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Daveson B, Blanchard M, Clapham S, Draper K, Connolly A, Currow D. Population-level, patient-reported outcomes: a case study regarding a public health intervention that involves patients with life-limiting illnesses. Front Public Health 2023; 11:1232881. [PMID: 37637805 PMCID: PMC10449265 DOI: 10.3389/fpubh.2023.1232881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Dying and death are public health concerns, but little is known about public health interventions that target populations living with life-limiting illnesses. This gap makes it difficult to identify best-practice public health interventions for this population and to achieve public health objectives. The study aimed to describe a public health intervention that intends to improve population-level outcomes using point-of-care and patient-reported outcomes. Methods A case study approach, informed by the Organization for Economic Co-operation and Development's (OECD) Best-Practice Public Health Framework, was used to describe coverage, effectiveness, and equity using mixed methods. Data from 2012 to 2022 were analyzed. Results Over the 10-year period, the number of deaths recorded in the programme (n = 16,358 to 32,421, +98.2%) as well as the percentage of the population that might benefit from palliative care increased (14.8% to 25.1%). The median age of those admitted for care (74 to 77 years) and the proportion of services participating in the programme located in outer regional and remote areas of Australia increased (2012: 59; 2022: 94; +5.4%). The access by patients that experience the greatest socioeconomic disadvantage decreased (2012: 18.2% n = 4,918; 2022: 15.9% n = 9,525). Improvements in relation to moderate distress related to pain were identified (2012: 63% n = 8,751, 2022: 69% n = 13,700), and one in five instances of severe distress related to pain did not improve (2012: 20% n = 781; 2022: 19% n = 635). Conclusion Population-level, patient-reported outcome data are useful and necessary in addressing public health objectives in populations with life-limiting illnesses. Our application of the OECD's Best-Practice Public Health Framework has helped to identify and describe a national intervention that may be transferred to other settings to address health promotion objectives. This may help improve the targeting of treatments to improve pain and issues related to equity.
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Affiliation(s)
- Barbara Daveson
- Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia
| | - Megan Blanchard
- Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia
| | - Sabina Clapham
- Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia
| | - Kylie Draper
- Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia
| | - Alanna Connolly
- Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Kluger BM, Miyasaki JM. Key concepts and opportunities. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:3-15. [PMID: 36055718 DOI: 10.1016/b978-0-323-85029-2.00014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuropalliative care is an emerging field dedicated to applying palliative care approaches to meet the needs of persons living with neurologic illness and their families. The development of this field acknowledges the unique needs of this population, including in terms of neuropsychiatric symptoms, the impact of neurologic illness on personhood, and the logistics of managing neurologic disability. In defining the goals of this field, it is important to distinguish between neuropalliative care as an approach to care, as a skillset, as a medical subspecialty, and as a public health goal as each of these constructs offers their own contributions and opportunities. As a newly emerging field, there are nearly unlimited opportunities to improve care through research, clinical care, education, and advocacy.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Oluyase AO, Higginson IJ, Yi D, Gao W, Evans CJ, Grande G, Todd C, Costantini M, Murtagh FEM, Bajwah S. Hospital-based specialist palliative care compared with usual care for adults with advanced illness and their caregivers: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Most deaths still take place in hospital; cost-effective commissioning of end-of-life resources is a priority. This review provides clarity on the effectiveness of hospital-based specialist palliative care.
Objectives
The objectives were to assess the effectiveness and cost-effectiveness of hospital-based specialist palliative care.
Population
Adult patients with advanced illnesses and their unpaid caregivers.
Intervention
Hospital-based specialist palliative care.
Comparators
Inpatient or outpatient hospital care without specialist palliative care input at the point of entry to the study, or community care or hospice care provided outside the hospital setting (usual care).
Primary outcomes
Patient health-related quality of life and symptom burden.
Data sources
Six databases (The Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and CareSearch), clinical trial registers, reference lists and systematic reviews were searched to August 2019.
