scholarly journals Palliative care referral criteria and outcomes in cancer and heart failure: a systematic review of literature

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Anecita P. Fadol ◽  
Ashley Patel ◽  
Valerie Shelton ◽  
Kate J. Krause ◽  
Eduardo Bruera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Symptom Burden ◽  
Cochrane Library ◽  
Early Integration ◽  
Patients With Cancer ◽  
Ovid Medline ◽  
Referral Criteria ◽  
Patient Reported ◽  
Hospice And Palliative Care

Abstract Background Cardiotoxicity resulting in heart failure (HF) is among the most dreaded complications of cancer therapy and can significantly impact morbidity and mortality. Leading professional societies in cardiology and oncology recommend improved access to hospice and palliative care (PC) for patients with cancer and advanced HF. However, there is a paucity of published literature on the use of PC in cardio-oncology, particularly in patients with HF and a concurrent diagnosis of cancer. Aims To identify existing criteria for referral to and early integration of PC in the management of cases of patients with cancer and patients with HF, and to identify assessments of outcomes of PC intervention that overlap between patients with cancer and patients with HF. Design Systematic literature review on PC in patients with HF and in patients with cancer. Data sources Databases including Ovid Medline, Ovid Embase, Cochrane Library, and Web of Science from January 2009 to September 2020. Results Sixteen studies of PC in cancer and 14 studies of PC in HF were identified after screening of the 8647 retrieved citations. Cancer and HF share similarities in their patient-reported symptoms, quality of life, symptom burden, social support needs, readmission rates, and mortality. Conclusion The literature supports the integration of PC into oncology and cardiology practices, which has shown significant benefit to patients, caregivers, and the healthcare system alike. Incorporating PC in cardio-oncology, particularly in the management of HF in patients with cancer, as early as at diagnosis, will enable patients, family members, and healthcare professionals to make informed decisions about various treatments and end-of-life care and provide an opportunity for patients to participate in the decisions about how they will spend their final days.

Comparative analysis of internal medicine physicians’ perspectives and attitudes when addressing palliative care needs in heart failure and cancer patients.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 7-7
Author(s):  
Vatsala Katiyar ◽  
Tiago Araujo ◽  
Ishaan Vohra ◽  
Rayli Pichardo ◽  
Vijaya Venkatasubbaraya Pavan Kedar Vijaya Venkatasubbar Mukthinuthalapati ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Palliative Care ◽  
Cancer Patients ◽  
Symptom Burden ◽  
Stage Iv ◽  
Care Needs ◽  
Early Integration ◽  
Survey Tool ◽  
Level Of Training

7 Background: Palliative care (PC) is heavily centered on patients with advanced and often incurable malignancies. Despite having a comparable symptomatic burden and worse mortality rates than some types of cancer, heart failure (HF) patients have decreased rate of palliative service referral of approximately 7%, as opposed to 48% in those with malignancies. We aim to understand the differences in the attitudes of physicians when addressing the PC needs for patients with advanced HF and malignancies. Methods: All the internal medicine residents at our institute were asked to fill out a structured paper-based questionnaire. The survey tool consisted of both Likert-type scales and open-ended questions focused on their attitude and perceptions while managing patients with advanced HF and Stage IV malignancy. Descriptive statistics and intergroup comparisons were then made for all quantifiable variables (Table). Results: Of the 137 medicine residents, 120 (87.6%) completed the survey. 70% were males and 96.6% residents were in the age group of 25-34 years. 62.5% residents had done a PC rotation prior to answering the survey and they were more comfortable in initiating goals of care (GOC) discussion for these patients. More residents were comfortable communicating the prognosis of patients with HF as compared to cancer patients irrespective of the level of training. Of the 26 residents interested in pursuing cardiology as a subspecialty, only 5 (19.2%) thought that the 5-year mortality of advanced HF ≥50%. Conclusions: Physicians often underestimate the symptom burden and mortality of HF patients and are less likely to consult PC for them. Early integration of PC in the management of HF patients is recommended and physicians need to be educated on these guidelines. [Table: see text]

Discussing the Evidence for Upstream Palliative Care in Improving Outcomes in Advanced Cancer

