Early Palliative Care in Real-world Clinical Practice: Effects on Quality of Life and Symptoms of Newly Diagnosed Incurable Advanced Cancer Outpatients of Comprehensive Cancer Centers (EVI Project) - A Prospective, Multicenter, Mixed-methods, Sequential Control Group Study

Background Patients with metastatic non-small-cell lung cancer (nsclc) experience great pain and stress. Our study aimed to explore the effect of early palliative care on quality of life in patients with nsclc.Methods A total of 150 patients were randomly divided into two groups: control group with conventional care and study group with early palliative care. The quality of life (qol) rating scale and self-rating scale of life quality (sslq) were used to analyze the patients’ quality of life. The Hospital Anxiety and Depression Scale-D/A (hads-d/a) and Patient Health Questionnaire 9 (phq-9) were used to analyze the patients’ mood. Pulmonary function indexes of peak expiratory flow (pef), functional residual capacity (frc), and trachea-esophageal fistula 25% (tef 25%) were analyzed using the lung function detector.Results The qol and sslq scales scores of patients receiving early palliative care were significantly higher than those in the control group (p < 0.05). Moreover, the questionnaire results of the hads-d/a and phq-9 were better in patients receiving palliative care than in the control group (p < 0.05 or p < 0.01). In addition, analytical results of pulmonary function showed that the levels of pef, frc, and tef 25% in patients assigned to early palliative care were remarkably higher than those in the control group (p < 0.01 or p < 0.001).Conclusions These data demonstrate that early palliative care improves life quality, mood, and pulmonary function of nsclc patients, indicating that early palliative care could be used as a clinically meaningful and feasible care model for patients with metastatic nsclc.

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The Palliative Outcome Scale (POS) applied to clinical practice and research: an integrative review

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.0993.2764 ◽

2016 ◽

Vol 24 (0) ◽

Cited By ~ 4

Author(s):

Fernanda Capella Rugno ◽

Marysia Mara Rodrigues do Prado De Carlo

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Clinical Practice ◽

Scientific Literature ◽

Service Organization ◽

Units Of Analysis ◽

Final Sample ◽

Measuring Outcomes ◽

Pc Method

ABSTRACT Objective: to identify and evaluate the evidence found in the international scientific literature on the application of the Palliative Outcome Scale (POS) in clinical practice and research in Palliative Care (PC). Method: integrative literature review, through the search of publications in journals indexed in PubMed / MEDLINE, LILACS, SciELO and CINAHL databases, between the years 1999 and 2014. Results: the final sample consisted of 11 articles. In the data analysis, the articles were classified into 2 units of analysis (studies using the POS as a resource in research and studies using the POS in clinical practice), in which the information was presented in the form of sub-themes related to publications of the selected studies, highlighting the synthesis of the results. Conclusion: POS emerged as an important tool for measuring outcomes to assess the quality of life of patients and families, of the quality of care provided and the PC service organization. The international scientific literature on the application of POS proved to be relevant to the advancement and consolidation of the field of knowledge related to PC.

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Telemedically Augmented Palliative Care

Advances in Healthcare Information Systems and Administration - Achieving Effective Integrated E-Care Beyond the Silos ◽

10.4018/978-1-4666-6138-7.ch009 ◽

2014 ◽

pp. 185-201

Author(s):

Romina Nemecek ◽

Patrick Huber ◽

Sophie Schur ◽

Eva Masel ◽

Stefanie Porkert ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Family Caregivers ◽

Hospital Admissions ◽

Intervention Group ◽

Symptom Burden ◽

Well Being ◽

Control Group ◽

User Friendly

Patients with advanced cancer have a substantial symptom burden, which deteriorates their quality of life. Palliative care improves well-being of patients and their family caregivers. Within the scope of a controlled pilot study, a user-friendly telepresence system is developed, which enables patients and family caregivers to send a direct request to a palliative care team. Additionally, a specially tailored database is developed, which contains up to date patient information. Twenty patients with advanced non-small cell lung cancer are consecutively assigned in a control and an intervention group. The intervention group receives the telemedically augmented care, whereas the control group receives standard care. The primary goal of this chapter is to determine the usability and feasibility; the secondary goal is the assessment of the intervention's impact on quality of life and the number of unscheduled hospital admissions. To sum up, telemedically supported ambulatory palliative care may synergistically help to improve safety and quality of life.

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Role of Patient Coping Strategies in Understanding the Effects of Early Palliative Care on Quality of Life and Mood

Journal of Clinical Oncology ◽

10.1200/jco.2017.73.7221 ◽

2018 ◽

Vol 36 (1) ◽

pp. 53-60 ◽

Cited By ~ 36

Author(s):

Joseph A. Greer ◽

Jamie M. Jacobs ◽

Areej El-Jawahri ◽

Ryan D. Nipp ◽

Emily R. Gallagher ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Depressive Symptoms ◽

