Early Integration of Palliative Care into Standard Oncology Care: Evidence and Overcoming Barriers to Implementation

Kain, Danielle; Eisenhauer, Elizabeth

doi:10.3747/co.23.3404

Cited by 39 publications

(30 citation statements)

References 19 publications

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“…In the NL, a recent study showed that GPs were more hesitant to engage in ACP with patients who were still being treated by specialists in hospital, as these patients are often less open to discussion 33. Numerous initiatives have been developed to make earlier integration of specialised palliative care services a reality 34–37. Consequently, certain topics may be more frequently discussed with palliative caregivers or nurses of the palliative homecare team rather than with GPs.…”

Section: Discussionmentioning

confidence: 99%

End-of-life communication in advanced cancer: international trends (2009–2014)

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et al. 2020

BMJ Support Palliat Care

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ObjectiveTo examine trends in end-of-life communication with people with cancer in general practice.MethodsMortality follow-back survey among general practitioners (GPs) in representative epidemiological surveillance networks in Belgium (BE), the Netherlands (NL) and Spain (ES) in 2009–2010 (ES: 2010–2011) and 2013–2014. Using a standardised form, GPs registered all deceased adult patients in their practice and reported for five end-of-life care topics whether they had been discussed with the patient. Non-sudden cancer deaths were included (n=2306; BE: 1233; NL: 729; ES: 344).ResultsA statistically significant increase was found between 2009/2010 and 2014 in the prevalence of communication about diagnosis (from 84% to 94%) and options for end-of-life care (from 73% to 90%) in BE, and in GPs’ awareness of patients’ preferences for medical treatment and a proxy decision-maker in BE (from 41% and 20% up to 53% and 28%) and the NL (from 62% and 32% up to 70% and 52%). Communication about options for end-of-life care and psychosocial problems decreased in the NL (from 88% and 91% down to 73%) and ES (from 76% and 77% down to 26% and 39%).ConclusionConsiderable change in GP–patient communication seems possible in a relatively short time span, but communication cannot be assumed to increase over time. Increasing specialisation of care and task differentiation may lead to new roles in communication for healthcare providers in primary and secondary care. Improved information sharing between GPs and other healthcare providers may be necessary to ensure that patients have the chance to discuss important end-of-life topics.

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Section: Discussionmentioning

confidence: 99%

End-of-life communication in advanced cancer: international trends (2009–2014)

Verkissen

Penders

Moreels

et al. 2020

BMJ Support Palliat Care

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“…The evidence indicates that timely referral into palliative care services has a positive impact on quality of life and can reduce hospitalisation and symptom burden [46] but research in this area is largely North American [47,48] or Japanese [49] and mainly relates to patients with cancer. Exceptions to this include investigative studies into symptom focused interventions for conditions such as breathlessness [50,51].…”

Section: Discussionmentioning

confidence: 99%

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

et al. 2018

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Background: The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites. Methods: The study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014)(2015)(2016) Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis. Results: Comparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The Macmillan brand engendered patient and carer confidence, bringing added value to existing services. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support. Conclusions: Macmillan Specialist Care at Home increases patient choice about place of death and enhances the quality of end of life experience. Clarification of key components is advocated to aid consistency of implementation across different sites and support future evaluative work.

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“…The benefits for oncology patients and their families of early introduction of palliative care are believed to substantially outweigh the potential ramifications 6,7 . In addition, early implementation of palliative care can aid in providing individualized and effective care for the patient, which promotes patient satisfaction and fulfils their needs 6,8 . Palliative management also proves suitable in various neurosurgical conditions, including traumatic head injuries, massive intracranial hemorrhages, and brain tumours 3 .…”

Section: Introductionmentioning

confidence: 99%