2016 ◽  
pp. e534-e538 ◽  
Author(s):  
Myles S. Nickolich ◽  
Areej El-Jawahri ◽  
Jennifer S. Temel ◽  
Thomas W. LeBlanc
Keyword(s):  
Palliative Care ◽  
Cancer Care ◽  
Symptom Burden ◽  
Early Integration ◽  
Patients With Cancer ◽  
Care Services ◽  
Palliative Care Services ◽  
American Society ◽  
Definition Of ◽  
State Of The Science

Palliative care has received increasing attention at the American Society of Clinical Oncology (ASCO) Annual Meeting since the publication of its provisional clinical opinion on the topic in 2012. Despite frequent discussion, palliative care remains a source of some controversy and confusion in clinical practice, especially concerning who should provide it, what it encompasses, and when and how it can help patients and their families. In this article, we provide a formal definition of palliative care and review the state of the science of palliative care in oncology. Several randomized controlled trials now show that palliative care improves important outcomes for patients with cancer. Related outcome improvements include a reduction in symptoms, improved quality of life, better prognostic understanding, less depressed mood, less aggressive end-of-life care, reduced resource utilization, and even prolonged survival. As such, ASCO recommends early integration of palliative care into comprehensive cancer care for all patients with advanced disease and/or significant symptom burden. Our aim is that this summary will facilitate greater understanding about palliative care and encourage further integration of palliative care services into cancer care. More research is needed to illuminate the mechanisms of action of palliative care and to improve the specificity of palliative care applications to unique scenarios and populations in oncology.

scholarly journals Understanding how a palliative-specific patient-reported outcome intervention works to facilitate patient-centred care in advanced heart failure: A qualitative study

2017 ◽  
Vol 32 (1) ◽  
pp. 143-155 ◽  
Author(s):  
Pauline M Kane ◽  
Clare I Ellis-Smith ◽  
Barbara A Daveson ◽  
Karen Ryan ◽  
Niall G Mahon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Chronic Heart Failure ◽  
Unmet Needs ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Specific Patient ◽  
Patient Centred Care ◽  
Palliative Care Outcome Scale ◽  
Patient Reported

Background: Palliative care needs of patients with chronic heart failure are poorly recognised. Policy makers advise a patient-centred approach to holistically assess patients’ needs and care goals. Patient-reported outcome measures are proposed to facilitate patient-centred care. Aim: To explore whether and how a palliative care–specific patient-reported outcome intervention involving the Integrated Palliative care Outcome Scale influences patients’ experience of patient-centred care in nurse-led chronic heart failure disease management clinics. Design: A feasibility study using a parallel mixed-methods embedded design was undertaken. The qualitative component which examined patients and nurses experience of the intervention is reported here. Semi-structured interviews were conducted and analysed using framework analysis. Setting/participants: Eligible patients attended nurse-led chronic heart failure disease management clinics in two tertiary referral centres in Ireland with New York Heart Association functional class II–IV. Nurses who led these clinics were eligible for inclusion. Results: In all, 18 patients and all 4 nurses involved in the nurse-led clinics were interviewed. Three key themes were identified: identification of unmet needs, holistic assessment and patient empowerment. The intervention impacted on processes of care by enabling a shared understanding of patients’ symptoms and concerns, facilitating patient–nurse communication by focusing on these unmet needs and empowering patients to become more involved in clinical discussions. Conclusion: This Integrated Palliative care Outcome Scale–based intervention empowered patients to become more engaged in the clinical consultation and to highlight their unmet needs. This study adds to the evidence for the mechanism of action of patient-reported outcome measures to improve patient-centred care and will help inform outcome selection for future patient-reported outcome measure research.

Mikor és hogyan integráljuk az onkológiai és a palliatív ellátást?

