The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: A systematic review of views from patients, carers and health-care professionals

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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The health care cost of palliative care for cancer patients: a systematic review

Supportive Care in Cancer ◽

10.1007/s00520-020-05512-y ◽

2020 ◽

Vol 28 (10) ◽

pp. 4561-4573

Author(s):

Sandhya Yadav ◽

Isaac W. Heller ◽

Nancy Schaefer ◽

Ramzi G. Salloum ◽

Sheri M. Kittelson ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Palliative Care ◽

Cancer Patients ◽

Health Care Cost

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The Decision-Making Process for Palliative Sedation for Patients with Advanced Cancer–Analysis from a Systematic Review of Prospective Studies

Cancers ◽

10.3390/cancers14020301 ◽

2022 ◽

Vol 14 (2) ◽

pp. 301

Author(s):

Alazne Belar ◽

Maria Arantzamendi ◽

Johan Menten ◽

Sheila Payne ◽

Jeroen Hasselaar ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Decision Making ◽

Palliative Care ◽

Prospective Studies ◽

Health Care Professionals ◽

Disease Process ◽

Palliative Sedation ◽

Clinical Aspects ◽

Decision Making Process

Background. The involvement of patients in decision making about their healthcare plans is being emphasized. In the context of palliative sedation, it is unclear how these decisions are made and who are involved in. The aim of the study is to understand how this decision-making is taken. Method. Information from a systematic review on clinical aspects of palliative sedation prospective studies were included. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014–December 2019). Data extraction and analysis regarded: (a) When and by whom the decision-making process is initiated; (b) patient involvement; (c) family involvement and (d) healthcare involvement. Results. Data about decision making were reported in 8/10 included articles. Palliative sedation was reported in 1137 patients (only 16 of them were non-cancer). Palliative sedation was introduced by the palliative care team during the disease process, at admission, or when patients experienced refractory symptoms. Only two studies explicitly mentioned the involvement of patients in decision making. Co-decision between families and the regular health care professionals was usual, and the health care professionals involved had been working in palliative care services. Conclusion. Patient participation in decision making appeared to be compromised by limited physical or cognitive capacity and family participation is described. The possibility of palliative sedation should be discussed earlier in the disease process.

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