Coping Strategies ◽

Indirect Effect ◽

Avoidant Coping ◽

Intervention Effects ◽

Early Palliative Care ◽

Patient Reported

Purpose The early integration of oncology and palliative care (EIPC) improves quality of life (QOL) and mood for patients with advanced cancer. However, the mechanisms by which EIPC benefits these outcomes remain unclear. We therefore examined whether EIPC improved patients’ coping strategies and if changes in coping accounted for intervention effects on QOL and depressive symptoms. Patients and Methods For this secondary analysis of an EIPC trial, we examined data from 350 patients with newly diagnosed incurable lung or GI cancer. Participants completed assessments of QOL (Functional Assessment of Cancer Therapy–General), depressive symptoms (Patient Health Questionnaire–9), and coping (Brief COPE) at baseline and 24 weeks. We used linear regression to test intervention effects on use of coping strategies and mediation regression models with bias-corrected bootstrapping to examine whether improvements in coping mediated the effects of early palliative care on patient-reported outcomes. Results Compared with usual oncology care, EIPC significantly increased patient use of approach-oriented coping strategies ( B = 1.09; SE = 0.44; P = .01) and slightly reduced use of avoidant strategies ( B = −0.44; SE = 0.23; P = .06) from baseline to 24 weeks. Also, the increased use of approach-oriented coping and reduction in avoidant coping were associated with higher QOL and lower depressive symptoms at 24 weeks. The positive changes in approach-oriented coping, but not avoidant coping, significantly mediated the effects of EIPC on QOL (indirect effect, 1.27; 95% CI, 0.33 to 2.86) and depressive symptoms (indirect effect, −0.39; 95% CI, −0.87 to −0.08). Conclusion Patients with incurable cancer who received EIPC showed increased use of approach-oriented coping, which was associated with higher QOL and reduced depressive symptoms. Palliative care may improve these outcomes by providing patients with the skills to cope effectively with life-threatening illness.

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Severe symptoms and very low quality-of-life among outpatients newly diagnosed with advanced cancer: data from a multicenter cohort study

Supportive Care in Cancer ◽

10.1007/s00520-020-05388-y ◽

2020 ◽

Vol 28 (11) ◽

pp. 5547-5555

Author(s):

Waldemar Siemens ◽

Stefan S. Schönsteiner ◽

Claudia Lorena Orellana-Rios ◽

Ulrike Schaekel ◽

Jens Kessler ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Cohort Study ◽

Advanced Cancer ◽

Physical Symptoms ◽

Newly Diagnosed ◽

Multicenter Cohort Study ◽

European Organization ◽

Multicenter Cohort

Abstract Purpose The aim of this study was to identify symptoms of severe intensity or very low scores for quality of life (QoL) domains in newly diagnosed outpatients with advanced cancer. Methods This multicenter cohort study from a state-wide palliative care network included adult outpatients with advanced cancer diagnosed within the preceding 8 weeks from four comprehensive cancer centers (DRKS00006162, registered on 19 May 2014). We used the Palliative Outcome Scale (POS), Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment of Cancer QoL Questionnaire-C30. For each questionnaire, cut-off scores defined symptoms and QoL domains that were considered “severe” or “very low.” Results Of 3155 patients screened, 481/592 (81.3%) were analyzed (mean age 62.4; women n = 245, 50.9%). We identified 324/481 (67.4%) patients experiencing at least one severe symptom or a very low QoL domain (median 2; range 0 to 16). Role functioning (n = 180, 37.4%), fatigue (n = 162, 33.7%), and social functioning (n = 126, 26.2%) were most commonly affected. QoL was very low in 89 patients (18.5%). Women experienced more anxiety symptoms, fatigue, and had lower POS scores. Patients often mentioned physical symptoms and fears of adverse events resulting from disease-modifying therapies (e.g., chemotherapy) as most relevant problems. Conclusions Already within the first 8 weeks after diagnosis, the majority of patients reported at least one severe symptom or a very low QoL domain. Gender differences were evident. The findings illustrate the value of early routine assessment of patient burden and the development of multi-professional and interdisciplinary palliative care.

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Assessment tools for palliative care.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.66 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 66-66

Author(s):

Sarina Isenberg ◽

Rebecca Aslakson ◽

Sydney Morss Dy ◽

Renee Wilson ◽

Julie Waldfogel ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Clinical Practice ◽

Quality Indicators ◽

Systematic Reviews ◽

Grey Literature ◽

Care Quality ◽

Assessment Tools ◽

Patient Reported

66 Background: Recent reviews have not comprehensively addressed palliative care (PC) assessment tools. This project summarizes the extent of evidence about PC assessment tools for patients and families, and how tools have been used for clinical care, quality indicators, and evaluation of interventions. Methods: We searched MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews for systematic reviews of assessment tools for PC, from January 2007 to March 2016. We searched the grey literature for domains without systematic reviews, and for domains with systematic reviews > three years old. Paired investigators independently screened search results and grey literature to determine eligibility, and assessed risk of bias of systematic reviews. The team selected the most recent and highest-quality systematic reviews for each domain. One investigator abstracted information, and a second investigator checked the information. Results: Using the National Consensus Project Palliative Care Guidelines domains, we included nine systematic reviews with 167 tools, and six tools from grey literature. Most tools were in physical, psychological, psychiatric, and social aspects of care, care at the end of life, and tools that cross domains (quality of life and caregiver-reported experience). Only two tools directly addressed spiritual aspects and none addressed cultural or patient-reported experience. Internal consistency reliability was evaluated for almost all tools; most reported construct validity; and few reported responsiveness (sensitivity to change). Few studies evaluated the use of assessment tools in quality indicators or clinical practice. A systematic review of 38 PC interventions and the assessment tools used found that at least 25 interventions included physical, psychosocial and psychiatric, and quality of life tools, but the tools varied extensively, and only nine included patient experience tools. Conclusions: Although assessment tools exist in many PC domains, tools are needed to assess spiritual and cultural aspects of care, and patient-reported experience. Research is needed concerning: tools in clinical practice and quality of care; comparison of existing tools; and evaluation and dissemination tools with evidence of responsiveness.

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