scholarly journals Shifting Palliative Care Paradigm in Primary Care From Better Death to Better End-of-Life : A Swiss Pilot Study

2021 ◽  
Author(s):  
Johanna Sommer ◽  
Christopher Chung ◽  
Dagmar M. Haller ◽  
Sophie Pautex
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Palliative Care ◽  
Pilot Study ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Communication Skills ◽  
Advanced Cancer Patients

Abstract Background: Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late.The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods: Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues.3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis.Results: 8 PCPs were trained. PCPs failed to recruit patients for fear of imposing additional loads on their patients. PCPs changed their approach of advanced cancer patients. They became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life.Conclusions: PCPs failed to recruit advanced cancer patients, but reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life.Trial registration : The ethics committee of the canton of Geneva approved the study (2018-00077 Pilot Study) in accordance with the Declaration of Helsinki

scholarly journals Shifting palliative care paradigm in primary care from better death to better end-of-life: a Swiss pilot study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Johanna Sommer ◽  
Christopher Chung ◽  
Dagmar M. Haller ◽  
Sophie Pautex
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Palliative Care ◽  
Pilot Study ◽  
End Of Life ◽  
Advanced Cancer ◽  
Communication Skills ◽  
Advanced Cancer Patients

Abstract Background Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late. The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues. 3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis. Results Eight PCPs were trained. Patient recruitment was a challenge for PCPs who feared to impose additional loads on their patients. PCPs became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life. Conclusions While the intervention was acceptable to PCPs, recruitment was a challenge and a follow up trial was not deemed feasible using the current design but PCPs reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life. Trial registration The ethics committee of the canton of Geneva approved the study (2018–00077 Pilot Study) in accordance with the Declaration of Helsinki.

scholarly journals Chemotherapy use and quality of life in cancer patients at the end of life: an integrative review

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Elham Akhlaghi ◽  
Rebecca H. Lehto ◽  
Mohsen Torabikhah ◽  
Hamid Sharif Nia ◽  
Ahmad Taheri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Palliative Chemotherapy ◽  
Palliative Therapy ◽  
Related Quality ◽  
Health Related

Abstract Background When curative treatments are no longer available for cancer patients, the aim of treatment is palliative. The emphasis of palliative care is on optimizing quality of life and provided support for patients nearing end of life. However, chemotherapy is often offered as a palliative therapy for patients with advanced cancer nearing death. The purpose of this review was to evaluate the state of the science relative to use of palliative chemotherapy and maintenance of quality of life in patients with advanced cancer who were at end of life. Materials and methods Published research from January 2010 to December 2019 was reviewed using PRISMA guidelines using PubMed, Proquest, ISI web of science, Science Direct, and Scopus databases. MeSH keywords including quality of life, health related quality of life, cancer chemotherapy, drug therapy, end of life care, palliative care, palliative therapy, and palliative treatment. Findings 13 studies were evaluated based on inclusion criteria. Most of these studies identified that reduced quality of life was associated with receipt of palliative chemotherapy in patients with advanced cancer at the end of life. Conclusion Studies have primarily been conducted in European and American countries. Cultural background of patients may impact quality of life at end of life. More research is needed in developing countries including Mideastern and Asian countries.

Changes in and correlates of individual quality of life in advanced cancer patients admitted to an academic unit for palliative care

2007 ◽  
Vol 21 (3) ◽  
pp. 199-205 ◽  
Author(s):  
Michael A Echteld ◽  
Lia van Zuylen ◽  
Marjolein Bannink ◽  
Erica Witkamp ◽  
Carin CD Van der Rijt
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Individual Quality ◽  
Academic Unit ◽  
Advanced Cancer Patients ◽  
Individual Quality Of Life

Spiritual Pain Is Associated with Decreased Quality of Life in Advanced Cancer Patients in Palliative Care: An Exploratory Study

2019 ◽  
Vol 22 (6) ◽  
pp. 663-669 ◽  
Author(s):  
Pedro E. Pérez-Cruz ◽  
Paola Langer ◽  
Cecilia Carrasco ◽  
Pilar Bonati ◽  
Bogomila Batic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Exploratory Study ◽  
Advanced Cancer Patients

Outcomes Associated with End-of-Life Discussions (DRAFT)

2018 ◽  
Author(s):  
Masanori Mori
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advanced Cancer Patients ◽  
Advance Care ◽  
Aggressive Care

Physicians and advanced cancer patients are often reluctant to talk about death. They frequently avoid end-of-life discussions (EOLds), although such conversations are essential to initiate advance care planning. In this prospective, a longitudinal multisite cohort study of advanced cancer patients and their informal caregivers, the authors suggested cascading benefits of EOLds between patients and their physicians. In total, 123 of 332 (37.0%) patients reported having EOLds with their physicians at baseline. EOLds were not associated with higher rates of emotional distress or psychiatric disorders. Instead, after propensity-score weighted adjustment, EOLds were associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care was associated with worse patient quality of life and worse bereavement adjustment. These findings may help destigmatize EOLds and assist physicians and patients in initiating such conversations and engaging in advance care planning.

Palliative care utilization in oncology patients with 30-day hospital readmission.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 110-110
Author(s):  
Chintan Pandya ◽  
Gradon Nielsen ◽  
John Hu ◽  
Jodi Ram ◽  
Cheryl Rozario ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Hospital Readmissions ◽  
Cost Of Care ◽  
Care Utilization ◽  
Advanced Cancer Patients ◽  
Discharge Disposition

110 Background: Reducing the rate of hospital readmissions is an important aspect of improving quality of life and cost of care for patients with advanced cancer. Early Palliative Care (PC) has been shown to improve quality of life and downstream healthcare utilization in patients with advanced cancer. The aim of this study was to examine palliative care (PC) utilization and factors associated with 30-day readmission in cancer patients. Methods: All patients with 30 day readmissions to the inpatient oncology service at the Wilmot Cancer Institute from July 2015-June 2016 were identified. Chart reviews were conducted to determine primary cancer stage and type; reason for, length of stay and discharge disposition (e.g. discharged on hospice, deceased) for index and readmission; potential preventability of readmission; and if and when the patient had met with PC. Results: A total of thirty-nine patients experienced a 30-day readmission, with 95% of patients having stage IV disease and 77% having a primary lung or GI malignancy. Most patients (74%) had not met with PC at the time of the index admission and 49% of patients had not met with PC by the time of readmission. Forty one percent (N = 17) of patients either died during readmission or were discharged on hospice. Forty one percent (N = 7) of those that died during readmission or were discharged on hospice did not meet with palliative care. Forty four percent of readmissions were classified as potentially preventable. Conclusions: Nearly half of all advanced cancer patients had not met with PC by the time of their readmission. Upon readmission, many patients were either discharged to hospice or died, suggesting that patients with advanced cancer could benefit from earlier PC. Increased and improved patient-oncologist PC communication, including referrals to PC specialists, may reduce readmission rates for patients with advanced cancer.

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