Characteristics of a palliative care consultation service with a focus on pain in a German university hospital

Abstract

BackgroundA minority of patients with incurable and advanced disease receive specialised palliative care. Specialised palliative care services that complement the care of difficult and complex cases ought to be integrated with services that deliver general care for most patients. A typical setting in which this integrative concept takes place is the hospital setting, where patients suffering from incurable and advanced disease are treated in many different departments.The aim of the study is to investigate the profile and spectrum of a palliative care consultation service (PCCS) at a German university hospital with special reference to pain therapy.MethodsWe retrospectively analysed the PCCS documentation of three years.ResultsMost patients were referred from non-surgical departments, 72% were inpatients, and 28% were outpatients. 98% of the patients suffered from cancer. Counselling in pain therapy was one of the key aspects of the consultation: For 76% of all consulted patients, modifications of the analgesic regimen were recommended, which involved opioids in 96%. Recommendations on breakthrough-pain medication were made for 70% of the patients; this was an opioid in most cases (68%). The most commonly used opioid was morphine. For 17% of the patients, additional diagnostic procedures were recommended. Besides pain management palliative care consultation implied a wide range of recommendations and services: In addition to organising home care infrastructure, palliative care services supported patients and their families in understanding the life-limiting diseases. They also coordinated physical therapy and social and legal advice.ConclusionThis survey clearly shows that for a consultation service to support patients with incurable or advanced disease, a multi-disciplinary approach is necessary to meet the complex requirements of a needs-adapted palliative care in inpatient or outpatient settings. Timely integration of palliative expertise may support symptom control and may give the required advice to patients, their carers, and their families.

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

“…It is anticipated that many patients facing an advanced, life-limiting disease would benefit from PC, and only a minority is provided with such service [8]. The demand for specialist PC in hospitals cannot be covered by PC units only [9,10], and it concerns a large variety of chronic diseasesnot only cancer [6,11,12]. Inpatient palliative care consultation (IPCC) teams have been established and shown a lowering of symptom burden in patients and their family caregivers [13][14][15].…”

“…The main reason for requesting IPCC is symptom management, especially pain management [9,15], but also a demand for social and communicative support [16], including patient and family distress as well as help with decision making [17]. An increasing request for PC visits also seems to develop in departments like intensive care and cardiology, particularly in scenarios of prolonged intensive care treatment or repeated admissions.…”

The Management of Pain and Opioid Use for Cancer Patients at Palliative Care Clinic

“…Bu çalışmada hastaların %15'i konsültasyon sonrası PBK'ne alınmış, %87'si hastaneden çıktıktan sonra palyatif bakım konsültan servisine veya palyatif bakım ünitesine yönlendirilmiş, hastaların klinik performansları, prognozları ve mortalite oranları bildirilmemiştir. [16] Yine bu çalışmada en fazla kullanılan opiodler %87 oranında morfin, %33 hidromorfon, %31 fentanil, %14 oksikodon ve %10 tramadol olup değişik kombinasyonlarda kullanılabilen bu opiodlerde en fazla tercih edilen kullanım yolu %86 ile oral yol olmuştur. Morfinin yavaş salınımlı formları, hidromorfon ve oksikodonun ise hızlı salınımlı formları daha fazla tercih edilmiştir.…”

“…Çalışmamızda tramadol kullanımının da %26 ile daha önceki çalışma ile karşılaştırıldığında daha yüksek olduğu görülmekte-dir. [16] Morfin ve tramadolün parenteral kullanımının yüksekliğinde oral yol kullanımını sınırlayan terminal dönem hastaların yüksekliği de etkili oldu. Oral morfin preparatlarının olmaması opioid doz titrasyonunu da zorlaştırmaktadır.…”

“…Opiod doz hesaplamalarında oral morfin dönüşüm oranları oksikodon 0.75, hidromorfon 0.13, fentanil 0.01, oral/ intravenöz 3/1olarak kabul edildi. [16] Opioid türü ve kullanım yolu belirlendi. Opioidlerin ağrı dışında kullanım endikasyonu varsa kaydedildi.…”