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Bhagavan C, Glue P, Evans W, Reynolds L, Turner T, King C, Russell BR, Morunga E, Mills JL, Layton G, Menkes DB. Effect of MDMA-assisted therapy on mood and anxiety symptoms in advanced-stage cancer (EMMAC): study protocol for a double-blind, randomised controlled trial. Trials 2024; 25:336. [PMID: 38773523 PMCID: PMC11110200 DOI: 10.1186/s13063-024-08174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/13/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Symptoms of anxiety and depression are common in patients with terminal illness and multiple challenges exist with timely and effective care in this population. Several centres have reported that one dose of the serotonergic psychedelic psilocybin, combined with therapeutic support, improves these symptoms for up to 6 months in this patient group. Drawing upon related therapeutic mechanisms, 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy may have the potential to achieve similar, positive mental health outcomes in this group. Preliminary evidence also supports the tolerability of MDMA-assisted therapy for anxiety and depression in advanced-stage cancer. METHODS Up to 32 participants with advanced-stage cancer and associated depression and anxiety will be randomised in a 1:1 ratio into one of two blinded parallel treatment arms. The intervention group will receive 120 mg (+ 60 mg optional supplemental dose) MDMA-assisted therapy. The psychoactive control group will receive 20 mg oral (+ 10 mg optional supplemental dose) methylphenidate-assisted therapy. For each medication-assisted therapy session, participants will undergo two 90-min therapeutic support sessions in the week preceding, and one 90-min support session the day after the experimental session. A battery of measures (mood, anxiety, quality of life, mystical experience, spiritual wellbeing, attitudes towards death, personality traits, holistic health and wellbeing, connectedness, demoralisation, expectations, qualitative data and safety measures) will be assessed at baseline and through to the end of the protocol. Participants will be followed up until either 12 months post-randomisation or death, whichever occurs first. DISCUSSION This study will examine the effect of MDMA-assisted therapy on symptoms of anxiety and depression in advanced-stage cancer. Potential therapeutic implications include establishing the safety and effectiveness of a novel treatment that may relieve mental suffering in patients with life-threatening illness. TRIAL REGISTRATION Trial registered on Australian New Zealand Clinical Trials Registry. REGISTRATION NUMBER ACTRN12619001334190p. Date registered: 30/09/2019. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378153&showOriginal=true&isReview=true.
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Affiliation(s)
- Chiranth Bhagavan
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Paul Glue
- Department of Psychological Medicine, Division of Health Sciences, University of Otago, 464 Cumberland Street, Central Dunedin, Dunedin, 9016, New Zealand
| | - Will Evans
- Mana Health, 7 Ruskin St, Parnell, Auckland, 1052, New Zealand
| | - Lisa Reynolds
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Thivya Turner
- Te Whatu Ora Southern, Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Chris King
- Te Whatu Ora Southern, Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Bruce R Russell
- School of Pharmacy, University of Otago, 18 Frederick Street, Dunedin North, Dunedin, 9016, New Zealand
| | - Eva Morunga
- Te Whatu Ora Te Toka Tumai, Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Jessica Lee Mills
- University of Auckland, 6 Symonds Street, Auckland, 1010, New Zealand
| | - Geoff Layton
- Ashburn Clinic, 496 Taieri Road, Halfway Bush, Dunedin, 9010, New Zealand
| | - David B Menkes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Waikato Clinical Campus, Peter Rothwell Academic Centre, Pembroke Street, Hamilton, 3240, New Zealand
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Bernhardt F, Bückmann A, Krüger J, Bauer B, Hofmeister U, Juhra C, Eveslage M, Fischhuber K, Storck M, Brix TJ, Lenz P. Telemedicine Plus Standard Care Versus Standard Care Only in Specialized Outpatient Palliative Care: A Randomized Controlled Noninferiority Trial. Telemed J E Health 2024; 30:1459-1469. [PMID: 38294865 DOI: 10.1089/tmj.2023.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Background: Patients suffering from incurable diseases are more likely to die in the hospital than at home. Specialized outpatient palliative care (PC) may be able to counteract this tendency. Similarly, potential benefits of telemedicine in health care were scientifically reported. The aim of this research was to compare patients receiving specialized outpatient PC plus telemedicine with those receiving standard specialized outpatient PC only. In this study, telemedicine is assumed to decrease the number of home visits and therefore should not be considered a mere add-on. Methods: This is a randomized controlled noninferiority trial. Recruitment lasted between January 2020 and October 2021. Quality of care was evaluated using the Integrated Palliative Care Outcome Scale (IPOS) at day 0, 7, and 14 after randomization. Change from day 0 to 7 was defined as the primary outcome (noninferiority margin = 4 points). This study was conducted in an urban setting in collaboration with a university hospital and a local specialized outpatient PC service. Results: A total of 196 patients were screened with 34 patients included (18 telemedicine/16 standard care). The mean change in the total score of the IPOS from day 0 to 7 amounted to -1.8 ± 3.9 (telemedicine) versus 1.2 ± 5.7 (standard care). The telemedicine group was statistically not relevantly inferior to the standard care group (t-test for noninferiority, p = 0.005). Conclusions: Although, due to COVID-19, the sample size remained rather small, our findings indicate that telemedical approaches offer a promising and equally effective option to provide specialized outpatient PC. Clinical Trial Registration Number: NCT06054048.
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Affiliation(s)
- Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| | - Andreas Bückmann
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| | - Janina Krüger
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Birgit Bauer
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Ulrike Hofmeister
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Muenster, Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Karen Fischhuber
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Tobias J Brix
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
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Doherty M, Chukwusa E, McQuillan R, Cranfield F, Gao W. The Palliative Care Needs of Patients with Multiple Sclerosis, Parkinson's Related Diseases, and Motor Neurone Disease: A Secondary Analysis of the OPTCARE Neuro Trial Data. J Palliat Med 2024; 27:622-629. [PMID: 38597932 DOI: 10.1089/jpm.2023.0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Background: Long-term neurological conditions include multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. National and international guidelines recommend a palliative approach for advancing neurological disease, but there is little research describing and comparing the palliative care needs of these patients side by side. Objective: The aim of this study was to describe and compare the symptom burden and psychological distress of patients with multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. Design: A cross-sectional secondary analysis of the OPTCARE Neuro trial data was performed. Setting/Subjects: Recruitment was from seven sites across the United Kingdom. Patients aged 18 years or older, severely affected by advanced stages of multiple sclerosis or Parkinson's-related diseases or any stage of motor neurone disease, with an unresolved symptom, and one other issue despite usual care were eligible. Measurements: Baseline demographics, Integrated Palliative care Outcome Scale (IPOS) Neuro, and Hospital Anxiety and Depression Scale (HADS) results were analyzed. Results: Data from 348 participants were analyzed. The mean IPOS Neuro-S24 score was 27, with no statistical difference found between groups (p = 0.341). The most common symptoms were poor mobility (68.5%), problems using legs (63%), and fatigue (34.8%). The HADS revealed that a quarter of participants met the criteria for a diagnosis of anxiety and depression. Conclusions: Multiple sclerosis, Parkinson's-related disease, and motor neurone disease patients who were eligible for the OPTCARE Neuro trial have unmet needs in the form of distressing physical and psychological symptoms. It is unclear how to address these needs. The answer likely lies in a collaborative approach between neurology, palliative care, psychology, and specialized allied health professionals. Future work should focus on investigating this.
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Affiliation(s)
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | | | | | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
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Takamizawa S, Ishiki H, Oyamada S, Takeda Y, Kiuchi D, Amano K, Matsuda Y, Yokomichi N, Kohara H, Suzuki K, Satomi E, Mori M. Psychological symptom burden associated with malignant wounds: Secondary analysis of a prospective cohort study. Palliat Support Care 2024; 22:396-403. [PMID: 37525610 DOI: 10.1017/s1478951523000536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Patients with malignant wounds suffer from physical and psychological symptom burden. Despite psychological support being required, the impact of malignant wounds on patients' psychological distress is poorly investigated. We evaluated psychological distress associated with malignant wounds for patients at their end of life. METHODS This study used the secondary analysis of the results of a large prospective cohort study, which investigated the dying process among patients with advanced cancer in 23 palliative care units in Japan. The primary outcome of this study was the prevalence of moderate to severe psychological symptom burden, evaluated by the Integrated Palliative Care Outcome Scale (IPOS)-feeling at peace scores of 2-4. In addition, the factors affecting psychological symptoms were investigated. The quality of death was also evaluated upon death using the Good Death Scale score. RESULTS Out of the total 1896 patients, 156 had malignant wounds (8.2%). Malignant wounds were more common in female and young people. The breast, head, and neck were the most prevalent primary sites. More patients with malignant wounds had IPOS-feeling at peace scores of 2-4 than patients without malignant wounds (41.0% vs. 31.3%, p = 0.024). Furthermore, psychological distress was associated with moderate to severe IPOS-pain and the frequency of dressing changes. The presence of malignant wounds did not affect the quality of death. SIGNIFICANCE OF RESULTS This study showed increased psychological distress due to malignant wounds. Patients with malignant wounds require psychological support in addition to the treatment of physical symptoms for maintaining their quality of life.
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Affiliation(s)
- Shigemasa Takamizawa
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yuma Takeda
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Daisuke Kiuchi
- Department of Palliative Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Yosuke Matsuda
- Palliative Care Department, St. Luke's International Hospital, Tokyo, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroyuki Kohara
- Department of Internal Medicine, Hatsukaichi Memorial Hospital, Hiroshima, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Monsen RE, Lerdal A, Nordgarden H, Gay CL, Herlofson BB. A comparison of the prevalence of dry mouth and other symptoms using two different versions of the Edmonton Symptom Assessment System on an inpatient palliative care unit. BMC Palliat Care 2024; 23:75. [PMID: 38493155 PMCID: PMC10943902 DOI: 10.1186/s12904-024-01405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Symptom assessment is key to effective symptom management and palliative care for patients with advanced cancer. Symptom prevalence and severity estimates vary widely, possibly dependent on the assessment tool used. Are symptoms specifically asked about or must the patients add them as additional symptoms? This study compared the prevalence and severity of patient-reported symptoms in two different versions of a multi-symptom assessment tool. In one version, three symptoms dry mouth, constipation, sleep problems were among those systematically assessed, while in the other, these symptoms had to be added as an "Other problem". METHODS This retrospective cross-sectional study included adult patients with advanced cancer at an inpatient palliative care unit. Data were collected from two versions of the Edmonton Symptom Assessment System (ESAS): modified (ESAS-m) listed 11 symptoms and revised (ESAS-r) listed 9 and allowed patients to add one "Other problem". Seven similar symptoms were listed in both versions. RESULTS In 2013, 184 patients completed ESAS-m, and in 2017, 156 completed ESAS-r. Prevalence and severity of symptoms listed in both versions did not differ. In ESAS-m, 83% reported dry mouth, 73% constipation, and 71% sleep problems, but on ESAS-r, these symptoms were reported by only 3%, 15% and < 1%, respectively. Although ESAS-r severity scores for these three symptoms were higher than on ESAS-m, differences did not reach statistical significance. CONCLUSION We identified significant differences in patient symptom reporting based on whether symptoms like dry mouth, obstipation and sleep problems were specifically assessed or had to be added by patients as an "Other problem".
