Implementation Of Early Palliative Care Research Articles

Incorporación de los «cuidados paliativos precoces» en la actividad de una consulta externa de cuidados paliativos en un centro oncológico terciario

ObjectiveTo audit the quality of care delivered in our Outpatient Clinic (OC) after its inception following an early palliative care (EPC) model, and to compare our experience with the relevant literature. Material and methodsA descriptive observational retrospective study was conducted on 100 consecutive advanced cancer patients who attended our OC in 2013. The cases are analyzed using 20 variables selected by consensus, and grouped into 6 categories (demographics [2], primary tumor [1], access to OC [1], OC clinical diagnoses [6], OC activity [7], impact [3]) ResultsThe mean age of the patients was 75 years, and 38% suffered from lung cancer. EPC criteria were completely fulfilled by 17%, and a further 26% partially fulfilled them. Only 33% of the patients would be considered traditional terminal cancer patients. Emerging clinical diagnoses were found in the sample: vitamin D deficiency 35%, adrenal insufficiency 18%, hypogonadism 5%, chemotherapy and radiotherapy induced encephalopathy 4%, aberrant opioid related behaviors 2%. The average number of visits to the OC was 3.5, plus an average of 1.14 telephone consultations, and the median follow-up among patients who died was 3.7 months. Patients on chemotherapy (CTP) who completely fulfilled EPC criteria had a higher average number of visits (6.12), and survived longer until death (7.7) months. Complex hospital diagnostic and therapeutic procedures were required in 82% of the patients, and 31% received palliative radiotherapy. Two thirds of the patients were admitted to the inpatient acute Palliative Care Unit at any given point during follow-up, and the majority died in the Unit beds (44 patients out of 56 deaths). The number of visits to the emergency department within 30 days of death was low (39 visits for 56 patients), and CTP within 30 days of death was also low (5.3%). DiscussionThe non-statistical analysis suggests that the OC attends a population with a varied survival and origin, but with the common characteristics of complex palliative care needs. Our preliminary data do not contradict current hypothesis suggesting that EPC might be cost saving. ConclusionOur initial experience with an OC suggests that an EPC model is feasible in our own environment. On the other hand, our preliminary data does not fail to support the potential benefits associated with the implementation of EPC.

Early Implementation of Palliative Care Can Improve Patient Outcomes

Patients with cancer experience many complex issues throughout the trajectory of the disease. These range from the physical consequences of cancer and treatment to the psychological, social, and spiritual issues associated with living with the disease. An individualized, comprehensive, and interdisciplinary approach is needed to reduce patient suffering and ensure appropriate symptom management and support from the time of first diagnosis to end of life. Data from randomized clinical trials prove that patients provided with early palliative care can experience relief of symptoms and improvements in quality of life, mood, satisfaction, resource use, and advanced care planning. Professional organizations such as ASCO have begun to develop recommendations that integrate palliative care into standard oncologic care from the time a person is diagnosed with metastatic or advanced cancer. NCCN has a palliative care guideline that recommends early and ongoing assessment of palliative care needs and referral to specialist palliative care services in more complex cases. In turn, oncologists need to consider how best to screen patients and integrate early palliative care with routine oncologic care, within the context of their busy clinics, to ensure that patients, families, and caregivers receive timely support.

Psychosocial Care for the Caregivers of Primary Malignant Brain Tumor Patients

Despite clinical experience that suggests a high burden of care among relatives of individuals with a primary malignant brain tumor (PMBT), little is known about their actual needs. In this study, the caregivers' personal experiences, quality of life, burden of care, and psychological well-being were examined. Fifty-nine percent did not receive any financial aid for home care, 33% had increased risk for psychosomatic problems, 45% had anxiety, and 33% increased depression levels. The caregiver's quality of life was most strongly affected by the burden of care (p < .001) and the patient's mental state (p < .03). To improve the situation, empathetic professionals and an early implementation of palliative care and social work are required.

The Shift to Early Palliative Care

For the current study, clinical observations of communication between patients, families, and clinicians during chronic, serious, or terminal illness in a cancer care trajectory were examined for patterns and trends. Five communication characteristics were concluded, which informed a typology of illness journeys experienced by patients with cancer and their families. The isolated journey characterizes an illness path in which communication about terminal prognosis and end-of-life care options are not present; communication is restricted by a curative-only approach to diagnosis as well as the structure of medical care. The rescued journey signifies a transition between curative care (hospital narrative) to noncurative care (hospice narrative), challenging patients and their families with an awareness of dying. The rescued journey allows communication about prognosis and care options, establishes productive experiences through open awareness, and affords patients and families opportunities to experience end-of-life care preferences. Finally, palliative care prior to hospice provides patients and families with an illness journey more readily characterized by open awareness and community, which facilitates a comforted journey. Nurses play a pivotal role in communicating about disease progression and plans of care. The typology presented can inform a structured communication curriculum for nurses and assist in the implementation of early palliative care.