Abstract
BackgroundWe investigated the need for additional professional support and associated factors in patients (pts) at initiation and in the course of in- and outpatient specialist palliative care (I-SPC/O-SPC).MethodsPts entering an urban SPC network consecutively completed questionnaires on psychosocial/spiritual problems and support needs within 72 h (T0) as well as within the first 6 weeks (T1) of SPC. Hierarchical linear regression analysis was used to investigate the impact of sociodemographic / disease-related variables, psychological / physical burden, social support, and SPC setting on the extent of support needs.ResultsFour hundred twenty-five pts (70 years, 48% female, 91% cancer, 67% O-SPC) answered at T0, and 167 at T1. At T0, main problems related to transportation, usual activities, and dependency (83–89%). At T1, most prevalent problems also related to transportation and usual activities and additionally to light housework (82–86%). At T0, support needs were highest for transportation, light housework, and usual activities (35–41%). Cross-sectional comparisons of SPC settings revealed higher problem scores in O-SPC compared to I-SPC at T0 (p = .039), but not at T1. Support need scores were higher in O-SPC at T0 (p < .001), but lower at T1 (p = .039). Longitudinal analyses showed a decrease of support need scores over time, independent from the SPC setting. At T0, higher distress (p = .047), anxiety/depression (p < .001), physical symptom burden (p < .001) and I-SPC (p < .001) were associated with higher support need scores (at T1: only higher distress, p = .037).ConclusionNeed for additional professional psychosocial/spiritual support was identified in up to 40% of pts. with higher need at the beginning of O-SPC than of I-SPC. During SPC, this need decreased in both settings, but got lower in O-SPC than in I-SPC over time. Support need scores were not only associated with psychological, but also physical burden.
Highlights
We investigated the need for additional professional support and associated factors in patients at initiation and in the course of in- and outpatient specialist palliative care (I-SPC/O-SPC)
Still representing the major patient group receiving palliative care in Western countries, professional support in coping with tasks, accepting the disease, generating strength, feeling trust, strengthening the sense of control and other psychosocial and spiritual needs is considered as part of standard patient care [2, 3]
It has been shown that non-cancer patients present with similar main needs compared to a matched cohort of cancer patients, there were some differences in quality, but not quantity of physical symptom burden [9]
Summary
We investigated the need for additional professional support and associated factors in patients (pts) at initiation and in the course of in- and outpatient specialist palliative care (I-SPC/O-SPC). International experts complain that “the multiple and varying needs of patients are still not being met adequately as part of routine cancer care” [4]. Various studies underline this complaint, demonstrating high proportions of unmet needs (50–90%) in patients with cancers across all stages and during the whole disease trajectory [5,6,7,8]. Clinical studies showed that timely inclusion of specialist palliative care (SPC) can improve quality of life or symptom burden, but is associated with a better addressing of patients’ needs, especially concerning information and care planning [10]. Psychosocial and spiritual interventions can successfully meet the complex psychosocial and spiritual needs of patients with advanced diseases [11,12,13,14]
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