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Affiliation(s)
- Ragnhild Elisabeth Monsen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, Oslo, 0317, Norway.
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, Oslo, 0317, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Hilde Nordgarden
- National Resource Centre for Oral Health in Rare Disorders, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Caryl L Gay
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, USA
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
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Ibrahim AM, Zaghamir DEF, Sultan Sultan HM, Ibrahim FM, Abdel-Aziz HR. Optimizing geriatric palliative care in Egypt: Comprehensive patient and family perspectives. Palliat Support Care 2024:1-10. [PMID: 38379421 DOI: 10.1017/s1478951524000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES In Egypt, palliative care for geriatric patients is understudied, necessitating exploration for service optimization. Amidst rising chronic illnesses and aging, understanding perspectives of geriatric patients and families is crucial for targeted improvements. This study aims to explore geriatric patients' and their families' perspectives on palliative care in Egypt, seeking opportunities to optimize service delivery for the elderly. METHODS Employing a cross-sectional design with 110 geriatric patients and an equal number of family caregivers from the Damietta Oncology Institute and the pain treatment clinics for cancer patients at Zagazig University Hospital, the study focuses on a specialized pain clinic. Validated tools (Palliative Care Outcome Scale, Family Satisfaction with End-of-Life Care [FAMCARE] Scale, Edmonton Symptom Assessment System [ESAS], Caregiver Strain Index [CSI]) assess quality of life, family satisfaction, symptom severity, and caregiver strain. RESULTS Geriatric patients (mean age: 65.0 ± 8.1 years; 45.5% male, 55.5% female) have diverse diagnoses (e.g., breast cancer 22%). Palliative care outcomes reveal challenges: low emotional well-being (2.6 ± 0.0) and alarming overall quality of life (1.8 ± 0.0). Family dissatisfaction (FAMCARE) is pervasive (total mean score 2.6 ± 0.5). Symptom severity (ESAS) is high, and caregiver strain (CSI) is notable (8.5 ± 2.2). SIGNIFICANCE OF THE RESULTS The findings underscore the significance of the challenges faced by geriatric patients and caregivers in palliative care. Patients confront considerable symptom burdens and emotional distress, while caregivers experience notable strain. Urgently needed are targeted interventions designed to enhance patient well-being, alleviate caregiver burden, and elevate satisfaction. The critical importance of implementing these interventions promptly is highlighted, as they are instrumental in improving the overall care experience for geriatric patients and their caregivers. Moreover, the results underscore the imperative of developing comprehensive support mechanisms to address the intricate dimensions of palliative care, ultimately contributing to a more compassionate and effective care continuum.
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Affiliation(s)
- Ateya Megahed Ibrahim
- Nursing College, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Family and Community Health Nursing, Faculty of Nursing, Port Said University, Port Said, Egypt
| | - Donia Elsaid Fathi Zaghamir
- Nursing College, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Lecturer of Pediatric Nursing, Faculty of Nursing, Port Said University, Port Said, Egypt
| | | | - Fatma Magdi Ibrahim
- Geriatric Nursing, Mansoura University, Mansoura, Egypt
- Community Health Nursing, RAK Medical and Health Sciences University, RAS Al-Khaimah, UAE
| | - Hassanat Ramadan Abdel-Aziz
- Nursing College, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Gerontological Nursing Department, Faculty of Nursing, Zagazig University, Zagazig, Egypt
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Maessen M, Fliedner MC, Gahl B, Maier M, Aebersold DM, Zwahlen S, Eychmüller S. An economic evaluation of an early palliative care intervention among patients with advanced cancer. Swiss Med Wkly 2024; 154:3591. [PMID: 38579309 DOI: 10.57187/s.3591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Early integration of palliative care into oncology care has shown positive effects on patient symptoms and quality of life. It may also reduce health care costs. However given the heterogeneity of settings and interventions and the lack of information on the minimally effective dose for influencing care utilisation and costs, it remains uncertain whether early palliative care reduces costs. OBJECTIVES We sought to determine whether an early palliative care intervention integrated in usual oncology care in a Swiss hospital setting reduced utilisation and costs of health care in the last month of life when compared with usual oncology care alone. METHODS We performed a cost-consequences analysis alongside a multicentre trial. We extracted costs from administrative health insurance data and health care utilisation from family caregiver surveys to compare two study arms: usual oncology care and usual oncology care plus the palliative care intervention. The intervention consisted of a single-structured, multiprofessional conversation with the patient about symptoms, end-of-life decisions, network building and support for carers (SENS). The early palliative care intervention was performed within 16 weeks of the diagnosis of a tumour stage not amenable or responsive to curative treatment. RESULTS We included 58 participants with advanced cancer in our economic evaluation study. Median overall health care costs in the last month of life were 7892 Swiss Francs (CHF) (interquartile range: CHF 5637-13,489) in the intervention arm and CHF 8492 [CHF 5411-12,012] in the control arm. The average total intervention treatment cost CHF 380 per patient. Integrating an early palliative care intervention into usual oncology care showed no significant difference in health care utilisation or overall health care costs between intervention and control arms (p = 0.98). CONCLUSION Although early palliative care is often presented as a cost-reducing care service, we could not show a significant effect of the SENS intervention on health care utilisation and costs in the last month of life. However, it may be that the intervention was not intensive enough, the timeframe too short or the study population too small for measurable effects. Patients appreciated the intervention. Single-structured early palliative care interventions are easy to implement in clinical practice and present low treatment costs. Further research about the economic impact of early palliative care should focus on extracting large, detailed cost databases showing potential shifts in cost and cost-effectiveness. CLINICAL TRIALS gov Identifier: NCT01983956.
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Affiliation(s)
- Maud Maessen
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- University Centre for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Monica C Fliedner
- University Centre for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Marina Maier
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Susanne Zwahlen
- Unit for Specialised Palliative Care, Lindenhof Hospital, Bern, Switzerland
| | - Steffen Eychmüller
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- University Centre for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Aworinde J, Evans CJ, Gillam J, Ramsenthaler C, Davies N, Ellis‐Smith C. Co-design of the EMBED-Care Framework as an intervention to enhance shared decision-making for people affected by dementia and practitioners, comprising holistic assessment, linked with clinical decision support tools: A qualitative study. Health Expect 2024; 27:e13987. [PMID: 38343168 PMCID: PMC10859658 DOI: 10.1111/hex.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Shared decision-making intends to align care provision with individuals' preferences. However, the involvement of people living with dementia in decision-making about their care varies. We aimed to co-design the EMBED-Care Framework, to enhance shared decision-making between people affected by dementia and practitioners. METHODS A theory and evidence driven co-design study was conducted, using iterative workshops, informed by a theoretical model of shared decision-making and the EMBED-Care Framework (the intervention) for person-centred holistic palliative dementia care. The intervention incorporates a holistic outcome measure for assessment and review, linked with clinical decision-support tools to support shared decision-making. We drew on the Medical Research Council (MRC) guidance for developing and evaluating complex interventions. Participants included people with dementia of any type, current or bereaved family carers and practitioners. We recruited via established dementia groups and research and clinical networks. Data were analysed using reflexive thematic analysis to explore how and when the intervention could enhance communication and shared decision-making, and the requirements for use, presented as a logic model. RESULTS Five co-design workshops were undertaken with participants comprising people affected by dementia (n = 18) and practitioners (n = 36). Three themes were generated, comprising: (1) 'knowing the person and personalisation of care', involving the person with dementia and/or family carer identifying the needs of the person using a holistic assessment. (2) 'engaging and considering the perspectives of all involved in decision-making' required listening to the person and the family to understand their priorities, and to manage multiple preferences. (3) 'Training and support activities' to use the Framework through use of animated videos to convey information, such as to understand the outcome measure used to assess symptoms. CONCLUSIONS The intervention developed sought to enhance shared decision-making with individuals affected by dementia and practitioners, through increased shared knowledge of individual priorities and choices for care and treatment. The workshops generated understanding to manage disagreements in determining priorities. Practitioners require face-to-face training on the intervention, and on communication to manage sensitive conversations about symptoms, care and treatment with individuals and their family. The findings informed the construction of a logic model to illustrate how the intervention is intended to work.
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Affiliation(s)
- Jesutofunmi Aworinde
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Catherine J. Evans
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
- Sussex Community NHS Foundation TrustBrightonUK
| | - Juliet Gillam
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Christina Ramsenthaler
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
- Department of Health SciencesZurich University of Applied Sciences (ZHAW)WinterthurSwitzerland
- Hull York Medical School, Wolfson Palliative Care Research CentreUniversity of HullHullEngland
| | - Nathan Davies
- Research Department of Primary Care and Population HealthCentre for Aging Population Studies, University College LondonLondonUK
| | - Clare Ellis‐Smith
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
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Perin M, de Souza A, Boniatti MM. Cancer symptoms: do patients, family caregivers and professionals agree? BMJ Support Palliat Care 2024; 13:e825-e828. [PMID: 35768202 DOI: 10.1136/spcare-2022-003712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the level of agreement among patients, their family caregivers and health professionals regarding the symptoms presented by patients with cancer. METHODS This is a cross-sectional study carried out in patients with cancer admitted to a hospital in Brazil from December 2019 to July 2020. One family caregiver for each patient was included in the study. In addition, nurses and physicians involved in patient care were included. Patients, family caregivers and health professionals responded to the Palliative Outcome Scale (POS). RESULTS Sixty-one patients with their family caregivers, 18 nurses and 8 physicians were included. Physicians reported a lower mean POS score than patients (p=0.008). In general, physicians and nurses underestimated the anxiety of the patient and the anxiety of the family caregivers and how much the patient feels that his or her life is worthwhile. Intraclass correlation coefficient showed moderate and good levels of agreement between patients' and family caregivers' responses (0.61). Agreement between patient and nurse (0.02) and physician (0.21) responses was poor. CONCLUSIONS The level of agreement between patients and healthcare professionals was very poor regarding patients' symptoms. However, the caregiver's perception of the patient's symptoms can be a reliable source of information.