Review methods
Two independent reviewers screened, data extracted and assessed methodological quality. Meta-analysis was carried out using RevMan (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark), with separate synthesis of qualitative data.
Results
Forty-two randomised controlled trials involving 7779 participants (6678 patients and 1101 unpaid caregivers) were included. Diagnoses of participants were as follows: cancer, 21 studies; non-cancer, 14 studies; and mixed cancer and non-cancer, seven studies. Hospital-based specialist palliative care was offered in the following models: ward based (one study), inpatient consult (10 studies), outpatient (six studies), hospital at home or hospital outreach (five studies) and multiple settings that included hospital (20 studies). Meta-analyses demonstrated significant improvement favouring hospital-based specialist palliative care over usual care in patient health-related quality of life (10 studies, standardised mean difference 0.26, 95% confidence interval 0.15 to 0.37; I
2 = 3%) and patient satisfaction with care (two studies, standardised mean difference 0.36, 95% confidence interval 0.14 to 0.57; I
2 = 0%), a significant reduction in patient symptom burden (six studies, standardised mean difference –0.26, 95% confidence interval –0.41 to –0.12; I
2 = 0%) and patient depression (eight studies, standardised mean difference –0.22, 95% confidence interval –0.34 to –0.10; I
2 = 0%), and a significant increase in the chances of patients dying in their preferred place (measured by number of patients with home death) (seven studies, odds ratio 1.63, 95% confidence interval 1.23 to 2.16; I
2 = 0%). There were non-significant improvements in pain (four studies, standardised mean difference –0.16, 95% confidence interval –0.33 to 0.01; I
2 = 0%) and patient anxiety (five studies, mean difference –0.63, 95% confidence interval –2.22 to 0.96; I
2 = 76%). Hospital-based specialist palliative care showed no evidence of causing serious harm. The evidence on mortality/survival and cost-effectiveness was inconclusive. Qualitative studies (10 studies, 322 participants) suggested that hospital-based specialist palliative care was beneficial as it ensured personalised and holistic care for patients and their families, while also fostering open communication, shared decision-making and respectful and compassionate care.
Limitation
In almost half of the included randomised controlled trials, there was palliative care involvement in the control group.
Conclusions
Hospital-based specialist palliative care may offer benefits for person-centred outcomes including health-related quality of life, symptom burden, patient depression and satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death) with little evidence of harm.
Future work
More studies are needed of populations with non-malignant diseases, different models of hospital-based specialist palliative care, and cost-effectiveness.
Study registration
This study is registered as PROSPERO CRD42017083205.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Gunn Grande
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Massimo Costantini
- Palliative Care Unit, Azienda Unità Sanitaria Locale – Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS), Reggio Emilia, Italy
| | - Fliss EM Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Tipologías de los madrileños ante la etapa final de la vida mediante un análisis de clusters. GACETA SANITARIA 2018. [DOI: 10.1016/j.gaceta.2017.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bajwah S, Yi D, Grande G, Todd C, Costantini M, Murtagh FE, Evans CJ, Higginson IJ. The effectiveness and cost‐effectiveness of inpatient specialist palliative care in acute hospitals for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2017; 2017:CD012780. [PMCID: PMC6483755 DOI: 10.1002/14651858.cd012780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
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Affiliation(s)
- Sabrina Bajwah
- Cicely Saunders Institute, King's College LondonDepartment of Palliative Care, Policy and RehabilitationBessemer RoadLondonUKSE5 9PJ
| | - Deokhee Yi
- Cicely Saunders Institute, King's College LondonDepartment of Palliative Care, Policy and RehabilitationBessemer RoadLondonUKSE5 9PJ
| | - Gunn Grande
- University of ManchesterSchool of Health Sciences, and Manchester Academic Health Science CentreJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Chris Todd
- University of ManchesterSchool of Health Sciences, and Manchester Academic Health Science CentreJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | | | - Fliss E Murtagh
- King's College LondonDepartment of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteLondonUK
| | - Catherine J Evans
- King's College LondonDepartment of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteLondonUK
| | - Irene J Higginson
- King's College LondonDepartment of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteLondonUK
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Daveson BA, Smith M, Yi D, McCrone P, Grande G, Todd C, Gysels M, Costantini M, Murtagh FE, Higginson IJ, Evans CJ. The effectiveness and cost-effectiveness of inpatient specialist palliative care in acute hospitals for adults with advanced illness and their caregivers. Hippokratia 2016. [DOI: 10.1002/14651858.cd011619.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Barbara A Daveson
