Case management in primary palliative care is associated more strongly with organisational than with patient characteristics: results from a cross-sectional prospective study

Abstract

Background: Case managers have been introduced in Dutch primary palliative care; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner and home care nurses. This study aims to describe support and investigate what characteristics of patients and the organizational setting are related to the number of contacts and to the number of times topics are discussed between the case manager and patients and/or informal carers. Methods: Prospective study following cancer patients (n = 662) receiving support from a palliative care case manager in Dutch primary care, using registration forms filled out by the case manager after contact with the patient and/or informal carer. In backward linear regression, the association was studied between patient or organizational characteristics and the number of contacts and the number of times conversation topics were discussed. Results: Organizational characteristics add more to explained variability in data than patient characteristics. Case managers provide support in a flexible manner with regard to the number, mode, persons present, and duration of contacts. Support covered all domains of palliative care, with most attention given to physical complaints, life expectancy and psychological aspects. Conclusions: Support offered by the case managers is prompted by characteristics of the organization for which they work. This is contradictory to the idea of patient centered care highly valued in palliative care.

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“…This result is consistent with those previously obtained from the research of Too et al 22 "Emotional anxiety and mental health problems in cancer patients can come from substantial social problems, such as the inability to work and reduced income, lack of insurance, and lack of support". 22 The same observation is made with regard to the results of the Van Der Plas et al 23 statistical study, which indicates that only 8% of patients have their full mobility. The 92% must rely on the help of parents, children or friends.…”

The Support, Education, and Advocacy (SEA) Program of Care for Women With Metastatic Breast Cancer: A Nurse-Led Palliative Care Demonstration Program

“…25 Expanding the oncology nurse role to manage palliative care needs is supported by current primary palliative care programs. Oncology nurses create care plans and provide supportive follow-up, 26 are engaged with patients in individual meetings in collaboration with caregivers, 27 and organize care among the interdisciplinary team members. 28 These roles are most successful when delivered earlier in the metastatic cancer disease trajectory rather than close to the end of life.…”

Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care

“…Finally, further research is needed to better understand the experiences of patients, relatives, home-care nurses and GPs with the support provided by the case manager. A more detailed paper on the content of the support provided by the case manager will be published soon [ 18 ].…”

“…a home-care organisation working together with a hospital). Detailed information on the content of the support provided by case managers can be found elsewhere [ 18 ]. There are case managers in the Netherlands for patients with dementia [ 19 ], but they are not included in this paper.…”