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Affiliation(s)
- Melissa Perin
- Post Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Rio Grande do Sul, Brazil
| | - Andressa de Souza
- Post Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Rio Grande do Sul, Brazil
| | - Márcio Manozzo Boniatti
- Post Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Rio Grande do Sul, Brazil
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McClung JA, Frishman WH, Aronow WS. The Role of Palliative Care in Cardiovascular Disease. Cardiol Rev 2024:00045415-990000000-00182. [PMID: 38169299 DOI: 10.1097/crd.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The American Heart Association has recommended that palliative care be integrated into the care of all patients with advanced cardiac illnesses. Notwithstanding, the number of patients receiving specialist palliative intervention worldwide remains extremely small. This review examines the nature of palliative care and what is known about its delivery to patients with cardiac illness. Most of the published literature on the subject concern advanced heart failure; however, some data also exist regarding patients with heart transplantation, pulmonary hypertension, valvular disease, congenital heart disease, indwelling devices, mechanical circulatory support, and advanced coronary disease. In addition, outcome data, certification requirements, workforce challenges, barriers to implementation, and a potential caveat about palliative care will also be examined. Further work is required regarding appropriate means of implementation, quality control, and timing of intervention.
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Affiliation(s)
- John Arthur McClung
- From the Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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Cuomo A. Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits. Drugs Context 2023; 12:2023-10-2. [PMID: 38148830 PMCID: PMC10751104 DOI: 10.7573/dic.2023-10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/28/2023] Open
Abstract
Cancer pain is an important challenge in treatment and requires a rapid onset of action for its control. In particular, breakthrough cancer pain (BTcP) should be adequately controlled with a stable dose of a short-acting oral opioid. Fentanyl is a synthetic, highly selective opioid with many advantageous chemical properties, including high lipophilicity and distinct pharmacokinetic properties. It is recommended for pain management in a variety of settings, including acute pain, chronic pain and BTcP. To date, its variously designed formulations allow non-invasive administration; amongst others, sublingual fentanyl has proven useful in the management of BTcP and in improving the quality of life of patients with cancer. This review provides an update on the management of BTcP with fentanyl, with consideration of safety, as it remains an important tool in the treatment of cancer pain.
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Affiliation(s)
- Arturo Cuomo
- Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples,
Italy
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Anagnostou D, Katsaragakis S, Panagiotou I, Patiraki E, Tserkezoglou A. Translation and cultural adaptation of the Greek integrated palliative care outcome scale (IPOS): challenges in a six-phase process. BMC Palliat Care 2023; 22:168. [PMID: 37919682 PMCID: PMC10621102 DOI: 10.1186/s12904-023-01278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/07/2023] [Indexed: 11/04/2023] Open
Abstract
AIM To translate and culturally adapt IPOS to the Greek population. METHODS A four phases- sequential study, which included verification of conceptual equivalence, double forward- backward translations and conceptual cognitive debriefing. Focus group interviews used 'think aloud' and 'verbal probing' techniques. Interviews were audio-recorded, transcribed verbatim and thematically analyzed using predefined categories. Purposely sampled from two oncology and palliative care units in Athens. RESULTS The Integrated Palliative Care Outcome Scale was well accepted by both patients and health professionals. Overall comprehension and acceptability of the scale were good. The comprehension and judgement challenges identified in the pre-final version were successfully resolved in the cognitive interviewing phase. Five out of the seventeen translated items of the scale were modified after cognitive debriefing. Comprehension difficulties were identified with specific terms (e.g., energy/feeling depressed) and with some answer options. Severity of symptoms and not their impact was a common difficulty. A judgement challenge was reported in relation to 7-days recall and fluctuation of symptoms. Layout concerns in relation to length of questions were also stated. All questions were considered important and none as inappropriate. CONCLUSION This study demonstrated face and content validity and acceptability of the Integrated Palliative Care Outcome Scale in the Greek context. Cognitive Interviewing proved valuable in refining concepts within the specific cultural context. CLINICAL IMPLICATIONS The IPOS outcome measure tool is now being used routinely in a palliative care service in Athens and is currently used to evaluate service outcomes.
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Ullrich A, Goldbach S, Hollburg W, Wagener B, Rommel A, Müller M, Kirsch D, Kopplin-Foertsch K, Schulz H, Bokemeyer C, Oechsle K. Specialist palliative care until the very end of life - reports of family caregivers and the multiprofessional team. BMC Palliat Care 2023; 22:153. [PMID: 37814271 PMCID: PMC10563273 DOI: 10.1186/s12904-023-01266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Specialist palliative care (SPC) includes care for incurably ill patients and their family caregivers at home or on a palliative care ward until the very end of life. However, in the last days of life, patients can rarely express their needs and little is known about SPC outcomes as reported by multiprofessional SPC teams and family caregivers. METHODS Using the Palliative Care Outcome Scale (POS; Score 0-40), proxy assessments of SPC outcomes in the patient's last 3 days of life were performed by SPC teams and primary family caregivers of three home care and three inpatient services. Additional questions were asked about problems solved 'particularly well' or 'inadequately' (last 7 days), which were content analyzed and quantified. RESULTS Proxy assessments by SPC teams were available in 142 patients (of whom 51% had died at home). Family caregiver assessments exist for a subgroup of 60 of these patients. SPC teams (POS total score: mean 13.8, SD 6.3) reported SPC outcomes slightly better than family caregivers (mean 16.7, SD 6.8). The POS items consistently rated as least affected (= 0) by both, SPC teams and family caregivers, were 'not wasted time' (team 99%/family caregivers 87%), 'information' (84%/47%) and 'support' (53%/31%). Items rated as most affected (= 4) were 'patient anxiety' (31%/51%), 'life not worthwhile' (26%/35%) and 'no self-worth' (19%/30%). Both groups indicated more problems solved 'particularly well' than 'inadequately'; the latter concerned mainly clinically well-known challenges during end-of-life care and family caregiver care. CONCLUSIONS This study shows the range and type of symptoms and other concerns reported in the patient's last days. Starting points for further improvements in family caregiver care and psychosocial and spiritual issues were identified.
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Affiliation(s)
- Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany.
| | - Sven Goldbach
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Wiebke Hollburg
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Bettina Wagener
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Annette Rommel
- Specialist outpatient palliative care team 'Das Palliativteam', Hamburg, Germany
| | - Marten Müller
- Palliative care ward, Asklepios Hospital Rissen, Hamburg, Germany
| | - Denise Kirsch
- Specialist outpatient palliative care team 'PCT Hamburg-West', Hamburg, Germany
| | | | - Holger Schulz
- Department of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany
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Burner-Fritsch I, Kolmhuber S, Hodiamont F, Bausewein C, Hriskova K. Implementing ePROM in specialist palliative home care: the professionals' perspective - a mixed-methods study. Palliat Care Soc Pract 2023; 17:26323524231186827. [PMID: 37560175 PMCID: PMC10408331 DOI: 10.1177/26323524231186827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
Background Over the last decades, patient-reported outcome measures (PROM) have been developed for a better understanding of patient needs. The Integrated Palliative Care Outcome Scale (IPOS) is an internationally recommended PROM in palliative care. The validated electronic version of IPOS (eIPOS) was implemented in four German specialist palliative home care (SPHC) teams for use in everyday clinical practice. Patients reported symptoms and concerns via eIPOS, which were transmitted directly to the electronic patient record of the respective SPHC team. Objectives The aim of the study was to describe and explore the health care professionals' (HCPs') experiences regarding acceptance and use of eIPOS in clinical practice in SPHC. Design The mixed-methods sequential explanatory design comprised an anonymized quantitative online survey followed by qualitative focus groups. Methods The online survey asked in both closed and open questions for HCP's experience with eIPOS. Ambiguous results from the survey were discussed in two focus groups. Survey data were analysed with descriptive and univariable statistics, and the framework approach was used for qualitative data. In a further step, we conducted integrated analysis of quantitative and qualitative results using joint displays. Results All HCPs of the four SPHC teams (n = 52) were invited to participate. HCPs participating in the survey (n = 32) and the focus groups (n = 7) saw potentials for implementing ePROM in palliative home care - as far as it is technically easy to handle and can be easily integrated into clinical practice. Conclusion Successful use of ePROMs is affected by the possibility of easy integration into the teams' different structures and processes and the HCPs' perceptions of potentials regarding ePROM use in SPHC. Registration The study is registered on clinicaltrials.org (NCT03879668).
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Affiliation(s)
- Isabel Burner-Fritsch
- Department of Palliative Medicine, University Hospital, LMU Munich, Bahnhofstraße 20, 83673 Bichl, Germany
| | - Stefanie Kolmhuber
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Katerina Hriskova
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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Haraldsdottir E, Lloyd A, Bijak M, Milton L, Finucane AM. Inpatient hospice admissions. Who is admitted and why: a mixed-method prospective study. Palliat Care Soc Pract 2023; 17:26323524231182724. [PMID: 37440785 PMCID: PMC10333996 DOI: 10.1177/26323524231182724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/01/2023] [Indexed: 07/15/2023] Open
Abstract
Background Over the next two decades, the numbers of people who will need palliative care in the United Kingdom and Ireland is projected to increase. Hospices play a vital role supporting people who require specialist palliative care input through community-based and inpatient palliative care services. Evidence is needed to understand the role of these different services to inform future service development. Objectives To describe the reasons for admission, and outcomes at the end of the stay, for patients admitted to two hospice inpatient units (IPUs). Design This was a mixed-methods study using a convergent, parallel mixed-methods design. Methods We reviewed the case notes of all patients admitted to two hospice inpatient units from July to November 2019; conducted semi-structured interviews with patients and families; as well as brief structured interviews with inpatient unit staff. Results Two hundred fifty-nine patients were admitted to a hospice IPU, accounting for 276 admissions in total. Overall, 53% were female; median age was 71 years (range: 26-95 years). Most patients (95%) were White British or Scottish, and 95% had a cancer diagnosis. Most patients were admitted from the community, under one-third were admitted from hospital. Most (85%) had previous palliative care involvement. Nearly, half had district nurse support (48%). Worry and anxiety was frequently reported as a reason for admission, alongside physical concerns. Median length of stay was 12 days, and 68% died during their stay. Hospice was recorded as the preferred place of care for 56% of those who died there. Conclusions Sustained efforts to promote the hospice as place of care for people with conditions other than cancer are needed alongside greater clarity regarding of the role of the hospice IPU, and who would benefit most from IPU support.
