, staff flexibility, a pre-existing IT infrastructure and strong leadership.ConclusionsSpecialist palliative care services have been flexible, highly adaptive and have adopted a ‘frugal innovation’ model in response to COVID-19. In addition to financial support, greater collaboration is essential to minimise duplication of effort and optimise resource use.ISRCTN16561225https://doi.org/10.1186/ISRCTN16561225Key StatementsWhat is already known about the topic?Specialist palliative care is part of a whole healthcare system response to COVID-19.Services need to make practice changes in response to the global pandemic.What this paper addsSpecialist palliative care services responded rapidly to COVID-19 in both planning for change and then adapting to needs and requirements.Services often relied on ‘improvisation’, ‘quick fixes’ and ‘making do’ when responding to the COVID-19 crisis.Implications for practice, theory or policyIn addition to financial support, greater collaboration is essential to build organisational resilience and drive forward innovation, by minimising duplication of effort and optimising resource use.The effectiveness and sustainability of any changes made during the crisis needs further evaluation.

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