Relationship between palliative care consultation service and end-of-life outcomes

Wu, Lijie; Chu, Cordia; Chen, Yuguang; Ho, Ching‐Liang; Pan, Hsueh-Hsing

doi:10.1007/s00520-015-2741-6

Cited by 15 publications

(19 citation statements)

References 17 publications

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“…Obermeyer et al reported that the female was associated with hospice enrollment in poor-prognosis cancer patients [ 22 ]. Another study showed that there were more men than women in patients receiving palliative care consultation service [ 23 ]. Until now, there were no consistent findings in gender distribution due to very limited studies.…”

Section: Discussionmentioning

confidence: 99%

“…The same finding is also mentioned by some past studies, indicating that patients cared by medical oncologists were significantly more likely to enroll in hospice than patients cared by other specialties. [ 22 , 23 ] Obermeyer et al assumed that the medical oncologists may make better prognostic estimates and may be more effective in discussing hospice care with patients when compared with other specialties [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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The effects of hospice-shared care for gastric cancer patients

et al. 2017

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BackgroundHospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients.MethodsA total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81).ResultsAmong the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, p<0.001), intubation (1% vs 27%, p<0.001), cardiopulmonary-cerebral resuscitation (0% vs 11%, p = 0.001), ventilator use (1% vs 27%, p<0.001), inotropic agent use (8% vs 46%, p<0.001), total or partial parenteral nutrition use (38% vs. 58%, p = 0.029), and blood transfusion (45% vs 74%, p<0.001). Besides, the hospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR) orders (95% vs 37%, p<0.001), receiving home hospice care (16% vs 1%, p<0.001), and indicating home as the realistically preferred place of death (41% vs 19%, p = 0.001). The hospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014.ConclusionThe use of hospice-shared care for gastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effects of hospice-shared care for gastric cancer patients

et al. 2017

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“…They collaborated with primary health professionals to mainly provide advice, support, and guidance regarding palliative care [ 4 , 5 ]. A study has confirmed the outcomes of PCCS, which revealed patients who received PCCS, received better symptom management, spiritual support and earlier development of resuscitation plans [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Path modeling of knowledge, attitude and practice toward palliative care consultation service among Taiwanese nursing staff: a cross-sectional study

Pan

Shih

et al. 2017

BMC Palliat Care

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BackgroundThe Taiwanese government has promoted palliative care consultation services (PCCS) to support terminally ill patients in acute ward settings to receive palliative care since 2005. Such an intervention can enhance the quality of life and dignity of terminally ill patients. However, research focusing on the relationship between the knowledge, attitude and practice of a PCCS using path modelling in nursing staff is limited. Therefore, the aim of this study was to elucidate the effect of path modeling on the knowledge, attitude and practice toward PCCS in Taiwanese nursing staff.MethodsThis was a cross-sectional, descriptive study design using convenience sampling. Data collected included demographics, knowledge, attitude and practice as measured by the PCCS inventory (KAP-PCCSI). Two hundred and eighty-four nursing staff from a medical center in northern Taiwan participated in the study in 2013. We performed descriptive statistics, regression analysis, and path modeling using SPSS 19.0 and set p < 0.05 as the statistical significance threshold.ResultsThe results showed that the identical factor significantly associated with knowledge, attitude, and practice toward PCCS among nurses was the frequency of contact with PCCS. In addition, higher level of knowledge toward PCCS was associated with working in haematology and oncology wards, and participation in education related to palliative care. A more positive attitude toward PCCS was associated with working in a haematology and oncology ward, and experience of friends or relatives dying. Higher level of practice toward PCCS was associated with nurses who participated in education related to palliative care. In the path modeling, we found that holders of a master’s degree indirectly positive affected practice toward PCCS. Possession of a bachelor degree or above, being single, working within a haematology and oncology ward, and frequency of contact with PCCS positively affected practice toward PCCS.ConclusionsBased on this study, it is proposed that consultation with PCCS has a positive impact on the care of terminally ill patients. Encouragement of staff to undertake further education can improve the practice of ward staff providing palliative care.

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“…Even though the optimal time point and extent of PC is still in debate [2], there is little doubt of a general benefit [3]. It has shown to improve patients' quality of life and symptom control [4], to reduce psychological distress for patients and family caregivers [5,6], and to decrease health care costs due to for example less intensive care unit treatment [7]. 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].…”

Section: Introductionmentioning

confidence: 99%

“…Improvement of mental well-being after IPCC seems to be based, inter alia, on spiritual care and high quality communication with patients and their family caregivers [24,25]. It leads to strengthened relationships and improved emotional stability especially concerning confrontation with death [4]. Additionally, IPCC has shown to enhance patients' awareness of the disease including its prognosis [26].…”

Section: Introductionmentioning

confidence: 99%

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

Coym

Kanitz

Puls

et al. 2020

BMC Health Serv Res

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Background: Inpatient palliative care consultation (IPCC) teams have been established to improve care for patients with specialist palliative care (PC) needs throughout all hospital departments. The objective is to explore physicians' perceptions on the impact of IPCC, its triggers, challenges and limits, and their suggestions for future service improvements. Methods: A Qualitative study drawing on semi-structured interviews with 10 PC specialists of an IPCC team and nine IPCC requesting physicians from oncology and non-oncological departments of a university hospital. Analysis was performed using qualitative content analysis. Results: PC specialists and IPCC requesting physicians likewise considered organization of further care and symptom-burden as main reasons for IPCC requests. The main impact however was identified from both as improvement of patients' (and their caregivers') coping strategies and relief of the treating team. Mostly, PC specialists emphasized a reduction of symptom burden, and improvement of further care. Challenges in implementing IPCC were lack of time for both. PC specialists addressed requesting physicians' skepticism towards PC. Barriers for realization of IPCC included structural aspects for both: limited time, staff capacities and setting. PC specialists saw problems in implementing recommendations like disagreement towards their suggestions. All interviewees considered education in PC a sensible approach for improvement. Conclusions: IPCC show various positive effects in supporting physicians and patients, but are also limited due to structural problems, lack of knowledge, insecurity, and skepticism by the requesting physicians. To overcome some of these challenges implementation of PC education programs for all physicians would be beneficial.

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Relationship between palliative care consultation service and end-of-life outcomes

Abstract: This study confirms the outcomes of PCCS and highlights the important predictors for patients at PCCS termination. These factors can be targeted to improve and enhance the quality of PCCS rendered in the future.

Cited by 15 publications

References 17 publications

The effects of hospice-shared care for gastric cancer patients

The effects of hospice-shared care for gastric cancer patients

Path modeling of knowledge, attitude and practice toward palliative care consultation service among Taiwanese nursing staff: a cross-sectional study

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

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