Abstract
BackgroundA minority of patients with incurable and advanced disease receive specialised palliative care. Specialised palliative care services that complement the care of difficult and complex cases ought to be integrated with services that deliver general care for most patients. A typical setting in which this integrative concept takes place is the hospital setting, where patients suffering from incurable and advanced disease are treated in many different departments.The aim of the study is to investigate the profile and spectrum of a palliative care consultation service (PCCS) at a German university hospital with special reference to pain therapy.MethodsWe retrospectively analysed the PCCS documentation of three years.ResultsMost patients were referred from non-surgical departments, 72% were inpatients, and 28% were outpatients. 98% of the patients suffered from cancer. Counselling in pain therapy was one of the key aspects of the consultation: For 76% of all consulted patients, modifications of the analgesic regimen were recommended, which involved opioids in 96%. Recommendations on breakthrough-pain medication were made for 70% of the patients; this was an opioid in most cases (68%). The most commonly used opioid was morphine. For 17% of the patients, additional diagnostic procedures were recommended. Besides pain management palliative care consultation implied a wide range of recommendations and services: In addition to organising home care infrastructure, palliative care services supported patients and their families in understanding the life-limiting diseases. They also coordinated physical therapy and social and legal advice.ConclusionThis survey clearly shows that for a consultation service to support patients with incurable or advanced disease, a multi-disciplinary approach is necessary to meet the complex requirements of a needs-adapted palliative care in inpatient or outpatient settings. Timely integration of palliative expertise may support symptom control and may give the required advice to patients, their carers, and their families.
Highlights
A minority of patients with incurable and advanced disease receive specialised palliative care
Specialised palliative care services that complement the care of difficult and complex cases ought to be integrated with services that deliver general care for most patients [2,3]
The purpose of this study is to determine the characteristics and needs of the patients that are being seen by palliative care consultation service (PCCS), the reasons why PCCS became involved, and an analysis of the recommendations made by the PCCS
Summary
A minority of patients with incurable and advanced disease receive specialised palliative care. A typical setting in which this integrative concept takes place is the hospital setting, where patients suffering from incurable and advanced disease are treated in many different departments. It is recognized increasingly more often that comprehensive care of cancer patients includes life-saving or life-prolonging anticancer treatment, and palliative care, which focuses on symptoms and other physical, psycho-social, or spiritual needs. Even at early stages 33% of the patients suffer pain, which increases to 59% during anticancer treatment and to up to 64% for patients with metastatic or advanced stages of disease. More than 80% of cancer patients experience pain caused by their disease, its treatment, or treatmentrelated complications [11]. Between 31% to 45% of these patients describe their pain at least as moderate to severe [12]
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