Multidisciplinary Palliative Care Team Research Articles

33 Re-moving Mountains: an Exploration into the Respite Needs of Adolescents with Life-Limiting Conditions

Aim: This study aimed to explore the respite needs of adolescents/young people with life-limiting conditions as perceived by adolescents/young people, their parents/carers and professionals from the multidisciplinary palliative care team. Background: Medical and technological advances have increased the life expectancy of many children/young people beyond the age of 18 years, creating a small but …

GPs' awareness of patients' preference for place of death

Being able to die in one's place of choice is an indicator of the quality of end-of-life care. GPs may play a key role in exploring and honouring patients' preferences for place of death. To examine how often GPs are informed about patients' preferred place of death, by whom and for which patients, and to study the expressed preferred place of death and how often patients die at their preferred place. One-year nationwide mortality retrospective study. Sentinel Network of GPs in Belgium, 2006. GPs' weekly registration of all deaths (patients aged =1 year). A total of 798 non-sudden deaths were reported. GPs were informed of patients' preferred place of death in 46% of cases. GPs obtained this information directly from patients in 63%. GP awareness was positively associated with patients not being hospitalised in the last 3 months of life (odds ratio [OR] = 3.9; 95% confidence interval [CI] = 2.8 to 5.6), involvement of informal caregivers (OR = 3.3; 95% CI = 1.8 to 6.1), use of a multidisciplinary palliative care team (OR = 2.5; 95% CI = 1.8 to 3.5), and with presence of more than seven contacts between GP and patient or family in the last 3 months of life (OR = 3.0; 95% CI = 2.2 to 4.3). In instances where GPs were informed, more than half of patients (58%) preferred to die at home. Overall, 80% of patients died at their preferred place. GPs are often unaware of their patients' preference for place of death. However, if GPs are informed, patients often die at their preferred location. Several healthcare characteristics might contribute to this and to a higher level of GP awareness.

The need for hospital-based neonatal palliative care programs in Saudi Arabia

The terms palliative care, supportive care, and comfort care are used to describe individualized care that can provide a dying person the best quality of life until the end. The term “end-of-life care” is also used in a general sense to refer to all aspects of care of a patient with a potentially fatal condition. While the concept of palliative care is not new, it has only recently been applied to the neonatal population. To the best of our knowledge, none of the neonatal intensive care units (NICUs) in Saudi Arabia have adopted a neonatal program for palliative care. We believe the main reason is lack of knowledge of such programs and the fear of being accused of being heartless and cruel by providing comfort care for dying babies. Comfort care begins with the diagnosis of a life-threatening/terminal condition, and continues throughout the course of illness regardless of the outcome. In this perspective, our aim is to introduce these programs for caregivers in the NICUs in Saudi Arabia. For this purpose, we have reviewed the current recommendations in establishing neonatal palliative care programs and discussed some of the social and religious aspects pertaining to this issue.

Preparing for the role of clinical pharmacist in a new specialty

As a new practitioner just out of residency, I accepted a newly created clinical pharmacy specialist position on a multidisciplinary palliative care team. I jumped at the opportunity to become part of a new and exciting field. Palliative care had just been recognized as a new specialty by the

Therapeutic Guidelines for the Treatment of Bone Metastasis: A Report from the American College of Radiology Appropriateness Criteria Expert Panel on Radiation Oncology

Bone metastases remain a therapeutic challenge because of the diversity of the problems they cause, the relative paucity of data regarding their treatment, and the necessity for management by a multidisciplinary palliative care team. The American College of Radiology convened an Appropriateness Criteria Expert Panel on Radiation Oncology for the treatment of bone metastasis to create representative clinical case scenarios and then rank the appropriate use of treatment modalities as well as the most reasonable radiotherapy dose schema and treatment planning methods. Here we present both the resulting Appropriateness Criteria and the rationale for making these decisions. The treatment recommendations are placed within the larger framework of the role of radiation in palliative care by discussing the efficiency of palliative radiotherapy schedules, cost effectiveness issues, and the need for additional research regarding the proper multidisciplinary care of patients with symptomatic bone metastasis.