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Affiliation(s)
| | | | | | | | - Anne M. Finucane
- Marie Curie Hospice, Edinburgh, UK; University of Edinburgh, Edinburgh, UK
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16
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Singh SP, Aggarwal R, Malhotra RK, Shekhar V, Singh VP, Bhatnagar S. Development and Validation of Total Pain Scale for Evaluation of Total Pain in Cancer Patients. Indian J Palliat Care 2023; 29:312-323. [PMID: 37700895 PMCID: PMC10493691 DOI: 10.25259/ijpc_256_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/11/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Cancer pain has all the components of total pain such as physical, social, psychological, and spiritual. These components contribute to the overall pain experience in cancer patients. Many instruments have been developed till date to assess the effect of pain in cancer patients but none of the instruments include all components of total pain. In this article, we describe the development and validation of the total pain scale (TPS) for the evaluation of total pain in cancer patients with pain. This study aimed to develop and validate a questionnaire for the evaluation of total pain in cancer patients with pain. Material and Methods This study included a review of existing pain questionnaires for cancer pain for item pool generation. Items were generated in the Hindi language by six stakeholders to create 23 items to develop TPS. TPS was applied to 300 Hindi-speaking cancer patients. Bivariate correlation was used to reduce the number of items as well as construction of the domain followed by factor analysis to finalise TPS. Confirmatory factor analysis (CFA) was performed for testing the validity and reliability of TPS. Results TPS is an 18-item scale composed of four domains (physical, social, spiritual and psychological domain). The internal consistency of TPS and its subscales was found to be very good (a = 0.84-0.88). CFA and structural equation modeling Goodness of fit has confirmed that model 4 is the best fit as it yielded a lesser root-mean-squared error of approximation value of 0.062 and a greater comparative fit index, Tucker-Lewis index value of 0.944. The convergent and divergent validity of TPS and its domain was good. Conclusion This study reports TPS to be a brief (18-item), valid, and reliable questionnaire in the Hindi language for assessment of all components of total pain in cancer patients with pain.
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Affiliation(s)
- Suraj Pal Singh
- Department of Oncoanaesthesia and Palliative Medicine, DR. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Aggarwal
- Department of Neurology, Neuroscience Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar Malhotra
- Department of Delhi Cancer Registry, DR. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Shekhar
- Department of Oncoanaesthesia and Palliative Medicine, DR. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vikram Partap Singh
- Department of Oncoanaesthesia and Palliative Medicine, DR. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, DR. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Bhardwaj T, Arora N, Paul A, Chowdhary P. Cultural Adaptation of Patient Health Questionnaire-9 in Hindi for Use with Patients with Cancer in Community Palliative Care Settings. Indian J Palliat Care 2023; 29:292-311. [PMID: 37700900 PMCID: PMC10493686 DOI: 10.25259/ijpc_96_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Patient Health Questionnaire-9 (PHQ-9) in Indian settings is yet not very often used in palliative care with the Hindi-speaking population. The Hindi version of PHQ-9 is available but its cultural adaptation to the Hindi-speaking population in North India receiving palliative care services is required to be tested. PHQ-9 as a depression screening questionnaire may help to identify depression symptoms among patients with cancer. This study aimed to examine the cultural equivalence of PHQ-9 Hindi for use with patients with cancer receiving palliative care services in North India. Material and Methods Based on the standard methodology of translation and adaptation of the scale, the following process was used: (i) Two focused group discussions with 17 experts working in a cancer palliative care setting, (ii) qualitative interviewing with 11 patients, and (iii) research team review. All interviews were audio recorded, transcribed, and item-wise content analysis was conducted. Results A few difficult phrases in the original PHQ-9 were 'dilchaspi', 'avasadgrast', 'kam urja', 'nakaam', parivar ko neecha dhikhana and 'ashthir' which were changed to Kam Mann Lagna, Mann Dukhi hona, kamjori, saksham nahi hain' 'asafal', Parivar ko nirash karna' and 'bechain,' respectively. Two items, namely no. 6 and 8 were changed to shorten the length for appropriately conveying the meaning. Conclusion Hindi language involves various dialects which change from region to region bringing variations in understanding the meaning of the words. It is recommended that culturally equivalent scales are used in practice and research. PHQ-9 is now culturally adapted for the Hindi-speaking population in North India. PHQ-9 will help identidy depressive symptoms at an early stage. Psychometric testing of PHQ-9 is underway.
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Affiliation(s)
- Tushti Bhardwaj
- Department of Social Work, Dr. Bhim Rao Ambedkar College, University of Delhi, New Delhi, India
| | - Neha Arora
- Department of Psychology, Dr. Bhim Rao Ambedkar College, University of Delhi, New Delhi, India
| | - Anu Paul
- Home Care, CanSupport, New Delhi, India
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Shiraishi R, Kizawa Y, Mori M, Maeda I, Hatano Y, Ishiki H, Miura T, Yokomichi N, Kodama M, Inoue K, Otomo S, Yamaguchi T, Hamano J. Comparison of Symptom Severity and Progression in Advanced Cancer Patients Among Different Care Settings: A Secondary Analysis. Palliat Med Rep 2023; 4:139-149. [PMID: 37360680 PMCID: PMC10288302 DOI: 10.1089/pmr.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Background Most people in Japan wish to spend their final days at home, but the majority fail to do so; earlier studies indicated a more pronounced worsening of symptoms if treated at home. Objectives This study compared the prevalence of symptom worsening and explored associated factors between patients with advanced cancer receiving palliative care in palliative care units (PCUs) and at home. Design We conducted a secondary analysis of two multicenter, prospective cohort studies involving patients with advanced cancer receiving palliative care in PCUs or at home. Setting/Subjects One study was conducted at 23 PCUs (January to December 2017) and the other on 45 palliative home care services (July to December 2017) in Japan. Measurements Symptom changes were categorized as stable, improved, or worse. Results Of the 2998 registered patients, 2877 were analyzed. Among them, 1890 patients received palliative care in PCUs, and 987 at home. Patients receiving palliative care at home were more likely to have worsening of pain (17.1% vs. 3.8%; p < 0.001) and drowsiness (32.6% vs. 22.2%; p < 0.001) than those in PCUs. By multivariate logistic regression analysis, palliative care at home was significantly associated with worsening of the Palliative Prognostic Index dyspnea subscale in the unadjusted model (odds ratio, 1.42 [95% confidence interval, 1.08-1.88]; p = 0.014) but not for any symptoms in the adjusted model. Conclusions After adjusting for patient background, the prevalence of symptom worsening was not different between patients with advanced cancer receiving palliative care at home and in PCUs.
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Affiliation(s)
- Ryuto Shiraishi
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Yoshiyuki Kizawa
- Division of Clinical Medicine, Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Keiko Inoue
- Medical Corporation Aisei-kai, Hirakata, Japan
| | | | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Ishii Y, Ito N, Matsumura Y, Aoyama M, Kohara I, Murai K, Takeuchi K, Yokoyama T, Miyashita M, Miyashita M. Validity and reliability of the Integrated Palliative Care Outcome Scale for non-cancer patients. Geriatr Gerontol Int 2023. [PMID: 37246235 DOI: 10.1111/ggi.14603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
AIM This study assessed the validity and reliability of the Integrated Palliative Care Outcome Scale for non-cancer patients. METHODS We recruited 223 non-cancer patients receiving palliative care and their healthcare providers (222) across two home care facilities and two hospitals for a cross-sectional study. We assessed the construct validity and known-group validity of the Integrated Palliative Care Outcome Scale. The weighted kappa and interclass correlation coefficients were assessed to ascertain reliability. RESULTS The scale scores were significantly higher for the 'non-stable' group (worsening condition group) measured in the palliative care phase than for the 'stable' group (P < 0.001). Regarding validity, Spearman's correlations between similar items on the Integrated Palliative Care Outcome Scale and Edmonton Symptom Assessment System ranged from 0.61 to 0.94. Regarding reliability, the weighted kappa coefficients ranged from 0.53 to 0.81 for patients and from 0.58 to 0.90 for healthcare providers. For inter-rater reliability between patients and healthcare providers, the weighted kappa coefficients for each item ranged from 0.03 to 0.42. CONCLUSION This study confirmed the validity and reliability of the Integrated Palliative Care Outcome Scale for non-cancer patients requiring palliative care. However, the inter-rater reliability indicates poor agreement between the assessments of patients and healthcare providers. This highlights the discrepancies between both their assessments and the importance of the patient's assessment. Geriatr Gerontol Int 2023; ••: ••-••.
