The integration of palliative care into treatment of oncology patients at the Istituto Oncologico Veneto (IOV): The interdisciplinary clinic of simultaneous care.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 150-150
Author(s):  
Antonella Galiano ◽  
Stefania Schiavon ◽  
Antonella Brunello ◽  
Michela Michielotto ◽  
Irene Guglieri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Health Department ◽  
Care Physician ◽  
Local Health ◽  
Oncology Patient ◽  
Early Integration ◽  
Symptomatic Disease ◽  
Assessment And Treatment

150 Background: WHO defines palliative care as an approach that improves the quality of life of patients (pts) and their families facing problems associated with life threatening illnesses. This occurs by means of early identification, assessment and treatment of pain and other problems physical, psychosocial, and spiritual. Recently, palliative care has been incorporated into the treatment of oncology pts earlier in the course of their disease. We aimed to explore this approach at our institution. Methods: We established an interdisciplinary clinic at IOV with the goal of promoting pts’ comprehensive support by integrating palliative care into active oncology treatments. Our primary objectives were to: optimize the quality of life of pts at every stage of their disease, ensure continuity of care through proper coordination of available services and avoid a sense of abandonment at the end of life. Pts included were those with advanced disease who had a life expectancy of less than one year, pts who had symptomatic disease regardless of prognosis, and pts who were considered frail, because of clinical, social, psychological, spiritual, logistical, and economical criteria. The multidisciplinary team consisted of a medical oncologist, a palliative care physician, a psychologist, a nurse and a nutritionist. Results: Between March 2014 and March 2016, 337 pts were visited, with different types of cancer. Median age was 69 (range: 34-93), 44% were men, median PS (ECOG) was 1.5, 47% were undergoing anti-cancer treatment. Reasons for referral included: physical complaints (71%), psychosocial issues (30.3%), nutritional problems (38%) and social problems (7%). For the 46% of patients, domiciliary health care was activated directly by the Local Health Department or through the General Practitioner; specific action have been made in relations to the problems encountered. Conclusions: The Interdisciplinary Clinic of Simultaneous Care carried out at IOV represents a successful pilot experience that proposes an organizational model for early integration of palliative care as an integral part of treating the oncology patient.

scholarly journals Impact of a specialised palliative care intervention in patients with advanced soft tissue sarcoma – a single-centre retrospective analysis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
F. Brandes ◽  
J. K. Striefler ◽  
A. Dörr ◽  
M. Schmiester ◽  
S. Märdian ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Soft Tissue ◽  
Symptom Relief ◽  
Soft Tissue Sarcomas ◽  
Symptom Burden ◽  
Early Integration ◽  
Symptomatic Disease ◽  
Care Intervention

Abstract Background Soft tissue sarcomas (STS) account for less than 1% of all malignancies. Approximately 50% of the patients develop metastases with limited survival in the course of their disease. For those patients, palliative treatment aiming at symptom relief and improvement of quality of life is most important. However, data on symptom burden and palliative intervention are limited in STS patients. Aim Our study evaluates the effectiveness of a palliative care intervention on symptom relief and quality of life in STS patients. Design/setting We retrospectively analysed 53 inpatient visits of 34 patients with advanced STS, admitted to our palliative care unit between 2012 and 2018. Symptom burden was measured with a standardised base assessment questionnaire at admission and discharge. Results Median disease duration before admission was 24 months, 85% of patients had metastases. The predominant indication for admission was pain, weakness and fatigue. Palliative care intervention led to a significant reduction of pain: median NRS for acute pain was reduced from 3 to 1 (p < 0.001), pain within the last 24 h from 5 to 2 (p < 0.001) and of the median MIDOS symptom score: 18 to 13 (p < 0.001). Also, the median stress level, according to the distress thermometer, was reduced significantly: 7.5 to 5 (p = 0.027). Conclusions Our data underline that specialised palliative care intervention leads to significant symptom relief in patients with advanced STS. Further efforts should aim for an early integration of palliative care in these patients focusing primarily on the identification of subjects at high risk for severe symptomatic disease.

Psychiatric and Psychological Interventions for the Control of Pain and Selected Physical Symptoms

2014 ◽  
pp. 103-114
Author(s):  
William S. Breitbart
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Psychiatric Disorders ◽  
Advanced Cancer ◽  
Terminally Ill ◽  
Physical Symptoms ◽  
Diagnosis And Treatment ◽  
Psychological Interventions ◽  
Assessment And Treatment

In addition to the diagnosis and treatment of psychiatric disorders in palliative care settings, pain and other troublesome physical symptoms must also be aggressively treated in efforts aimed at the enhancement of the patient’s quality of life. These symptoms must be assessed by the psycho-oncologist concerned with the assessment and treatment of affective and other syndromes in the terminally ill population. This chapter provides a brief overview of the prevalence, assessment, and management of the commonly encountered, distressing physical symptoms such as pain, insomnia, and nausea among patients with advanced cancer.