Development of an Ambulatory Palliative Care Pharmacist Practice

The roles of a pharmacist in hospice and inpatient palliative care settings have been described. However, no reports of a palliative care pharmacist in an ambulatory care setting have been published. Our objective was to establish a model for incorporating an outpatient clinical pharmacist as part of a multidisciplinary palliative care team. A palliative care pharmacist based out of a retail pharmacy was incorporated as part of a consultative ambulatory palliative care service (known as the Doris A. Howell Service) at the University of California, San Diego Moores Cancer Center. The pharmacist completed all legal requirements to prescribe under a collaborative practice agreement in California (including National Provider Identifier [NPI] and US Drug Enforcement Agency [DEA] US Drug Enforcement Agency (DEA) registration). From November 2006 through August 2007, the palliative care pharmacist consulted 29 new patients (the average age of patients was 49; range, 20-78 years) who had 114 clinic visits. The most common reason for referral to the palliative care pharmacist was for pain management (27/29; 93%). During the 114 patient clinic visits, 98% (112/114) of the palliative care pharmacist medication recommendations were accepted by the primary care oncologist. Physicians completed a satisfaction survey and reported that the top three useful activities of the Howell Service were: additional time spent with patients without physician present (90.9%), pain and symptom management (81.8%), and psychosocial support (72.7%). This is the first report of a palliative care pharmacist in a retail-based ambulatory care setting. Initial results demonstrate the success of this pilot program.

Characteristics of Referral to a Multidisciplinary Palliative Home Care Team

Until now, in Belgium at least, no scientific information has been available about which patients are referred to multidisciplinary palliative home care teams (MHCT) and by which caregivers, nor about timing of referral and factors associated with it. A prospective cohort study was carried out during a nine-month period in the oldest Flemish MHCT, and included all patients for whom a palliative care trajectory had been initiated. In total, 325 patients (54% male, mean age 71 years, 83% cancer patients) were referred: 25% by their GP, 24% by hospital social workers, and 22% by the patient's family. Median timing of referral was 26 days (IQR 8-78) before death. Patients of 75 years or older were more likely to have been referred later by comparison with younger patients. Timely referral to a MHCT seems to be difficult and not equal for all patients. Referral timing varies largely by age groups and diseases.

92 The Impact of Occupational Therapy Input on a Weekly Multidisciplinary Palliative Care Team Meeting

The occupational therapy (OT) department was invited to provide input to a weekly palliative care, multidisciplinary team meeting (MDTM) in a large teaching hospital. Over the following 6 months (January–June 2006) the number of patients with advanced incurable disease referred to the MDT was audited to assess the additional benefit of input to the specialist palliative care team (PCT) via involvement in the weekly …

Multidisciplinary perspectives of music therapy in adult palliative care

Background: Music therapy aims to provide holistic support to individuals through the sensitive use of music by trained clinicians. A recent growth in music therapy posts in UK palliative care units has occurred despite a paucity of rigorous research. Study aim: To explore the role of music therapy within multidisciplinary palliative care teams, and guide the future development of the discipline. Design: In-depth qualitative interviews with 20 multidisciplinary colleagues of music therapists, based in five UK hospices. Results : Analysis of interview material revealed a number of themes relevant to the study aims. Music therapy was valued by most interviewees; however there exists some lack of understanding of the role of the music therapist, particularly amongst nurses. Emotional, physical, social, environmental, creative and spiritual benefits of music therapy were described, with some benefits perceived as synergistic, arising from collaborations with other disciplines. Interviewees found experiencing or witnessing music therapy is effective in developing an understanding of the discipline. Conclusion: Music therapy is an appropriate therapeutic intervention for meeting the holistic needs of palliative care service users. More understanding and integration of music therapy could be encouraged with collaborative work, educational workshops, and the utilization of environmentally focused techniques. The study merits further research to explore and develop these findings. Palliative Medicine 2007; 21: 235—241

