Differences in primary palliative care between people with organ failure and people with cancer: An international mortality follow-back study using quality indicators

Abstract

People who died of organ failure are at risk of receiving lower quality palliative care than people who died of cancer, but the differences vary per country. Initiatives to improve palliative care should have different priorities depending on the healthcare and cultural context.

IDentification of patients in need of general and specialised PALLiative care (ID-PALL©): item generation, content and face validity of a new interprofessional screening instrument.

“…Following literature findings that people with life limiting non-cancer conditions have less access to palliative care (16,23), the items were designed for patients with either oncological or nononcological pathologies. Finally, the CICE determined which items belonged in the generalised PC or specialised PC categorisations.…”

“…Proportions of patients with PC needs varies (9%-73%), and people are often identified late, which bears important consequences for care (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). These consequences include, but are not limited to (i) excess hospital mortality, whereby 80% of palliative patients die in hospital when the majority of people wish to die at home (19,20); (ii) suboptimal symptom management (21)(22)(23); (iii) unplanned hospitalisations with long hospital stays (24,25); (iv) prescription of inappropriate treatments due to a lack of advance care planning (26,27); and, (v) insufficient support for the patient and their relatives (24,28,29). On the other hand, when patients receive PC, their health is enhanced through improved pain relief, less dyspnoea and depression, and enhanced quality of life, patient satisfaction and chances of dying at home (30)(31)(32)(33)(34)(35).…”

IDentification of patients in need of general and specialised PALLiative care (ID-PALL©): item generation and content validity of a new interprofessional screening instrument.

“…This process was completed by a committee of interdisciplinary clinical experts (CICE) composed of one clinical nurse specialist (FTL), one psychologist (MB) and two physicians (MB, GDB), who were in charge of ensuring the relevance, comprehensiveness and comprehensibility for the clinical practice, by reformulating, adding or clustering items (39). Following literature findings that people with life limiting non-cancer conditions have less access to palliative care (12,19), the items were designed for patients with either oncological or non-oncological pathologies. Finally, the CICE determined which item belonged to which group (generalised PC or specialised PC).…”

“…Numerous consequences arise from inadequate identification. These include, but are not limited to (i) excess hospital mortality -80% -when the majority of people wish to die at home (15,16); (ii) suboptimal symptom management (17)(18)(19); (iii) unplanned hospitalisations with long hospital stays (20,21); (iv) prescription of inappropriate treatments due to a lack of advance care planning (22,23); and, (v) insufficient support for the patient and their relatives (20,24,25). On the other hand, when patients receive PC, their health is enhanced with improved pain relief, less dyspnoea and depression, and enhanced quality of life, patient satisfaction and chances of dying at home (26)(27)(28)(29)(30)(31); psychological distress, decisional conflict, acute interventions or hospital readmissions are reduced (32)(33)(34)(35), and quality of life for families is improved (36).…”

IDentification of patients in need of general and specialised PALLiative care (ID-PALL©): item generation, content and face validity of a new interprofessional screening instrument.

“…Proportions of patients with PC needs vary (9%-73%), and people are often identified late in their disease trajectory, which bears important consequences for care (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). These consequences include, but are not limited to (i) excess hospital mortality, whereby 80% of palliative patients die in hospital when the majority of people wish to die at home (19,20); (ii) suboptimal symptom management (21)(22)(23); (iii) unplanned hospitalisations with long hospital stays (24,25); (iv) prescription of inappropriate treatments due to a lack of advance care planning (26,27); and, (v) insufficient support for the patient and their relatives (24,28,29). On the other hand, when patients receive PC, their health and wellbeing is enhanced through improved pain relief, less dyspnoea and depression, and enhanced quality of life, patient satisfaction and chances of dying at home (30)(31)(32)(33)(34)(35).…”