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Affiliation(s)
- Yoko Ishii
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
- Jichi Medical University School of Nursing, Tochigi, Japan
| | - Nao Ito
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
- Iwate Medical University School of Nursing, Iwate, Japan
| | - Yuko Matsumura
- Department of Nursing, Kyoto City Hospital, Kyoto, Japan
| | - Maho Aoyama
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Izumi Kohara
- Jichi Medical University School of Nursing, Tochigi, Japan
| | | | | | - Takako Yokoyama
- Multifunctional Small Nursing Care Home "Aisanchi", Tochigi, Japan
| | - Masako Miyashita
- Tohoku Bunka Gakuen University, Faculty of Health and Welfare Department of Nursing, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
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20
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Hirayama T, Ogawa Y, Ogawa A, Igarashi E, Soejima S, Hata K, Utsumi Y, Mashiko Y, Ogata K, Kayano A, Yanai Y, Suzuki SI. Behavioral activation for depression in patients with advanced cancer: study protocol for a multicenter randomized controlled trial. BMC Cancer 2023; 23:427. [PMID: 37170203 PMCID: PMC10173594 DOI: 10.1186/s12885-023-10926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/06/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Though behavioral activation (BA) has been shown to be effective for depression, evidence in patients with advanced cancer has not been established. This study aimed to examine the effectiveness of a BA program on depression in this population. METHODS A randomized controlled trial with a wait-list control group (waiting group) of 38 patients with advanced cancer and depression will be conducted at three sites in Japan. The BA program consists of seven sessions. Outcome measures will be evaluated at three times in the intervention group; at the entry, at the end of the intervention and 4 months after the end of the intervention and four times in the waiting group: at the entry, before the intervention, at the end of the intervention, and 4 months after the end of the intervention. Primary outcome is Beck Depression Inventory-II (BDI-II) score. To examine the main effect of the intervention, two-way repeated measures analysis of variance (ANOVA) will be conducted, with timing and intervention status as the independent variables and BDI-II score as the dependent variable. One-way repeated measures ANOVA will be conducted to combine data from the intervention and control groups and examine changes in BDI-II scores by timing in both groups. Secondary endpoints (anxiety, quality of life, spirituality, degree of behavioral activation, value, and pain) will be evaluated with rating scales. Two-way repeated measures ANOVA will be conducted to examine whether there are differences between the groups before and after the intervention, with timing and intervention status as the independent variables and scores on each rating scale as the dependent variables. DISCUSSION This multicenter randomized controlled trial is the first study to assess the effectiveness of BA on depression in patients with advanced cancer. Our findings will provide evidence about the effectiveness of BA on depression and provide an intervention option that is acceptable and feasible for the treatment of depression in this population. The results of this study will lead to improved mood and rebuilding to regain life purpose and value in this vulnerable population. TRIAL REGISTRATION NUMBER jRCT, jRCT1030210687, Registered 22 March 2022, https://jrct.niph.go.jp/en-latest-detail/jRCT1030210687 .
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Affiliation(s)
- Takatoshi Hirayama
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yuko Ogawa
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Asao Ogawa
- Department of Psycho-Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba Japan
| | - Emi Igarashi
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi Japan
| | - Saaya Soejima
- Department of Psycho-Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba Japan
| | - Kotone Hata
- Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-shi, Saitama Japan
| | - Yusuke Utsumi
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi Japan
| | - Yuki Mashiko
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Kyoka Ogata
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Ayako Kayano
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yuko Yanai
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Shin-ichi Suzuki
- Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-shi, Saitama Japan
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Braulke F, Para S, Alt-Epping B, Tewes M, Bäumer M, Haberland B, Mayer-Steinacker R, Hopprich A, de Wit M, Grabe M, Bender-Säbelkampf S, Weßling C, Aulmann C, Gerlach C, Regincos P, Fischer F, Haarmann S, Huys T, Drygas S, Rambau A, Kiani A, Schnabel A, Buhl C, Seipke S, Hiemer S, Polata S, Meßmann M, Hansmeier A, Anastasiadou L, Letsch A, Wecht D, Hellberg-Naegele M, Krug U, Wedding U, van Oorschot B. Systematic symptom screening in patients with advanced cancer treated in certified oncology centers: results of the prospective multicenter German KeSBa project. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04818-8. [PMID: 37145199 PMCID: PMC10374724 DOI: 10.1007/s00432-023-04818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Guidelines recommend a structured symptom screening (SC) for especially advanced cancer patients (CPs). The aim of this multicenter German prospective quality assurance project KeSBa (Kennzahl Symptom- und Belastungserfassung) was to gain knowledge on SC procedures in Oncology Centers (OCs) for advanced cancer patients and a first impression on the consequences of SC. METHODS The KeSBa project consisted of three phases: pilot, 3 months screening and feedback phase. Participating OCs decided to use either the Minimal Documentation System (MIDOS) or the Integrated Palliative care Outcome Scale (IPOS) and defined the cutoff values for positive screening results. RESULTS Out of 172 certified German OCs, 40 (23%) participated in the KeSBa pilot phase, 29 (16.8%) in the 3 months screening phase using MIDOS (n = 18, 58.6%) or IPOS (n = 11, 41.3%) and in the feedback round. 25/29 performed paper-based screening (86.2%). 2.963 CPs were screened. Results were documented for 1255 (42.2%, SC +) positive and 874 (29.5%, SC-) negative screenings depending on the center´s schedules: 452 SC + CPs (28.4%) and 42 SC- CPs (2.6%) had contact to specialized palliative care or other supportive specialist teams afterwards, 458 SC + CPs (28.8%) and 605 SC- CPs (38.1%) remained in standard oncology care. In the feedback round missing resources (personal and IT) and improved communication were mentioned most often. CONCLUSION Routine SC is feasible in advanced CPs treated in OCs but associated with considerable workload. In 42.2% of CPs SC was classified as positive, indicating the need of further diagnostics or professional judgment. SC requires staff and IT resources.
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Affiliation(s)
- Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Servet Para
- Interdisciplinary Center Palliative Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Bäumer
- Kliniken Maria Hilf GmbH Mönchengladbach, Mönchengladbach, Germany
| | | | | | - Anne Hopprich
- Department of Radiooncology and Radiotherapy, University Medical Center Mainz, Mainz, Germany
| | - Maike de Wit
- Cancer Center Berlin-Neukölln - Vivantes Klinikum Neukölln, Berlin, Germany
| | - Michaela Grabe
- Cancer Center Rems-Murr-Hospital Winnenden, Winnenden, Germany
| | | | | | | | - Christina Gerlach
- Department of Palliative Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Pascale Regincos
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Soraya Haarmann
- Kliniken Heilbronn GmbH, Fachklinik Löwenstein, Löwenstein, Germany
| | | | - Sabine Drygas
- Brüderkrankenhaus St. Josef Paderborn, Paderborn, Germany
| | - Anett Rambau
- Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Alexander Kiani
- Klinikum Bayreuth GmbH, and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | | | - Christoph Buhl
- Department of Oncology, Hematology, Palliative Medicine, Special Pain Therapy, Hospital Leverkusen, Leverkusen, Germany
| | - Stefanie Seipke
- Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | | | - Silke Polata
- Evangelisches Waldkrankenhaus Berlin-Spandau, Berlin, Germany
| | - Maximilian Meßmann
- Department of Palliative Medicine, Hospital St. Elisabeth Straubing GmbH, Straubing, Germany
| | | | | | - Anne Letsch
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Daniel Wecht
- Specialist Care in Oncology and Palliative Care, University Hospital Gießen and Marburg, Marburg, Germany
| | | | - Utz Krug
- Department of Oncology, Hematology, Palliative Medicine, Special Pain Therapy, Hospital Leverkusen, Leverkusen, Germany
| | - Ulrich Wedding
- Department of Palliative Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Birgitt van Oorschot
- Interdisciplinary Center Palliative Medicine, University Hospital Würzburg, Würzburg, Germany
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22
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Gahr S, Brunner S, Heckel M, Ostgathe C. Gibt es entitätsspezifische Kriterien für den Beginn der spezialisierten Palliativversorgung für nicht heilbare Krebserkrankungen? Ein Scoping Review. ZEITSCHRIFT FÜR PALLIATIVMEDIZIN 2023. [DOI: 10.1055/a-2054-1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Zusammenfassung
Hintergrund/Ziel Patienten mit nicht heilbaren Krebserkrankungen eine spezialisierte Palliativversorgung zum richtigen Zeitpunkt anzubieten, stellt eine Herausforderung dar. Ziel des Scoping Reviews war, geeignete entitätsspezifische Kriterien zu finden.
Methode Im Februar 2020 wurde in den Online-Datenbanken PubMed und Scopus ein Scoping Review durchgeführt. Ziel der Literatursuche war die Identifikation von englisch- und deutschsprachigen Originalarbeiten, die zwischen 2009 und Februar 2020 veröffentlicht wurden und Hinweise darauf geben, welche entitätsspezifischen und entitätsunabhängigen Kriterien nicht heilbarer Krebserkrankungen herangezogen werden, um betroffene Patienten zeitgerecht in die spezialisierte Palliativversorgung zu integrieren. Insgesamt wurden 13 relevante Artikel identifiziert. Der Methode des Scoping Reviews entsprechend, wurde auf eine formale Bewertung der methodischen Qualität der eingeschlossenen Literatur verzichtet.
Ergebnisse Unter den relevanten Publikationen waren 6 Reviews und 7 Originalarbeiten. In keiner der analysierten Publikationen wurden explizit charakteristische Kriterien zu spezifischen Krebsentitäten angeführt. Für die Integration in eine spezialisierte Palliativversorgung wurden unabhängig der Krebsentität als Kriterien Unheilbarkeit/fortgeschrittenes Tumorleiden, Lebensqualität, belastende Symptome, ECOG-Status, psychosoziale Bedürfnisse, Komorbiditäten, tumorassoziierte Komplikationen, Behandlungsentscheidung/keine Behandlungsmöglichkeiten und begrenzte Lebenszeitprognose herangezogen oder vorgeschlagen. Die Erhebung der Kriterien erfolgte mittels Instrumenten, für die keine konkreten Kennwerte angegeben waren, die eine zur Einbindung in spezialisierte Palliativversorgung relevante Ausprägung der Kriterien detektieren könnten.
Schlussfolgerung Für den Zeitpunkt einer zeitgerechten Integration der spezialisierten Palliativversorgung bei nicht heilbaren Krebserkrankungen gibt es bislang keine entitätsspezifischen Kriterien und Kennwerte. Aus der Analyse lässt sich jedoch ableiten, dass entitätsunabhängig alle Patienten mit einer nicht heilbaren bzw. fortgeschrittenen Krebserkrankung, die unter Verminderung/Verlust ihrer Lebensqualität und einer komplexen Symptomlast, v.a. Depressionen und Schmerzen leiden, das Angebot einer spezialisierten Palliativversorgung erhalten sollten. Kriterien generell als Kennwerte festzulegen und konsekutiv einen Messwert bzw. Cut-off-Wert zu definieren, könnte eine Möglichkeit sein, über z.B. ein Scoringsystem eine zeitgerechte Integration der Palliativmedizin zu erleichtern. Unklar ist bislang, welche Kombinationen von Erhebungsinstrumenten oder Screeningtools der Erfassung einer zeitgerechten Integration dienen könnten.