Palliative care teams and the contingencies that impact them: from the teams

The article is the second of two describing the contingencies that drive and influence the operations of multidisciplinary palliative care teams. The results of analysis reported here are drawn from data gathered in a total of 11 interviews that took place with management teams and multidisciplinary care delivery teams in three palliative care case study organisations in Sydney, Australia, over a period of some 13 months. A model of the management and operation of multidisciplinary palliative care teams is presented to provide a context and to indicate the scope of the research completed so far.

Palliative care teams and the contingencies that impact them: a background

The article is the first of two describing the contingencies that drive and influence the operations of multidisciplinary palliative care teams. Australian research into the management of multidisciplinary palliative care teams is introduced and appropriate elements of a wide-ranging literature review are reported. A model of the management and operation of multidisciplinary palliative care teams is presented to provide a context and to indicate the scope of the research completed so far.

Configured for innovation: the case of palliative care

PurposeTo begin a process of understanding how palliative care organisations are configured to enable innovative multidisciplinary patient care teams and their management in an uncertain, complex and dynamic environment.Design/methodology/approachA range of literature was reviewed to suggest configuration and characteristics that were tested using semi‐structured interviews with the senior medical staff member at each of three Australian case study organisations. Data gathered from these interviews was supplemented with data gathered from semi‐structured interviews with multidisciplinary management teams and patient care teams dealing with inpatients and home‐care patients.FindingsA hybrid configuration is suggested, based on Mintzberg's typology of organisations. Responses from interviews modify some characteristics of the suggested configuration, though generally appearing to support it. Characteristics of the external and internal environments are described.Research limitations/implicationsPalliative care is rarely written off outside the healthcare literature and comparatively infrequently within it. Configuration is used to suggest the characteristics of innovative teams in an uncertain, dynamic, complex environment. The use and management of multidisciplinary patient care teams in palliative care offers interesting insights for a broad range of organisations.Practical implicationsA contribution to the discourse on the relationship between configuration and innovation based in organisations without commercial imperative, delivering multi‐level care for and by people involved in the end‐of‐life process.Originality/valueThe paper continues a line of publications, beginning in 2002, describing the management of innovation in multidisciplinary palliative care teams. The originality and value of this paper and this line of research is in taking a management view of a unique environment that offers insights and lessons to a broad range of organisations.

Place of death: hospital-based advanced home care versus conventional care

The purpose of this prospective nonrandomized study was to evaluate time spent at home, place of death and differences in sociodemographic and medical characteristics of patients, with cancer in palliative stage, receiving either hospital-based advanced home care (AHC), including 24-hour service by a multidisciplinary palliative care team or conventional hospital care (CC). Recruitment to the AHC group and to the study was a two-step procedure. The patients were assigned to either hospital-based AHC or CC according to their preferences. Following this, the patients were asked to participate in the study. Patients were eligible for the study if they had malignant disease, were older than 18 years and had a survival expectancy of 2-12 months. A total of 297 patients entered the study and 280 died during the study period of two and a half years, 117 in the AHC group and 163 in the CC group. Significantly more patients died at home in the AHC group (45%) compared with the CC group (10%). Preference for and referral to hospital-based AHC were not related to sociodemographic or medical characteristics. However, death at home was associated with living together with someone. Advanced hospital-based home care targeting seriously ill cancer patients with a wish to remain at home enable a substantial number of patients to die in the place they desire.

