Abstract
BackgroundHospital-based Palliative Care Consultation Teams (PCCTs) have a consulting role to specialist services at their request. Referral of patients is often late. Early palliative care in oncology has shown its effectiveness in improving quality of life, thereby questioning the “on request” model of PCCTs. Whether this evidence changed practice is unknown. This multicentre prospective cohort study aims to describe the activity and integration of PCCTs at the patient level.MethodsFor consecutive patients newly referred to participating PCCTs, the team collected the following data: circumstances of first referral, problems identified, number of interventions, patient’s survival after first evaluation and place of death.ResultsSeventeen PCCTs based in university hospitals in Paris area, recruited 744 newly referred adult patients, aged 72 ± 15 years, 52% males, and 504(68%) with cancer as primary diagnosis. After 6 months, 548(74%) had died. At first evaluation, 12% patients were outpatients, 88% were inpatients. Symptoms represented the main reasons for referral and problems identified; 79% of patients had altered performance status; 24% encountered the PCCT only once. Median survival (1st-3rd quartile) after first evaluation by the PCCT was 22 (5–82) days for overall patients, and respectively 31 (8–107) days and 9 (3–34) days for cancer versus noncancer patients (p < 0.0001). Place of death was acute care hospital for 51.7% patients, and home or Palliative Care Unit for 35%. Patients referred earlier died more often in PCU.ConclusionThe study provides original data showing a still late referral to the PCCTs in France. Cancer patients represent their predominant activity. The integrated palliative care model seems to emerge besides the “on request” model which originally characterised their missions.
Highlights
Hospital-based Palliative Care Consultation Teams (PCCTs) have a consulting role to specialist services at their request
Our study provides for the first time some original multicentre data describing detailed activity of PCCTs based in French university hospitals
Our results suggest that the early referral to PCCT has some impact on the trajectory of care, allowing that more patients die at home or in Palliative Care Unit (PCU)
Summary
Hospital-based Palliative Care Consultation Teams (PCCTs) have a consulting role to specialist services at their request. In 2013, the National End of Life Observatory counted 430 PCCT and 127 PCU all around the country This high number of PCCTs is the result of the national policy for palliative care development whose. The more recent report, delivered to the French President for revision of the law on end of life [4] pointed the poor integration of palliative care in curative medicine with elusion of death by patients and professionals. PCCTs are on first line to acculturate health professionals to palliative care They have a consulting role, but usually advise specialist services only at their request. Some reasons described to explain this timing are the fear of harming the patient, the will of maintaining hope, the uncertainty of prognosis estimate, the insufficient communication skills [11, 12] and the lack of common referral criteria [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