2021 ◽  
Vol 162 (44) ◽  
pp. 1769-1775
Author(s):  
Orsolya Horváth ◽  
Enikő Földesi ◽  
Katalin Hegedűs
Keyword(s):  
Palliative Care ◽  
Care Providers ◽  
Yale University ◽  
Early Integration ◽  
Advantages And Disadvantages ◽  
Referral Criteria ◽  
Number Of Patients ◽  
Oncology Care ◽  
The Right

Összefoglaló. A palliatív ellátások korai bevonása az onkológiai betegek ellátásába előnnyel jár mind a beteg életminősége, mind a kezelés színvonala, mind a költséghatékonyság szempontjából. Szükség van egy olyan modellre, mely alapján a megfelelő időben, a megfelelő beteg a megfelelő minőségű palliatív ellátásban részesül. Ebben a közleményben a palliatív ellátás korai integrációjának előnyei, szintjei és a speciális palliatív ellátás fogalmának ismertetése után a leginkább elterjedt beutalási modellek előnyeit és hátrányait mutatjuk be a nemzetközi szakirodalom alapján. A speciális palliatív ellátást igénylő betegek kiszűrésére szolgáló, prognózisalapú modellek hátránya, hogy nincs elég kapacitás az ilyen módon beutalt nagyszámú beteg ellátására, ezért széles körben nem terjedtek el. A tüneteken alapuló modellek sokszor bonyolultak és a mindennapi klinikai gyakorlatban nem használatosak. Az új kutatások alapján egyszerű, gyakorlatias kérdéssorokat alkalmaznak, melyekkel könnyen kiemelhetők, akik profitálnak a speciális palliatív intervencióból. Ezek közül a Yale egyetemi és a PALLIA -10 modellt ismertetjük részletesen. Amennyiben az aktív onkológiai ellátást végzők a megfelelő palliatív beutalási kritériumokat ismerik és alkalmazzák, a betegek időben jutnak a megfelelő komplex kezeléshez anélkül, hogy a palliatív ellátórendszer túlterhelődne. Orv Hetil. 2021; 162(44): 1769–1775. Summary. Early integration of palliative care into the trajectory of cancer care brings advantages into the patients’ quality of life, the level of care and cost-efficiency, too. On the basis of a predefined model, the right patient may receive the right level of palliative care at the right time. Having defined the advantages, the levels of early integration of palliative care and the concept of special palliative care, we also aim to describe the advantages and disadvantages of the most common referral models on the basis of international literature in this article. The drawback of prognosis-based models to identify patients needing special palliative care is the lack of capacity to provide care for the large number of patients so recognised; therefore they have not become widespread. Needs-based models tend to be complicated and thus rarely applied in everyday clinical practice. On the basis of new researches, simple, pragmatic questionnaires are utilised through which the patients who could benefit from special palliative care interventions are easy to identify. Here we give a detailed report of the Yale University and PALLIA-10 models. On condition that appropriate palliative referral criteria are known and applied by active oncology care providers, patients may receive adequate complex care without the palliative care system being overloaded. Orv Hetil. 2021; 162(44): 1769–1775.

scholarly journals A cross-sectional assessment of symptom burden among patients with advanced cervical cancer

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tolcha Kebebew ◽  
Azwihangwisi Helen Mavhandu-Mudzusi ◽  
Annah Mosalo
Keyword(s):  
Cervical Cancer ◽  
Palliative Care ◽  
Addis Ababa ◽  
Symptom Burden ◽  
Advanced Cervical Cancer ◽  
Patient Anxiety ◽  
Emotional Symptoms ◽  
Cross Sectional ◽  
Limited Mobility ◽  
Patient Reported

Abstract Background The increasing burden of chronic non-communicable diseases in developing countries is driving attention to palliative care services. Identification of disease-specific symptoms of concern and their prevalence will guide designing, monitoring, and evaluating palliative care programmes. This study assessed the burden of symptoms and problems among patients with advanced cervical cancer. Methods This research followed a cross-sectional study design to quantitatively review the symptom burden among patients diagnosed with advanced cervical cancer attending treatment at Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia from January to July 2019. Symptoms were assessed using a patient-reported, seven-day recall Integrated Palliative Care Outcome Scale (IPOS) version III. Frequency, median and mean scores with a standard deviation were used in the descriptive analysis whereas t-test and one-way analysis of variance were used for comparisons. Results There were 385 patients with advanced cervical cancer, stage IIB-IVB, successfully interviewed. The median age was 50 years, the majority were illiterate (63.1%) and in marital union (62.3%). Over 50% of the patients experienced pain, weakness, poor appetite, constipation, limited mobility, and dry mouth. The burdens of emotional symptoms such as patient anxiety, family anxiety, and patient depression were also prevalent at 79.7%, 82.3%, and 47.0%, respectively. Patients who are illiterate, at a higher stage of the disease, not currently in marriage, and who received palliative radiotherapy bear a higher symptom burden. Conclusion Patients with advanced cervical cancer bear a high symptom burden. Early initiation of palliative care is recommended to alleviate the concerning symptoms, and to improve patients’ quality of life.