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Affiliation(s)
- Susanne Gahr
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Sarah Brunner
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
- Medizinisches Zentrum für Informations- und Kommunikationstechnik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Maria Heckel
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Christoph Ostgathe
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
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23
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Zucker BE, Leandro L, Forbes K, Blazeby JM, Chamberlain C. Training surgeons to optimize communication and symptom management in patients with life-limiting conditions: systematic review. BJS Open 2023; 7:zrad015. [PMID: 37104753 PMCID: PMC10129389 DOI: 10.1093/bjsopen/zrad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/08/2022] [Accepted: 01/22/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Surgeons routinely care for patients with life-limiting illness, requiring communication and symptom management skills supported by appropriate training. The objective of this study was to appraise and synthesize studies that assessed surgeon-directed training interventions that aimed to optimize communication and symptom management for patients with life-limiting illness. METHODS A PRISMA-concordant systematic review was undertaken. MEDLINE, Embase, Allied and Complementary Medicine Database (AMED), and the Cochrane Central Register of Controlled Trials were searched from inception until October 2022 for studies reporting on the evaluation of surgeon-training interventions intending to improve surgeons' communication or symptom management of patients with life-limiting disease. Data on the design, trainer and patient participants, and the intervention were extracted. Risk of bias was assessed. RESULTS Of 7794 articles, 46 were included. Most studies employed a before-after approach (29 studies) and nine included control groups with five being randomized studies. General surgery was the most frequently included sub-specialty (22 studies). Trainers were described in 25 of 46 studies. Most training interventions aimed to improve communication skills (45 studies) and 13 different training interventions were described. Eight studies reported a measurable improvement in patient care, such as increased documentation of advance care discussions. Most study outcomes focused on surgeons' knowledge (12 studies), skills (21 studies), and confidence/comfort (18 studies) in palliative communication skills. Studies had a high risk of bias. CONCLUSION Whilst interventions exist to improve the training of surgeons managing patients with life-threatening conditions, evidence is limited, and studies measure the direct impact on patient care insufficiently. Improved research is needed to lead to better methods for training surgeons to benefit patients.
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Affiliation(s)
- Benjamin E Zucker
- Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lorna Leandro
- Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Karen Forbes
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Charlotte Chamberlain
- Population Health Sciences, University of Bristol, Bristol, UK
- Department of Palliative Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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24
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Seipp H, Haasenritter J, Hach M, Becker D, Schütze D, Engler J, Bösner S, Kuss K. State-wide implementation of patient-reported outcome measures (PROMs) in specialized outpatient palliative care teams (ELSAH): A mixed-methods evaluation and implications for their sustainable use. BMC Palliat Care 2022; 21:216. [PMID: 36461081 PMCID: PMC9716659 DOI: 10.1186/s12904-022-01109-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Such patient-reported outcome measures (PROMs) and patient-centered outcome measures as the Integrated Palliative Care Outcome Scale (IPOS), Phase of Illness, and IPOS Views on Care (IPOS VoC), facilitate patient-centered care and help improve quality. To ensure sustainability, implementation and usage should be adapted according to setting. When settings involve several distinct teams that differ in terms of views and working practices, it is more difficult to integrate outcome measures into daily care. The ELSAH study aimed to learn how health professionals working in specialized outpatient palliative care (SOPC) viewed the use of these outcome measures in daily care, and what they express is needed for successful sustainable, state-wide application. METHODS We used a parallel mixed-methods design involving three focus groups (n = 14) and an online-survey based on normalization process theory (n = 76). Most participants were nurses and physicians from 19 SOPC-teams in Hesse, Germany. We used a triangulation protocol including convergence coding matrices to triangulate findings. RESULTS The majority of health professionals were able to integrate the outcome measures into their working lives and said that it had become a normal part of their day-to-day work. To ensure their sustainable integration into daily care, the motivation and concerns of health professionals should be taken into consideration. Health professionals must clearly recognize how the measures help improve daily care and quality evaluation. CONCLUSIONS To implement the outcome measures in a number of teams, it will be necessary to take individual team characteristics into account, because they influence motivation and concerncs. Further, it will be necessary to offer opportunities for them to engage in peer support and share information with other teams. The sustainable use of outcome measures in SOPC will require continuous support within each team as well as across teams. When several distinct teams are working in the same setting, a cross-team coordination unit can help to coordinate their work efficiently. TRIAL REGISTRATION German Clinical Trials Register DRKS-ID: DRKS00012421; www.germanctr.de/DRKS00012421.
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Affiliation(s)
- Hannah Seipp
- grid.10253.350000 0004 1936 9756Department of General Practice and Family Medicine, Philipps-University of Marburg, Karl-Von-Frisch-Straße 4, 35032 Marburg, Germany
| | - Jörg Haasenritter
- grid.10253.350000 0004 1936 9756Department of General Practice and Family Medicine, Philipps-University of Marburg, Karl-Von-Frisch-Straße 4, 35032 Marburg, Germany
| | - Michaela Hach
- Professional Association of Specialized, Palliative Homecare in Hesse, Weihergasse 15, 65203 Wiesbaden, Germany
| | - Dorothée Becker
- Professional Association of Specialized, Palliative Homecare in Hesse, Weihergasse 15, 65203 Wiesbaden, Germany
| | - Dania Schütze
- grid.7839.50000 0004 1936 9721Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Jennifer Engler
- grid.7839.50000 0004 1936 9721Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Stefan Bösner
- grid.10253.350000 0004 1936 9756Department of General Practice and Family Medicine, Philipps-University of Marburg, Karl-Von-Frisch-Straße 4, 35032 Marburg, Germany
| | - Katrin Kuss
- grid.10253.350000 0004 1936 9756Department of General Practice and Family Medicine, Philipps-University of Marburg, Karl-Von-Frisch-Straße 4, 35032 Marburg, Germany
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25
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Hsiao WH, Wang CL, Lee LC, Chien SP, Hsu CC, Chu WM. Exploring Risk Factors of Unexpected Death, Using Palliative Care Outcomes Collaboration (PCOC) Measures, among Terminal Patients Receiving Palliative Care in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13294. [PMID: 36293875 PMCID: PMC9602686 DOI: 10.3390/ijerph192013294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Palliative care has the ability to relieve both physical discomfort and psychological distress in terminally ill patients. However, unexpected death may still occur in palliative care settings. This study aimed to utilize Palliative Care Outcomes Collaboration (PCOC) data to better determine any associated factors which may surround unexpected death in palliative care settings. Data were extracted from the PCOC database by the palliative care team within Taichung Veterans General Hospital (TCVGH). Data of deceased patients were extracted during the period from January 2021 to December 2021 from multiple palliative care settings. The deaths of patients whose last recorded palliative phase was 1-3 were defined as unexpected. A total of 280 deceased patients were included, with mean age at death being 67.73, 61% being male, and 83.2% cancer patients. We discovered that shortness of breath, as assessed by the Symptom Assessment Scale (SAS), decreased risk of unexpected death (OR: 0.91, 95% CI: 0.84-0.98), while impending death discharge (OR: 3.93, 95% CI: 1.20-12.94) and a higher Australia-modified Karnofsky performance status (AKPS) score (OR: 1.15, 95% CI: 1.10-1.21) were associated with unexpected death. Thus, medical staff must inform the family of patients early on regarding any risk factors surrounding unexpected death to help everyone involved be prepared in advance.
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Affiliation(s)
- Wen-Hsuan Hsiao
- Department of Medical Education, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chun-Li Wang
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Lung-Chun Lee
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407, Taiwan
| | - Szu-Pei Chien
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Public Health, China Medical University, Taichung 404, Taiwan
| | - Chin-Chu Hsu
- Department of Nursing, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
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26
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Bravington A, Obita G, Baddeley E, Johnson MJ, Murtagh FE, Currow DC, Boland EG, Nelson A, Seddon K, Oliver A, Noble SI, Boland JW. The range and suitability of outcome measures used in the assessment of palliative treatment for inoperable malignant bowel obstruction: A systematic review. Palliat Med 2022; 36:1336-1350. [PMID: 36131489 PMCID: PMC10150264 DOI: 10.1177/02692163221122352] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Malignant bowel obstruction, a complication of certain advanced cancers, causes severe symptoms which profoundly affect quality of life. Clinical management remains complex, and outcome assessment is inconsistent. AIM To identify outcomes evaluating palliative treatment for inoperable malignant bowel obstruction, as part of a four-phase study developing a core outcome set. DESIGN The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA); PROSPERO (ID: CRD42019150648). Eligible studies included at least one subgroup with obstruction below the ligament of Treitz undergoing palliative treatment for inoperable malignant bowel obstruction. Study quality was not assessed because the review does not evaluate efficacy. DATA SOURCES Medline, Embase, the Cochrane Database, CINAHL, PSYCinfo Caresearch, Open Grey and BASE were searched for trials and observational studies in October 2021. RESULTS A total of 4769 studies were screened, 290 full texts retrieved and 80 (13,898 participants) included in a narrative synthesis; 343 outcomes were extracted verbatim and pooled into 90 unique terms across six domains: physiological, nutrition, life impact, resource use, mortality and survival. Prevalent outcomes included adverse events (78% of studies), survival (54%), symptom control (39%) and mortality (31%). Key individual symptoms assessed were vomiting (41% of studies), nausea (34%) and pain (33%); 19% of studies assessed quality of life. CONCLUSIONS Assessment focuses on survival, complications and overall symptom control. There is a need for definitions of treatment 'success' that are meaningful to patients, a more consistent approach to symptom assessment, and greater consideration of how to measure wellbeing in this population.