Palliative care teams and individual behaviours

This paper is the second in a series that will examine the management of innovation by cross‐functional, multidisciplinary patient care teams in palliative care. Two further outcomes of this research are reported here. The first is that within palliative care a number of distinct individual behaviours are identified that act as foundations for the successful development and application of innovative practices by multidisciplinary teams. The second is that interviews with multidisciplinary palliative care teams in case studies in Australia confirm the existence and use of these behaviours. Individual behaviours within these teams are found to fall into two groups: those used by palliative care professionals when working with patients and patient‐based carers; and those used by professionals when dealing with each other away from patients. The purpose of both groups is to generate useful valid information, knowledge and learning that can be transferred across boundaries regardless of boundary type or location.

Mongolia: The Present Situation and Future of Palliative Care

Cancer annually affects 10 million people and causes 6 million deaths worldwide. Mongolia has a very small population. In 2000, there were about 2.4 million inhabitants in Mongolia. The mortality rate is 598.3 per 100,000 (14,237 deaths in 2000). The main causes of death were cardiovascular diseases (31–38%); cancer (21–22%); injury, poisoning and other external causes (13–16%); diseases of the respiratory system (6–18%); and diseases of digestive system (8%). Forty-one percent of Mongolian patients who died from cancer had liver cancer, 16% had stomach cancer, 13% had pulmonary cancer, 11% had esophageal cancer, and 2% had cervical cancer. The epidemiology of cancer pain or other quality-of-life concerns has not been evaluated in Mongolia. Overall, 10,672 patients died in hospital in 2000, 4119 from cardiovascular diseases and 2649 (24.8%) from cancer. Most cancer patients (1668/2649 in 2000) died during the first year after the diagnosis of cancer. This means that 62% of cancer patients were diagnosed very late and required palliative care more than cancer treatment. Only 3976 patients died at home during 2000. Of this group, 1627 (41%) had cancer. Thus, 41% of the total home deaths were related to cancer. These patients were incurable and stayed at home without palliative treatment, suffering from pain, dyspnea, anorexia, cachexia, constipation, depression, and many other uncomfortable problems and symptoms because family doctors were not trained in palliative care.

The promise of a good death

The promise of a good death

Does being religious help or hinder coping with chronic illness? A critical literature review.

This paper reviews a number of studies relating to religion and coping with chronic illness, emphasizing those aspects relevant to palliative care. After pointing out that religious and existential needs are common in chronic illness, a critical examination is made of those studies which purport to demonstrate associations between spiritual beliefs, religious practices and psychological prognosis. Recommendations are made as to how religious issues can be dealt with in clinical practice, with particular relevance to the multidisciplinary palliative care team.

Educational program in palliative and hospice care at the University of Maryland School of Medicine.

The objective of this enterprise was and is to develop a validatable educational program on palliative and hospice care with a multidisciplinary perspective for the University of Maryland School of Medicine. An interdisciplinary education committee consisting of experts in palliative and hospice care and an expert in educational design and evaluation was established to develop the program. Program development, which is ongoing, includes a comprehensive instructional design phase, vertical integration of the program into the medical school curriculum, and outcome evaluation. The instructional design phase has been accomplished; hence, the focus of this paper is on this aspect of program development. In addition, some integration of specific content areas into the medical school curriculum has been implemented. When complete, the program will focus on developing skills and knowledge using a variety of interactive educational modalities, including problem-based learning, case study discussions, role playing, and practical experience at hospice and palliative care sites. Topics to be covered are symptom control, the compassionate approach to patient care, communication between physicians and patients or family members, professional collaboration on a multidisciplinary palliative care team, ethical and legal issues pertaining to end-of-life care, and the value of palliative medicine as a profession.

Physiotherapy in palliative oncology

Outreach multi-disciplinary palliative care teams have tended to duplicate hospital-based teams which historically have consisted almost exclusively of doctors and nurses. This paper outlines the role of physiotherapy in palliative care. It provides a conceptual framework for physiotherapy involvement and its potential to contribute within the palliative care team therapeutically and cost-effectively. To put physiotherapy management of the disease process into perspective, some basic data on terminal illness, and statistics of a Brisbane hospice, are included. The need for more outreach physiotherapy intervention is emphasised.