Palliative care is increasing, but curative care is growing even faster in the last months of life

Hamano, Jun; Amblàs-Novellas, Jordi

doi:10.3399/bjgp21x716921

Cited by 7 publications

(3 citation statements)

References 6 publications

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“…Given the evidence of an upward trend in PPC enrollment, it is inferred that the downward trend in PPC duration is due to increases in short‐term users. Short‐term use of PPC may be associated with new curative/experimental treatments (Murray & Amblàs, 2021) or overmedicalization (Jawed, 2022), which indicates unnecessary clinical intervention that may cause health risks without the ability to resolve a health problem (Kaczmarek, 2019).…”

Section: Discussionmentioning

confidence: 99%

Pediatric palliative care utilization by decedent children: A nationwide population‐based study, 2002–2017

Tang

et al. 2023

J of Nursing Scholarship

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PurposeThis study aimed (1) to describe how trends in pediatric palliative care (PPC) utilization changed from 2002 to 2017, and (2) to examine factors predicting PPC utilization among decedent children in Taiwan.DesignThis retrospective, correlational study retrieved 2002–2017 data from three national claims databases in Taiwan.MethodsChildren aged 1 through 18 years who died between January 2002 and December 2017 were included. Pediatric palliative care utilization was defined as PPC enrollment and PPC duration, with enrollment described by frequency (n) and percentage (%) and duration described by mean and standard deviation (SD). Logistic regression was used to examine the associations of various demographic characteristics with PPC enrollment; generalized linear regression was used to examine associations of the demographic characteristics with PPC duration.FindingsAcross the 16‐year study period, PPC enrollment increased sharply (15.49 times), while PPC duration decreased smoothly (by 29.41%). Cause of death was a continuous predictor of both PPC enrollment and PPC duration. The children less likely to be enrolled in PPC services were those aged 1 to 6 years, boys, living in poverty, living in rural areas, and diagnosed with life‐threatening noncancer diseases.ConclusionThis study used nationwide databases to investigate PPC enrollment and PPC duration among a large sample of deceased children from 2002 to 2017. The findings not only delineate trends and predictors of PPC enrollment and PPC duration but also highlight great progress in PPC as well as the areas still understudied and underserved. This information could help the pediatric healthcare system achieve the core value of family‐centered care for children with life‐threatening diseases and their families.Clinical RelevancePediatric palliative care should be widely and continuously implemented in routine pediatric clinical practice to enhance quality of life for children and their families at the end of life.

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Section: Discussionmentioning

confidence: 99%

Pediatric palliative care utilization by decedent children: A nationwide population‐based study, 2002–2017

Tang

et al. 2023

J of Nursing Scholarship

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“…Furthermore, while integrated PC delivery gradually increases in the last year of life, disease-modifying and potentially curative care and unplanned care are not decreasing. Instead, it is rapidly increasing, particularly in the last 3 months of life [3]. Growing evidence shows that the NECesidades PALiativas (NECPAL) Centro Coordinador Organización Mundial de la Salud -Instituto Catalán de Oncología (CCOMS-ICO©) tool is validated with widespread use to identify patients likely in PC needs [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the early palliative approach can prevent or ameliorate suffering and must be an informed option and available for all [ 2 , 6 , 14 ]. Therefore, we hypothesised that the timely identification supported by a predictive mortality risk model would be necessary for PC National Programme Design in Argentina [ 3 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Palliative and prognostic approach in cancer patients identified in the multicentre NECesidades PALiativas 2 study in Argentina

Tripodoro¹,

Llanos²,

Daud³

et al. 2021

ecancer

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Background Early identification of palliative needs has proven benefits in quality of life, survival and decision-making. The NECesidades PALiativas (NECPAL) Centro Coordinador Organización Mundial de la Salud - Instituto Catalán de Oncología (CCOMS-ICO©) tool combines the physician’s insight with objective disease progression parameters and advanced chronic conditions. Some parameters have been independently associated with mortality risk in different populations. According to the concept of the ‘prognostic approach’ as a companion of the ‘palliative approach’, predictive models that identify individuals at high mortality risk are needed. Objective We aimed to identify prognostic factors of mortality in cancer in our cultural context. Method We assessed cancer patients with palliative needs until death using this validated predictive tool at three hospitals in Buenos Aires City. This multifactorial, quantitative and qualitative non-dichotomous assessment process combines subjective perception (the surprise question: Would you be surprised if this patient dies in the next year?) with other parameters, including the request (and need) for palliative care (PC), the assessment of disease severity, geriatric syndromes, psychosocial factors and comorbidities, as well as the use of healthcare resources. Results 2,104 cancer patients were identified, 681 were NECPAL+ (32.3%). During a 2-year follow-up period, 422 NECPAL+ patients died (61.9%). The mean overall survival was 8 months. A multivariate model was constructed with significant indicators in univariate analysis. The best predictors of mortality were: nutritional decline ( p < 0.000), functional decline ( p < 0.000), palliative performance scale (PPS) ≤ 50 ( p < 0.000), persistent symptoms ( p < 0.002), functional dependence ( p < 0.000), poor treatment response ( p < 0.000), primary cancer diagnosis ( p = 0.024) and condition (in/outpatients) ( p < 0.000). Only three variables remained as survival predictors: low response to treatment ( p < 0.001), PPS ≤ 50 ( p < 0.000) and condition (in/outpatients) ( p < 0.000). Conclusion This prospective model aimed to improve cancer survival prediction and timely PC referral in Argentinian hospitals.

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Embracing ambivalence and hesitation: a Ricoeurian perspective on anticipatory choice processes at the end of life

van Wijngaarden

2024

Med Health Care and Philos

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Especially older adults are increasingly stimulated to think about, talk about and record their preferences with regard to future (health)care decisions, preferably in a pro-active manner. In this paper, I analyse these anticipatory choice processes. My goal is twofold: Firstly, to provide a deeper understanding of what it actually means to decide in advance about end-of-life treatments or options. Secondly, to make a theoretical contribution to bioethics and ACP-theories by rethinking the concept of end-of-life choices from a phenomenological viewpoint. To achieve this, I start by presenting a case narrative that elucidates how these anticipatory choices are lived. Secondly, I map out a theoretical framework about choice based on the phenomenology of the will of Paul Ricoeur. Finally, guided by this Ricoeurian framework, I investigate the potential meaning of choice in the context of contemporary advance care planning trajectories. The analysis demonstrates that choice and agency always imply notions of passivity and uncontrollability. It also indicates the significant value of hesitation and ambivalence. Moreover, it highlights the importance of the notion of co-responsibility in the context of anticipated end-of-life choices, and the relevant distinction between a (willed) choice and a wish. To improve care and support regarding end-of-life trajectories and to promote meaningful conversations, it is imperative to integrate these underrated elements more substantially in our theories, language and practical approaches. I conclude by suggesting that, in order to do justice to the real-life complexities, we might even need to revise the notion of advance ‘directives’.

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Palliative care is increasing, but curative care is growing even faster in the last months of life

Cited by 7 publications

References 6 publications

Pediatric palliative care utilization by decedent children: A nationwide population‐based study, 2002–2017

Pediatric palliative care utilization by decedent children: A nationwide population‐based study, 2002–2017

Palliative and prognostic approach in cancer patients identified in the multicentre NECesidades PALiativas 2 study in Argentina

Embracing ambivalence and hesitation: a Ricoeurian perspective on anticipatory choice processes at the end of life

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