Specialist Palliative Care For Patients Research Articles

The Australian Palliative Care Outcomes Collaboration (PCOC) - measuring the quality and outcomes of palliative care on a routine basis

Australia is leading the way in establishing a national system (the Palliative Care Outcomes Collaboration - PCOC) to measure the outcomes and quality of specialist palliative care services and to benchmark services across the country. This article reports on analysis of data collected routinely at point-of-care on 5939 patients treated by the first fifty one services that voluntarily joined PCOC. By March 2009, 111 services have agreed to join PCOC, representing more than 70% of services and more than 80% of specialist palliative care patients nationally. All states and territories are involved in this unique process that has involved extensive consultation and infrastructure and close collaboration between health services and researchers. The challenges of dealing with wide variation in outcomes and practice and the progress achieved to date are described. PCOC is aiming to improve understanding of the reasons for variations in clinical outcomes between specialist palliative care patients and differences in service outcomes as a critical step in an ongoing process to improve both service quality and patient outcomes.

A cost calculation model for specialist palliative care for patients with non-small cell lung cancer in a tertiary centre

Five-year survival of patients with non-small cell lung cancer (NSCLC) is below 15%. Therefore, an early integration of palliative care according to the 2002 WHO definition is indispensable. In this paper, we describe methodical and financial aspects of prospective pricing of palliative care within a concept of integrated care for patients with NSCLC in Germany. Four structures of palliative care services were defined (hospital support, home care, day care and in-patient care). Prospectively, resource use was estimated, using real cost data from the finance department of the University Hospital. Resource use was forecasted on the basis of operating experience, data of the national core documentation of palliative care patients and recommendations from the European Commission. Expected average hospital support team services were priced at 483 euros and budgeted for 10% (stage 1) to 90% (stage 4) of patients. Home care (60 visits, 4,573 euros) and day-care (5 visits) services were budgeted for between 5% (stage 1) and 30% (stage 4). The resulting prospective reimbursements range from 393 euros (stage 1) to 2,503 euros (stage 4). In-patient care was excluded from the prospective payments and reimbursed separately. For the first time, global reimbursements covering palliative care hospital support, home care and day care for patients with NSCLC were prospectively calculated and successfully negotiated. The contractual specification of palliative care services may contribute to transparency and quality in cancer care.

Specialist palliative care for patients with non-cancer diagnosis

Specialist palliative care for patients with non-cancer diagnosis

Specialist palliative care for patients with non-cancer diagnosis

All patients with palliative care needs should receive an equitable service, and there is evidence to suggest that patients with life-limiting illnesses other than cancer would benefit from specialist palliative care services. The author discusses how this might be achieved and the barriers that exist to prevent it happening.

Development of a holistic admission assessment: an integrated care pathway for the hospice setting

This article describes the development of a holistic admission assessment for all inpatients admitted to a 66-bedded hospice, structured in the form of an integrated care pathway (ICP). The need for an improved assessment process was identified by clinical staff, who recognized that the existing assessment was not truly holistic and was dependent on the skills of the assessors. The assessment also lacked appropriate goals and actions. The recently published National Institute for Clinical Excellence (NICE) guidance on Improving Supportive and Palliative Care for Adults with Cancer, has also highlighted key areas for the improvement of patient assessment in specialist palliative care (NICE, 2004). Implementation of the ICP has resulted in a systematic and timely holistic assessment process for patients. The ICP addresses effectively the NICE recommendations for the assessment of specialist palliative care patients.

The increasing use of reiki as a complementary therapy in specialist palliative care

Palliative medicine and complementary therapies (CTs) have developed within the NHS as parallel philosophies of care. As a result, the last decade has seen an increase in the integration and usage of CTs, as adjunct therapies to conventional medical treatment. Documented benefits of relaxation, decreased perception of pain, reduced anxiety and improved sense of wellbeing have been shown to enable an enhanced quality of life, where curative treatment is no longer an option. Reiki is a more recent addition to the range of CTs available to cancer patients. As an energy-healing intervention it has gained in popularity as a non-invasive and non-pharmacological approach. Anecdotal evidence suggests that the profound relaxation effect has a positive impact on alleviating anxiety, stress, perception of pain and promotes a feeling of wellbeing particularly relating to the nature of psychospiritual wellbeing. However, there is very little evidence to support its application within clinical practice, and none within the specific field of specialist palliative care (SPC). This article will consider the position of reiki as an emerging CT within SPC. The function of the hospice movement, the role of CTs together with an understanding of energy healing will also be explored. Within this context, the rise in popularity of reiki and its potential benefits for SPC patients will be discussed. These considerations will then form the basis of the justification for further research in SPC.

Deaths from heart failure in general practice: implications for palliative care.

Trial and observational research indicates a high one-year mortality with a significant potential for specialist palliative care for patients with heart failure. A community observational study was undertaken in two general practices, with a total population of 21,000. There were three objectives: to determine the prevalence of symptomatic heart failure, to document mortality in the cohort over six and 12 months, and to establish the population in which a palliative care approach was adopted. A search of the computerized medical records yielded 548 patients with symptomatic heart failure (2.6% of the total study population). Over a six-month period, 31 patients (6% of the cohort) died and over a 12-month period 64 patients (12% of the cohort) died. 'Sudden death' was recorded in the records of 14 patients and death from coexisting malignancy was recorded in seven patients. A palliative care approach in patients not dying suddenly or of malignancy was recorded in 21 cases (33% of the total deaths). The findings do not indicate a high mortality in patients with symptomatic heart failure in general practice. The role of specialist palliative care in many cases would appear to be limited by the difficulty in predicting prognosis. In a significant number of cases, general practitioners appear to be aware of the need for a palliative care approach in patients dying of heart failure.

A collaborative nursing model for advanced non-malignant disease.

This article reviews the arguments for and against specialist palliative care for patients with advanced non-malignant disease. It argues the case for a collaborative model of education to develop the skills of specialist nurses so that they can better care for such patients. A clinically based collaborative nursing model of palliative care, which has not been derived from current cancer models, has also been developed. In addition, a brief overview of the current provision of care for cancer patients is given, since it is against this background that care for patients with advanced non-malignant disease will be developed.