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
| | - Melinda Smith
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
| | - Deokhee Yi
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
| | - Paul McCrone
- King's College London; Institute of Psychiatry; Box P024 De Crespigny Park London UK SE5 8AF
| | - Gunn Grande
- University of Manchester; School of Nursing, Midwifery and Social Work; Jean McFarlane Building Oxford Road Manchester Greater Manchester UK M13 9PL
| | - Chris Todd
- University of Manchester; School of Nursing, Midwifery and Social Work; Jean McFarlane Building Oxford Road Manchester Greater Manchester UK M13 9PL
| | - Marjolein Gysels
- University of Amsterdam; Amsterdam Institute of Social Science Research; Amsterdam Netherlands
| | - Massimo Costantini
- IRCCS Arcispedale S. Maria Nuova; Palliative Care Unit; Reggio Emilia Italy
| | - F E Murtagh
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
| | - Irene J Higginson
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
| | - Catherine J Evans
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
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Abstract
BACKGROUND Palliative care is a recent development in health worldwide. In Brazil, a growing number of people with cancer require palliative care, emphasizing the need for investment in this aspect of health to increase the quality of life of patients during the dying process. As a developing country, Brazil lacks knowledge regarding the themes, material and financial resources, and policies of palliative care. OBJECTIVE The aim of this study was to provide insights into the Brazilian palliative care system from the perspectives of nurses and physicians. METHODS This was a descriptive and qualitative study, conducted at the palliative care unit of the Instituto Nacional de Câncer in Brazil. Twelve professionals, among them 8 nurses and 4 physicians, were interviewed in November 2013. The data were analyzed using the thematic analysis method. Ethical aspects were respected. RESULTS The perspectives of the participants were characterized by 3 themes regarding the initial phase of development of palliative cancer care in Brazil: (1) controversies about when palliative cancer care should be initiated, (2) the World Health Organization recommendations and current practices, and (3) the need to invest in palliative cancer care education in Brazil. CONCLUSIONS The development of palliative care is in the initial stages, and there is a possibility for growth due to recent advances. IMPLICATIONS FOR PRACTICE Knowledge about these challenges to palliative care could contribute to the development of strategies, such as the establishment of service organizations and networks, as well as educational and political investments for the advancement of palliative care.
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Bausewein C, Daveson BA, Currow DC, Downing J, Deliens L, Radbruch L, Defilippi K, Lopes Ferreira P, Costantini M, Harding R, Higginson IJ. EAPC White Paper on outcome measurement in palliative care: Improving practice, attaining outcomes and delivering quality services - Recommendations from the European Association for Palliative Care (EAPC) Task Force on Outcome Measurement. Palliat Med 2016; 30:6-22. [PMID: 26068193 DOI: 10.1177/0269216315589898] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Outcome measurement plays an increasing role in improving the quality, effectiveness, efficiency and availability of palliative care. AIM To provide expert recommendations on outcome measurement in palliative care in clinical practice and research. METHODS Developed by a European Association for Palliative Care Task Force, based on literature searches, international expert workshop, development of outcome measurement guidance and international online survey. A subgroup drafted a first version and circulated it twice to the task force. The preliminary final version was circulated to wider expert panel and 28 international experts across 20 European Association for Palliative Care member associations and the European Association for Palliative Care Board of Directors and revised according to their feedback. The final version was approved by the European Association for Palliative Care Board for adoption as an official European Association for Palliative Care position paper. RESULTS In all, 12 recommendations are proposed covering key parameters of measures, adequate measures for the task, introduction of outcome measurement into practice, and national and international outcome comparisons and benchmarking. Compared to other recommendations, the White Paper covers similar aspects but focuses more on outcome measurement in clinical care and the wider policy impact of implementing outcome measurement in clinical palliative care. Patient-reported outcome measure feedback improves awareness of unmet need and allows professionals to act to address patients' needs. However, barriers and facilitators have been identified when implementing outcome measurement in clinical care that should be addressed. CONCLUSION The White Paper recommends the introduction of outcome measurement into practice and outcomes that allow for national and international comparisons. Outcome measurement is key to understanding different models of care across countries and, ultimately, patient outcome having controlled for differing patients characteristics.