Are families the barrier? Evaluating attitudes toward early integration of palliative care in pediatric hematopoietic stem cell transplant.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 112-112
Author(s):  
Deena R. Levine ◽  
Justin N. Baker
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Early Integration

112 Background: The benefits of early integration of palliative care (PC) in oncology have been well established yet, there remain significant barriers to PC integration, especially in the setting of pediatric hematopoietic stem cell transplant (HSCT). HSCT patients are prone to a great degree of treatment related toxicity and are at high risk for morbidity and mortality and, while ideally suited to benefit, inherent factors in this cure oriented field preclude the integration of PC services. Most notably, family receptivity to PC is often perceived as a barrier in HSCT yet there is no data on family attitudes toward PC in this setting. This study aimed to evaluate perceived symptom burden and patient and parent attitudes toward early PC integration in pediatric HSCT. Methods: After IRB approval, development and pre-testing, novel survey tools were administered to HSCT patients and parents. Eligibility criteria included parent of an HSCT recipient < age 10 or patient/parent dyad for patients aged 10-17, time from HSCT > 1 month and < 1 year, English-speaking, and consent/assent. Data was assessed for trends in response content frequencies, percentages and parent/child concordance. Results: Interim analysis of the first 34 participants revealed high levels of perceived symptom related suffering in the first month of HSCT with suffering from: nausea 96%, loss of appetite 88%, diarrhea 88%, pain 83%, depression 79%, anxiety 75%, and constipation 42%. 90% of patients and 71% parents expressed that a great deal or a lot of attention should be paid to quality of life from the start of HSCT. The majority of patient and parent respondents (60/46%) indicated they would likely want to meet with PC early in HSCT and very few reported definite opposition (0% children, 4% parents). Conclusions: Pediatric HSCT patients experience a high degree of symptom related suffering, perceive quality of life as a high priority, and are largely in favor of early PC involvement. Our findings suggest that family receptivity should not be a barrier to early PC in pediatric HSCT and that aggressive cure directed therapy can and should be accompanied by aggressive quality of life directed care through early PC integration.

Palliative care in the ambulatory setting: Bon Secours St. Francis Hospital (BSSFH).

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 109-109
Author(s):  
Jennifer Ashley ◽  
Jennifer Huggins Bayne ◽  
John Weems ◽  
Terra Spann ◽  
Leigh Stinnett ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Community Setting ◽  
Transitions Of Care ◽  
Ambulatory Setting ◽  
Cancer Center ◽  
Early Integration ◽  
Disease States ◽  
Economics Of Health

109 Background: Palliative care is integral to holistic cancer therapy. Early integration of palliative principles results in improvements in quality of life and survival. Despite the evident value of specialized palliative services, the conventional delivery paradigm, particularly in community centers, has remained episodic, crisis driven, and principally provided in the acute care setting. BSSFH opened its cancer center in October 2014. We chose to embed palliative services in the ambulatory setting to introduce patients early in their cancer journey to an integrated program of symptom management. Methods: The BSSFH Cancer Center is a 65,000 sq ft facility located in Greenville, SC. The analytic caseload for 2016 was approximately 1250. One palliative care practitioner per day sees patients both independently and concurrently with medical, gynecological and radiation oncology colleagues. These individuals also participate in Lean projects optimizing care in a variety of disease states. Mandatory referrals at presentation were initially codified for patients with stage 4 lung , and subsequently for pancreatic and all patients receiving multimodality therapy for head and neck carcinomas. Additional patients are referred from our weekly Interdisciplinary Care Rounds or otherwise at the discretion of their attendings. Results: The program showed ongoing growth through 2016, shortly following its inception. Total outpatient encounters in 2015 were 559 while in 2016 were 928. Total new referrals were 158 in 2015 and 190 in 2016 implying that the increase in total visits had less to do with new patient referrals and were more a result of visit-to-visit management of complex circumstances. Conclusions: Palliative medicine is optimally provided with consistency and not episodically. This is best accomplished when such care occurs in both the acute and ambulatory settings through an ongoing therapeutic relationship. BSSFH has created a model in which such care is feasible in the community setting. We are now trying to assess what impact this intervention has had on quality of life, simplifying transitions of care, and on the economics of health care within our system.

Depression, anxiety, and delirium

2021 ◽  
pp. 255-266
Author(s):  
Pamela J. Mosher ◽  
Anna C. Muriel
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Mental Health Professionals ◽  
Psychological Symptoms ◽  
Active Listening ◽  
Paediatric Palliative Care ◽  
Assessment And Treatment ◽  
Close Observation ◽  
Life Threatening

The assessment and treatment of psychological disorders such as depression, anxiety, and delirium can prove challenging in paediatric palliative care (PPC). Clinicians face the difficulties of distinguishing among symptoms of disease progression, medical side effects, and ‘normal’ psychological distress; the roles of cognitive and emotional development; and the lack of standardized assessment measures. Because research in this area is limited, recommendations often are extrapolated from adult palliative care (PC), or paediatric psychiatric or psychological literature in populations without life-threatening conditions. Patient- and family-centred care require that we address these symptoms, which may not meet clear diagnostic criteria, but significantly impair quality of life (QOL). Careful history taking, active listening, and close observation are essential in unearthing psychological symptoms. Collaboration with mental health professionals is recommended whenever possible, to provide specialist assessment and inform non-pharmacological and psychopharmacological treatment. Clinicians must incorporate limited data with clinical judgement and consultation to guide interventions that best reduce suffering and improve quality of life.

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