scholarly journals Prescreening of Patient-reported Symptoms using the Edmonton Symptom Assessment System (ESAS) in Outpatient Palliative Cancer Care

2019 ◽  
Author(s):  
Garden Lee ◽  
Han Sang Kim ◽  
Si Won Lee ◽  
Eun Hwa Kim ◽  
Bori Lee ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Care ◽  
Severe Symptom ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment System ◽  
Advanced Cancer Patients ◽  
Edmonton Symptom Assessment System ◽  
Patient Reported

Abstract Background: Although early palliative care is associated with a better quality of life and improved outcomes in end-of-life cancer care, the criteria of palliative care referral are still elusive. Methods: We collected patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS) at the baseline, first, and second follow-up visit. The ESAS evaluates ten symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, appetite, and wellbeing. A total of 71 patients were evaluable, with a median age of 65 years, male (62%), and the Eastern Cooperative Oncology Group (ECOG) performance status distribution of 1/2/3 (28%/39%/33%), respectively. Results: Twenty (28%) patients had moderate/severe symptom burden with the mean ESAS ≥5. Interestingly, most of the patients with moderate/severe symptom burdens (ESAS ≥5) had globally elevated symptom expression. While the mean ESAS score was maintained in patients with mild symptom burden (ESAS<5; 2.7 at the baseline; 3.4 at the first follow-up; 3.0 at the second follow-up; P =0.117), there was significant symptom improvement in patients with moderate/severe symptom burden (ESAS≥5; 6.5 at the baseline; 4.5 at the first follow-up; 3.6 at the second follow-up; P <0.001). Conclusions: Advanced cancer patients with ESAS ≥5 may benefit from outpatient palliative cancer care. Prescreening of patient-reported symptoms using ESAS can be useful for identifying unmet palliative care needs in advanced cancer patients.

Pulmonary referrals to specialist palliative medicine: a survey

2021 ◽  
pp. bmjspcare-2021-003386
Author(s):  
Michael Bonares ◽  
Kenneth Mah ◽  
David Christiansen ◽  
John Granton ◽  
Andrea Weiss ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Chronic Respiratory Disease ◽  
Life Care ◽  
Care Needs ◽  
Patients With Cancer ◽  
Referral Criteria ◽  
Referral Practices ◽  
Palliative Care Needs

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.

Palliative care in heart failure

ESC CardioMed ◽  
2018 ◽  
pp. 1908-1911
Author(s):  
James Beattie
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Symptom Burden ◽  
Clinical Population ◽  
Complex Nature ◽  
Disease Course ◽  
Disease Trajectory ◽  
Challenges And Opportunities ◽  
Potential Benefits ◽  
Preferences For Care

From an evolutionary base in the care of those with cancer, the potential benefits of palliative care for those affected by other life-limiting diseases such as heart failure have been widely recognized. People with heart failure are subject to a symptom burden and mortality risk similar to those associated with malignant disease, but the clinical scenario is often more complicated. This relatively aged clinical population tend to have multiple co-morbidities and an unpredictable disease trajectory. The beneficial but increasingly complex nature of comprehensive heart failure therapy in polypharmacy, implantable devices, and cardiac surgical intervention may undermine clinical coordination, patient autonomy, and ultimately conflict with patients’ and families’ changing preferences for care along a progressive disease course to the end of life. This chapter describes the challenges and opportunities in providing palliative care to this burgeoning clinical cohort.

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