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Affiliation(s)
- Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, Munich, Germany
| | | | | | | | - Luc Deliens
- Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Kath Defilippi
- Hospice Palliative Care Association of South Africa, Cape Town, South Africa
| | | | | | - Richard Harding
- King's College London, Cicely Saunders Institute, London, UK
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10
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Daveson BA, Smith M, Yi D, McCrone P, Grande G, Todd C, Gysels M, Costantini M, Murtagh FE, Higginson IJ, Evans CJ. The effectiveness and cost-effectiveness of inpatient specialist palliative care in acute hospitals for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Einleitung
Mit der zunehmend - auch den öffentlichen Diskurs - beschäftigenden Frage nach der in einer Gesellschaft für angemessen gehaltenen Gestaltung des Lebensendes, tritt nunmehr auch die Public Health Perspektive eines ‚guten Sterbens‘ in den Vordergrund. Diese wird anhand aktueller Publikationen vorgestellt.
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Affiliation(s)
- Ulrich Stößel
- ⁎ Dr. Ulrich StößelAbt. Med. Psychologie & Med. SoziologieMedizinische FakultätUniversität FreiburgHebelstr. 2979104 Freiburg
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12
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Calanzani N, Moens K, Cohen J, Higginson IJ, Harding R, Deliens L, Toscani F, Ferreira PL, Bausewein C, Daveson BA, Gysels M, Ceulemans L, Gomes B. Choosing care homes as the least preferred place to die: a cross-national survey of public preferences in seven European countries. BMC Palliat Care 2014; 13:48. [PMID: 25927972 PMCID: PMC4430987 DOI: 10.1186/1472-684x-13-48] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022] Open
Abstract
Background Care homes are increasingly becoming places where people spend the final stages of their lives and eventually die. This trend is expected to continue due to population ageing, yet little is known about public preferences regarding this setting. As part of a larger study examining preferences and priorities for end of life care, we investigated the extent to which care homes are chosen as the least preferred place of death, and the factors associated with this negative preference. Methods We conducted a cross-sectional telephone survey among 9,344 adults from random private households in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We asked participants where they would least prefer to die in a situation of serious illness with less than one year to live. Multivariate binary logistic regressions were used to identify factors associated with choosing care homes as the least preferred place of death in each country. Results Care homes were the most frequently mentioned least preferred place of death in the Netherlands (41.5%), Italy and Spain (both 36.7%) and the second most frequent in England (28.0%), Portugal (25.8%), Germany (23.7%) and Flanders (18.9%). Only two factors had a similar and significant effect on the least preferred place of death in more than one country. In Germany and the Netherlands those doing housework were less likely to choose care homes as their least preferred place (AOR 0.72; 95% CI:0.54-0.96 and AOR 0.68; 95% CI:0.52-0.90 respectively), while those born in the country where the survey took place were more likely to choose care homes (AOR 1.77; 95% CI:1.05-2.99 and AOR 1.74; 95% CI:1.03-2.95 respectively). Experiences of serious illness, death and dying were not associated with the preference. Conclusions Our results suggest it might be difficult to promote care homes as a good place to die. This is an urgent research area in order to meet needs and preferences of a growing number of older people with chronic, debilitating conditions across Europe. From a research perspective and in order to allow people to be cared for and die where they wish, our findings highlight the need to build more in depth evidence on reasons underlying this negative preference. Electronic supplementary material The online version of this article (doi:10.1186/1472-684X-13-48) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natalia Calanzani
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, SE5 9PJ, UK. .,Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Doorway 1, Edinburgh, EH8 9AG, UK.
| | - Katrien Moens
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, SE5 9PJ, UK.