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Affiliation(s)
- Alison Bravington
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK
| | | | - Elin Baddeley
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK
| | | | - Elaine G Boland
- Queen's Centre for Oncology and Haematology, Cottingham, Hull, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Kathy Seddon
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Alfred Oliver
- National Cancer Research Institute, Consumer Liaison Group, Trans-Humber Consumer Research Panel, London, UK
| | - Simon Ir Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK
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27
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Mitchinson L, Chu C, Bruun A, Sisk AR, Armstrong M, Vindrola-Padros C, Kupeli N, Candy B, Stone P. How best to capture the impact of complementary therapies in palliative care: A systematic review to identify and assess the appropriateness and validity of multi-domain tools. Palliat Med 2022; 36:1320-1335. [PMID: 36071641 PMCID: PMC9606018 DOI: 10.1177/02692163221122955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complementary therapies are widely used in palliative care settings. Qualitative research found that people with advanced disease report a range of physical and psychological benefits from complementary therapies, however evidence of their effectiveness from clinical trials is inconclusive. This may be because trials are limited by use of inappropriate outcome measures. AIMS To identify tools which capture the impact of massage, reflexology and aromatherapy in people with advanced disease. We (1) identified multi-domain tools used to evaluate these therapies in populations with any chronic health condition and (2) assessed whether tools were valid and psychometrically robust in populations with advanced disease. DESIGN A two-stage systematic review was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines (PROSPERO: CRD42020161199). DATA SOURCES Six databases were searched (August 2021). Study methodological quality, tool psychometric properties and evidence quality were assessed. A global comparison score was generated. RESULTS Stage 1: 66 trials using 40 different multi-domain tools were identified. Stage 2: Of these tools, we identified papers for seven tools regarding development or validation in advanced disease populations. The majority of psychometric data were inconsistent or inconclusive. Data were mostly of low quality due to methodological issues. CONCLUSION Of the tools identified, 'Functional Assessment of Cancer Therapy - General' appears to be the most suitable alternative tool against COMSIN criteria, for trials of massage, reflexology and aromatherapy in palliative care. Further tool validation is required before firm recommendations can be made. Co-development of a core outcome set could ensure relevant domains are assessed.
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Affiliation(s)
- Lucy Mitchinson
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Christina Chu
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Ali-Rose Sisk
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Megan Armstrong
- Primary Care and Population Health, University College London, London, UK
| | - Cecilia Vindrola-Padros
- Department of Targeted Intervention and Rapid Research, Evaluation and Appraisal Lab (RREAL), University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, University College London, London, UK
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28
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Higginson IJ, Hocaoglu MB, Fraser LK, Maddocks M, Sleeman KE, Oluyase AO, Chambers RL, Preston N, Dunleavy L, Bradshaw A, Bajwah S, Murtagh FEM, Walshe C. Symptom Control and Survival for People Severely ill With COVID: A Multicentre Cohort Study (CovPall-Symptom). J Pain Symptom Manage 2022; 64:377-390. [PMID: 35752399 DOI: 10.1016/j.jpainsymman.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022]
Abstract
CONTEXT Evidence of symptom control outcomes in severe COVID is scant. OBJECTIVES To determine changes in symptoms among people severely ill or dying with COVID supported by palliative care, and associations with treatments and survival. METHODS Multicentre cohort study of people with COVID across England and Wales supported by palliative care services, during the pandemic in 2020 and 2021. We analysed clinical, demographic and survival data, symptom severity at baseline (referral to palliative care, first COVID assessment) and at three follow-up assessments using the Integrated Palliative care Outcome Scale - COVID version. RESULTS We included 572 patients from 25 services, mostly hospital support teams; 496 (87%) were newly referred to palliative care with COVID, 75 (13%) were already supported by palliative care when they contracted COVID. At baseline, patients had a mean of 2.4 co-morbidities, mean age 77 years, a mean of five symptoms, and were often bedfast or semiconscious. The most prevalent symptoms were: breathlessness, weakness/lack of energy, drowsiness, anxiety, agitation, confusion/delirium, and pain. Median time in palliative care was 46 hours; 77% of patients died. During palliative care, breathlessness, agitation, anxiety, delirium, cough, fever, pain, sore/dry mouth and nausea improved; drowsiness became worse. Common treatments were low dose morphine and midazolam. Having moderate to severe breathlessness, agitation and multimorbidity were associated with shorter survival. CONCLUSION Symptoms of COVID quickly improved during palliative care. Breathlessness, agitation and multimorbidity could be used as triggers for timelier referral, and symptom guidance for wider specialities should build on treatments identified in this study.
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Affiliation(s)
- Irene J Higginson
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK; King's College Hospital NHS Foundation Trust (I.J.H., K.F.S.), Denmark Hill, UK.
| | - Mevhibe B Hocaoglu
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK
| | - Lorna K Fraser
- Health Sciences (L.K.F.), University of York, York, North Yorkshire, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK; King's College Hospital NHS Foundation Trust (I.J.H., K.F.S.), Denmark Hill, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK
| | - Rachel L Chambers
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK
| | - Nancy Preston
- International Observatory on End of Life Care (N.P., L.D., C.W.), Division of Health Research, Lancaster University, Lancaster, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care (N.P., L.D., C.W.), Division of Health Research, Lancaster University, Lancaster, UK
| | - Andy Bradshaw
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK; Wolfson Palliative Care Research Centre (A.B., F.E.M.M.), Hull York Medical School, University of Hull, Hull, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre (A.B., F.E.M.M.), Hull York Medical School, University of Hull, Hull, UK
| | - Catherine Walshe
- International Observatory on End of Life Care (N.P., L.D., C.W.), Division of Health Research, Lancaster University, Lancaster, UK
| | -
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK; Wolfson Palliative Care Research Centre (A.B., F.E.M.M.), Hull York Medical School, University of Hull, Hull, UK; International Observatory on End of Life Care (N.P., L.D., C.W.), Division of Health Research, Lancaster University, Lancaster, UK
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Barriers and facilitators to multidimensional symptom management in palliative care: A focus group study among patient representatives and clinicians. Palliat Support Care 2022:1-12. [PMID: 36177886 DOI: 10.1017/s147895152200133x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES It is widely acknowledged that co-occurring symptoms in patients with a psychosocial and spiritual aspects should also be considered. However, this multidimensional approach is difficult to integrate into daily practice, especially for generalist clinicians not specialized in palliative care. We aimed to identify the barriers and facilitators to multidimensional symptom management. METHODS Focus group meetings were conducted with the following stakeholders: (1) patient representatives, (2) generalist community nurses, (3) generalist hospital nurses, (4) general practitioners, (5) generalist hospital physicians, and (6) palliative care specialists. Audiotapes were transcribed verbatim and thematically analyzed. RESULTS Fifty-one participants (6-12 per group) reported barriers and facilitators with 3 main themes: multidimensional symptom assessment, initiating management of nonphysical problems, and multidisciplinary collaboration. As barriers, generalist clinicians and palliative care specialists reported that generalist clinicians often lack the communication skills to address nonphysical problems and are unaware of available resources for multidimensional symptom management. Palliative care specialists felt that generalist clinicians may be unaware that assessing nonphysical problems is important and focus on pharmacological interventions. Generalist nurses and palliative care specialists indicated that hierarchical difficulties between them and generalist physicians are barriers to multidisciplinary collaboration. Reported facilitators included using symptom assessment scales and standardized questions on nonphysical problems. SIGNIFICANCE OF RESULTS Generalist clinicians can be supported by improving their communication skills, increasing their awareness of available resources for multidimensional symptom management, and by using a standardized approach to assess all 4 dimensions of palliative care.
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Palliative Care Outcome Scale Assessment for Cancer Patients Eligible for Palliative Care: Perspectives on the Relationship between Patient-Reported Outcome and Objective Assessments. Curr Oncol 2022; 29:7140-7147. [PMID: 36290838 PMCID: PMC9600518 DOI: 10.3390/curroncol29100561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 01/13/2023] Open
Abstract
(1) Background: The importance of patient-reported outcome (PRO), i.e., prioritizing patient voice, has increased in cancer treatment, as well as palliative and supportive settings. The Integrated Palliative Care Outcome Scale (IPOS), a hybrid evaluation consisting of "patient evaluation" (PRO) and "peer evaluation" by medical professionals, was developed as a successor version of the Support Team Assessment Schedule (STAS) in 2013 and has been utilized worldwide. The Japanese version of the IPOS (IPOS-J) was developed and released in 2019. The purpose of this study was to explore the applicability of the IPOS-J to clinical practice in the future. (2) Methods: We conducted the following two studies with terminally ill cancer patients: (i) Can an evaluation with the IPOS-J performed by medical professionals (peer evaluation) replace the STAS-J evaluation? (ii) Can the quality of palliative care improve by combining the IPOS-J patient evaluation with the peer evaluation? (3) Results: The overall intervention rate and urgent intervention rate for the STAS-J and IPOS-J was 34.4 vs. 34.1% (p = 0.91) and 10.4 vs. 9.9% (p = 0.78), respectively. The patients selected "intervention required" but the medical professionals selected "no intervention required" in 47 cases. The medical team performed appropriate intervention after re-assessment. As a result, more than 70% of the patients were "intervention-free" after 1 week of intervention. (4) Conclusions: The IPOS-J peer evaluation was as useful as the STAS-J evaluation. A hybrid type of evaluation, combining patient evaluation (PRO) and peer evaluation, may help us to understand patient needs and improve the quality of palliative care.
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Assessment of symptom intensity and psychological well-being of patients with advanced cancer undergoing palliative care in a Brazilian public hospital: A cross-sectional study. Palliat Support Care 2022:1-7. [PMID: 35920303 DOI: 10.1017/s1478951522000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The characterization of clinical-emotional aspects of advanced cancer patients is essential for palliative care. To date, there is scarce information regarding the socio-demographic and clinical profiles, as well as the quality of care given to hospitalized patients under this condition, particularly in South American countries. The objectives of this study were to analyze the socio-demographic profile, symptoms (including psychological well-being), and the quality of life of advanced cancer patients admitted to the oncology ward of the General Hospital of the University of Campinas, Brazil. METHODS In this cross-sectional study, patients were invited to fill the selected questionnaires such as Edmonton Symptom Assessment Scale (ESAS) and Palliative Care Outcome Scale (POS). Descriptive analyses were performed, regarding socio-demographic profile, symptoms, level of information over treatment aims, and quality-of-life scores. RESULTS Fifty-nine patients were included, of whom 29 were male and 30 female, with a mean age of 58 years. Overall, 31.9% presented pain at the time of the interview, 52.5% depression, and 76.3% anxiety. The median individual scores for ESAS and POS (and interquartile range) were, respectively, 27 (17-41) and 14 (9-19). Patients with previous knowledge of treatment objectives reported worse depression scores in the ESAS (median 2 vs. 0, p 0.02), even when correcting for possible confounders. SIGNIFICANCE OF RESULTS In contrast to current literature, in which pain is a prevalent report, depression and anxiety were more evident in this specific population of hospitalized patients. This framework reflects the need for valuing not only physical but also emotional symptoms to achieve the integrality of care.
