Standardizing integration of palliative care into comprehensive cancer therapy—a disease specific approach

Gaertner, Jan; Wolf, Juergen; Hallek, Michael; Glossmann, Jan-Peter; Voltz, Raymond

doi:10.1007/s00520-011-1131-y

Cited by 73 publications

(72 citation statements)

References 37 publications

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“…For some diseases identifying the ''when'' and ''why'' of palliative care utilization can appear intuitive (eventually standardized for diseases such as cancer 40 ), however identifying ''signposts'' for MS remains challenging, mainly because of patient symptomatic complexity and heterogeneity. 28 Obtaining consensus among accomplished experts on criteria for palliative care integration outlines initial guidelines for specifying palliative care assignments and infrastructure.…”

Section: Resultsmentioning

confidence: 99%

Palliative Care for Severely Affected Patients with Multiple Sclerosis: When and Why? Results of a Delphi Survey of Health Care Professionals

Strupp

Romotzky

Galushko

et al. 2014

Journal of Palliative Medicine

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Background: Patients severely affected by multiple sclerosis (MS) present with complex symptoms and needs requiring an interdisciplinary care approach. Objective: Analysis of when and why specialized palliative care integration would be beneficial via examining health care professionals' attitudes. Design: A two-round online Delphi study and expert workshop were undertaken and analyzed descriptively. Setting/Subjects: Following an extensive online search, 164 professionals with expertise in treating and caring for severely affected patients with MS were contacted. Professionals included neurologists, urologists, general practitioners, MS nurses, speech therapists, physiotherapists, psychologists, and palliative care physicians. Forty-six consented to participate: 33 of 46 (71.4%) and 15 of 33 (45.5%) experts responded in the first and second round, respectively. Results: Consensus was reached among all respondents (100%) defining the term ''severely affected'': 78.8% and 86.7%, respectively, thought that specialized palliative care should begin once the disease has progressed (Expanded Disability Status Scale [EDSS] > 6 and nursing care required). When the need exists for communication about disease progression (93.3%), psychological support (93.3%), relatives support (93.3%), and pain medication (86.7%) specialized palliative care should be consulted. Specialized palliative homecare was rated (93.3%) ''very important.'' The workshop documented the paucity of home visits and specialized MS care in nursing homes. Conclusions: Our results clearly identified specific areas in which palliative care will likely prove to be a valuable asset in the treatment course of MS. This information should serve clinicians, indicating when to consider palliative care services and help further reduce or eliminate uncertainty about how palliative care can be integrated in the course of MS.

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Section: Resultsmentioning

confidence: 99%

Palliative Care for Severely Affected Patients with Multiple Sclerosis: When and Why? Results of a Delphi Survey of Health Care Professionals

Strupp

Romotzky

Galushko

et al. 2014

Journal of Palliative Medicine

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“…In order to prepare patients and their social milieu for this situation, the WHO recommends early involvement of services specialized in palliative medicine [705]. The reasons for this are (I) best possible alleviation of symptoms and quality of life through joint interdisciplinary treatment, (II) optimized, need-oriented, cross-specialty care, (III) comprehensive care of patients and their relatives concerning psychosocial and spiritual issues, (IV) strengthening of trust and imparting assurance vis-à-vis the interdisciplinary treatment team through coordination of tumor-specific and palliative medicine measures, (V) support in the care and management of patients with well-advanced disease through coordination of inpatient and specialized outpatient palliative care [706].…”

Section: Gcpmentioning

confidence: 99%

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Pflugfelder

Kochs

Blum

et al. 2013

J Deutsche Derma Gesell

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181

148

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“…They reached a consensus (standard operating procedure) about the timing of early palliative care for 19 specific malignancies, and identified when and where this care should be delivered. 17 They recommended specialized palliative care for all patients with cancer who have no curative treatment options, and that it should be integrated soon after completing cancer staging and starting disease-specific systemic treatment and delivered at the same location as anticancer therapy. Examples of timing for integration of palliative care based on malignancy are shown in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…The palliative care infrastructure differs by region, with some countries supporting palliative home care services and others preferring that services be delivered at palliative care units or hospices. 17,18 Finally, the team should determine who has primary responsibility for treatment based on the disease course. As long as patients remain on an oncology treatment structure, the palliative care physicians serve a consulting role and do not make disease-specific treatment decisions.…”

Section: S-20mentioning

confidence: 99%

“…For example, for each solid tumor type, the team must decide whether it is appropriate to integrate palliative care immediately after diagnosis of metastatic or relapsed disease, or recommend waiting until the initiation of systemic chemotherapy. 17 At this point, patients typically receive disease-specific treatment in an oncology setting (eg, oncology unit, oncology outpatient clinic), with the oncologist having the primary responsibility for treatment.…”

Section: S-20mentioning

confidence: 99%

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Provision of Palliative Care and Pain Management Services for Oncology Patients

Marchetti¹,

Voltz²,

Rubio³

et al. 2013

J Natl Compr Canc Netw

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Early initiation of palliative care to address pain and other symptoms offers the potential to improve quality of life for patients with cancer. The approaches to implementing and delivering palliative care and pain management services vary depending on patient needs, available resources, provider training, and clinical setting. This article describes the experiences in developing programs in which the need for early palliative care or pain management services for patients with cancer was recognized. In each case, collaborative efforts, careful planning, administrative support, and ample time were needed to implement such services. To tailor services based on the available resources, different approaches were taken, including structuring of services within oncology units; creation of an integrated partnership between oncology and palliative care departments; establishment of a multidisciplinary comprehensive service; and incorporation of nurse-based pain services to address acute, chronic, and cancer pain. These examples offer insights into how to optimize delivery of services in a variety of settings with varying resources. (JNCCN 2013;11(Suppl 1): S17-S27) recommends that combined standard oncology and palliative care should be considered early in the disease process for patients with metastatic cancer and/or a high symptom burden. Meanwhile, the European Society for Medical Oncology (ESMO) formalized the relationship between medical oncology and palliative care in a series of policy statements published in 2003. 4 These policies recognize that alleviation of pain and other symptoms should be given a high priority, that medical oncologists must be experts in evaluating and managing these symptoms, and that cancer centers should provide supportive and palliative care as part of their basic services. Provision of Palliative Care and Pain Management Services for Oncology PatientsAlthough agreement exists on the need for early palliative care services for patients with cancer, less guidance is available on optimal ways to develop successful programs. The availability of palliative care and pain management services varies by country and geographic location, and across medical centers. Programs incorporating palliative care services must base their design on the needs of the patients, the training and availability of health care providers, and the resources available.

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Standardizing integration of palliative care into comprehensive cancer therapy—a disease specific approach

Abstract: With this concept, the authors provide a framework for realizing EI and hope to initiate a discussion about specific recommendations for EI.

Cited by 73 publications

References 37 publications

Palliative Care for Severely Affected Patients with Multiple Sclerosis: When and Why? Results of a Delphi Survey of Health Care Professionals

Palliative Care for Severely Affected Patients with Multiple Sclerosis: When and Why? Results of a Delphi Survey of Health Care Professionals

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Provision of Palliative Care and Pain Management Services for Oncology Patients

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