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Irene J Higginson
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, SE5 9PJ, UK.
| | - Richard Harding
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, SE5 9PJ, UK.
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,VU University Medical Center, EMGO Institute for Health & Care Research, Palliative Care Center of Expertise and Department of Public & Occupational Health, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.
| | - Franco Toscani
- Fondazione Lino Maestroni - ONLUS, Istituto di Ricerca in Medicina Palliativa, Via Palestro, 1, 26100, Cremona, Italy.
| | - Pedro L Ferreira
- Centre for Health Studies and Research (CEISUC), Faculty of Economics, University of Coimbra, Av Dias da Silva 165, 3004-512, Coimbra, Portugal.
| | - Claudia Bausewein
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, SE5 9PJ, UK. .,Department of Palliative Medicine, Munich University Hospital, Campus Großhadern, Marchioninistr, 15, Munich, Germany.
| | - Barbara A Daveson
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, SE5 9PJ, UK.
| | - Marjolein Gysels
- Centre for Social Science and Global Health, University of Amsterdam, O.Z. Achterburgwal 185, 1012, DK, Amsterdam, The Netherlands. .,Barcelona Centre for International Health Research (CRESIB - Hospital Clínic - Universitat de Barcelona), Rosselló 132, SA 1ª, Barcelona, 08036, Spain.
| | - Lucas Ceulemans
- University Antwerp Belgium, Campus Drie Eiken, D.R.307, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Antwerp, Belgium.
| | - Barbara Gomes
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, SE5 9PJ, UK.
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Higginson IJ, Gomes B, Calanzani N, Gao W, Bausewein C, Daveson BA, Deliens L, Ferreira PL, Toscani F, Gysels M, Ceulemans L, Simon ST, Cohen J, Harding R. Priorities for treatment, care and information if faced with serious illness: a comparative population-based survey in seven European countries. Palliat Med 2014; 28:101-10. [PMID: 23703237 DOI: 10.1177/0269216313488989] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health-care costs are growing, with little population-based data about people's priorities for end-of-life care, to guide service development and aid discussions. AIM We examined variations in people's priorities for treatment, care and information across seven European countries. DESIGN Telephone survey of a random sample of households; we asked respondents their priorities if 'faced with a serious illness, like cancer, with limited time to live' and used multivariable logistic regressions to identify associated factors. SETTING/PARTICIPANTS Members of the general public aged ≥ 16 years residing in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. RESULTS In total, 9344 individuals were interviewed. Most people chose 'improve quality of life for the time they had left', ranging from 57% (95% confidence interval: 55%-60%, Italy) to 81% (95% confidence interval: 79%-83%, Spain). Only 2% (95% confidence interval: 1%-3%, England) to 6% (95% confidence interval: 4%-7%, Flanders) said extending life was most important, and 15% (95% confidence interval: 13%-17%, Spain) to 40% (95% confidence interval: 37%-43%, Italy) said quality and extension were equally important. Prioritising quality of life was associated with higher education in all countries (odds ratio = 1.3 (Flanders) to 7.9 (Italy)), experience of caregiving or bereavement (England, Germany, Portugal), prioritising pain/symptom control over having a positive attitude and preferring death in a hospice/palliative care unit. Those prioritising extending life had the highest home death preference of all groups. Health status did not affect priorities. CONCLUSIONS Across all countries, extending life was prioritised by a minority, regardless of health status. Treatment and care needs to be reoriented with patient education and palliative care becoming mainstream for serious conditions such as cancer.
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Affiliation(s)
- Irene J Higginson
- 1King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
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