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Myring G, Mitchell PM, Kernohan WG, McIlfatrick S, Cudmore S, Finucane AM, Graham-Wisener L, Hewison A, Jones L, Jordan J, McKibben L, Muldrew DHL, Zafar S, Coast J. An analysis of the construct validity and responsiveness of the ICECAP-SCM capability wellbeing measure in a palliative care hospice setting. BMC Palliat Care 2022; 21:121. [PMID: 35804325 PMCID: PMC9264696 DOI: 10.1186/s12904-022-01012-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For outcome measures to be useful in health and care decision-making, they need to have certain psychometric properties. The ICECAP-Supportive Care Measure (ICECAP-SCM), a seven attribute measure (1. Choice, 2. Love and affection, 3. Physical suffering, 4. Emotional suffering, 5. Dignity, 6. Being supported, 7. Preparation) developed for use in economic evaluation of end-of-life interventions, has face validity and is feasible to use. This study aimed to assess the construct validity and responsiveness of the ICECAP-SCM in hospice inpatient and outpatient settings. METHODS A secondary analysis of data collated from two studies, one focusing on palliative care day services and the other on constipation management, undertaken in the same national hospice organisation across three UK hospices, was conducted. Other quality of life and wellbeing outcome measures used were the EQ-5D-5L, McGill Quality of Life Questionnaire - Expanded (MQOL-E), Patient Health Questionnaire-2 (PHQ-2) and Palliative Outcomes Scale Symptom list (POS-S). The construct validity of the ICECAP-SCM was assessed, following hypotheses generation, by calculating correlations between: (i) its domains and the domains of other outcome measures, (ii) its summary score and the other measures' domains, (iii) its summary score and the summary scores of the other measures. The responsiveness of the ICECAP-SCM was assessed using anchor-based methods to understand change over time. Statistical analysis consisted of Spearman and Pearson correlations for construct validity and paired t-tests for the responsiveness analysis. RESULTS Sixty-eight participants were included in the baseline analysis. Five strong correlations were found with ICECAP-SCM attributes and items on the other measures: four with the Emotional suffering attribute (Anxiety/depression on EQ-5D-5L, Psychological and Burden on MQOL-E and Feeling down, depressed or hopeless on PHQ-2), and one with Physical suffering (Weakness or lack of energy on POS-S). ICECAP-SCM attributes and scores were most strongly associated with the MQOL-E measure (0.73 correlation coefficient between summary scores). The responsiveness analysis (n = 36) showed the ICECAP-SCM score was responsive to change when anchored to changes on the MQOL-E over time (p < 0.05). CONCLUSIONS This study provides initial evidence of construct validity and responsiveness of the ICECAP-SCM in hospice settings and suggests its potential for use in end-of-life care research.
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Affiliation(s)
- Gareth Myring
- grid.5337.20000 0004 1936 7603Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK ,grid.410421.20000 0004 0380 7336The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Paul Mark Mitchell
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - W. George Kernohan
- grid.12641.300000000105519715Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Sonja McIlfatrick
- grid.12641.300000000105519715Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Sarah Cudmore
- grid.104846.fDivision of Nursing, Queen Margaret University, Edinburgh, UK ,grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Anne M. Finucane
- grid.4305.20000 0004 1936 7988Clinical Psychology, University of Edinburgh, Edinburgh, UK ,grid.470550.30000 0004 0641 2540Marie Curie Hospice, Edinburgh, UK
| | - Lisa Graham-Wisener
- grid.4777.30000 0004 0374 7521School of Psychology, Queen’s University Belfast, Belfast, UK
| | - Alistair Hewison
- grid.6572.60000 0004 1936 7486School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Louise Jones
- grid.83440.3b0000000121901201Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Joanne Jordan
- grid.10837.3d0000 0000 9606 9301School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Laurie McKibben
- grid.12641.300000000105519715Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Deborah H. L. Muldrew
- grid.12641.300000000105519715Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Shazia Zafar
- grid.6572.60000 0004 1936 7486School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Joanna Coast
- grid.5337.20000 0004 1936 7603Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Saunders CH, Durand MA, Kirkland KB, MacMartin MA, Barnato AE, Elwyn G. Psychometric assessment of the consideRATE questions, a new measure of serious illness experience, with an online simulation study. PATIENT EDUCATION AND COUNSELING 2022; 105:2581-2589. [PMID: 35260261 DOI: 10.1016/j.pec.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the psychometric properties of the consideRATE questions, a measure of serious illness experience. METHODS We recruited people at least 50 years old via paid panels online, with US-Census-based quotas. We randomized participants to a patient experience story at two time points. Participants completed a series of measures, including the consideRATE questions. We assessed convergent (Pearson's correlation), discriminative (one-way ANOVA with Tukey's test for multiple comparisons) and divergent (Pearson's correlation) validity. We also assessed intra-rater reliability (intra-class correlation) and responsiveness to change (t-tests). RESULTS We included 809 individuals in our analysis. We established convergent validity (r = 0.77; p < 0.001); discriminative validity (bad/neutral stories [mean diff=0.4; p < 0.001]; neutral/ good stories [mean diff=1.3; p < 0.001]) and moderate divergent validity (r = 0.57; p < 0.001). We established sensitivity to change in all stories (bad/good [mean diff=1.52; p < 0.001]; good/bad [mean diff= -1.68; p < 0.001]; neutral/bad [mean diff= -0.57; p < 0.001]; good/neutral [mean diff= -1.11; p < 0.001]; neutral/good [mean diff= 1.1; p < 0.001]) but one (bad/neutral [mean diff= 0.4; p < 0.07]). Intra-rater reliability was demonstrated between time points (r = 0.77; p < 0.001). CONCLUSIONS the consideRATE questions were reliable and valid in a simulated online test. PRACTICE IMPLICATIONS the consideRATE questions may be a practical way to measure serious illness experience and the effectiveness of interventions to improve it.
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Affiliation(s)
- Catherine H Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA.
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA.
| | - Kathryn B Kirkland
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA.
| | | | - Amber E Barnato
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA.
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Sandham MH, Hedgecock E, Hocaoglu M, Palmer C, Jarden RJ, Narayanan A, Siegert RJ. Strengthening Community End-of-Life Care through Implementing Measurement-Based Palliative Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137747. [PMID: 35805407 PMCID: PMC9265763 DOI: 10.3390/ijerph19137747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022]
Abstract
The increasing demand for palliative care in New Zealand presents a potential threat to the quality of service delivery. One strategy to overcome this is through the implementation of valid and reliable patient-reported outcome measures. This mixed-methods study aimed to (1) implement measurement-based palliative care (MBPC) in a community palliative care service in Auckland, New Zealand; (2) evaluate the clinical utility of MBPC perceived by clinicians; (3) describe patient characteristics as measured by the Integrated Palliative Care Outcome Scale (IPOS), the Australasian Modified Karnofsky Performance Scale (AKPS), and Phase of Illness (POI); and (4) evaluate the internal consistency of the IPOS. Participants were over 18 years of age from a community outpatient palliative care service. In a phased approach to implementation, healthcare staff were educated on each instrument used for patient assessment. Uptake and internal consistency were evaluated through descriptive statistics. An interpretive descriptive methodology was used to explore the clinical utility of MBPC through semi-structured interviews with seven clinical staff members. Individual patient assessments (n = 1507) were undertaken predominantly on admission, with decreasing frequency as patients advanced through to the terminal phase of their care. Mean total IPOS scores were 17.97 (SD = 10.39, α = 0.78). The POI showed that 65% of patients were in the stable phase, 20% were in the unstable phase, 9% were in the deteriorating phase, and 2% were in the terminal phase. Clinicians reported that MBPC facilitated holistic and comprehensive assessments, as well as the development of a common interdisciplinary language. Clinicians expressed discomfort using the psychosocial and spiritual items. Measurement-based palliative care was only partially implemented but it was valued by staff and perceived to increase the quality of service delivery. Future research should determine the optimal timing of assessments, cultural responsivity for Māori and Pacific patients, and the role of MBPC in decision support for clinicians.
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Affiliation(s)
- Margaret H. Sandham
- School of Clinical Sciences, Auckland University of Technology (AUT), North Shore Campus, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand;
- Correspondence:
| | | | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College, London WC2R 2LS, UK;
| | - Celia Palmer
- Hospice West Auckland, Te Atatu, Auckland 0610, New Zealand;
| | - Rebecca J. Jarden
- Department of Nursing, Melbourne School of Health Sciences, 161 Barry Street, Carlton, VIC 3053, Australia;
| | - Ajit Narayanan
- School of Engineering, Computing and Mathematical Sciences, Auckland University of Technology (AUT), AUT Tower, 2-14 Wakefield Street, Auckland 1010, New Zealand;
| | - Richard J. Siegert
- School of Clinical Sciences, Auckland University of Technology (AUT), North Shore Campus, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand;
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Seipp H, Haasenritter J, Hach M, Becker D, Schütze D, Engler J, Ploeger C, Bösner S, Kuss K. Integrating patient- and caregiver-reported outcome measures into the daily care routines of specialised outpatient palliative care: a qualitative study (ELSAH) on feasibility, acceptability and appropriateness. BMC Palliat Care 2022; 21:60. [PMID: 35501844 PMCID: PMC9063228 DOI: 10.1186/s12904-022-00944-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
The use of patient-reported outcome measures (PROM) and caregiver-reported outcome measures can raise the patient centeredness of treatment and improve the quality of palliative care. Nevertheless, the everyday implementation of self-report in patients and caregivers is complex, and should be adapted for use in specific settings. We aimed to implement a set of outcome measures that included patient and caregiver self- and proxy-reported outcome measures in specialised outpatient palliative care (SOPC). In this study, we explore how the Integrated Palliative Outcome Scale (IPOS), IPOS Views on Care (IPOS VoC) and the Short-form Zarit Caregiver Burden Interview (ZBI-7) can be feasibly, acceptably and appropriately implemented in the daily care routines of SOPC.
Methods
Five SOPC teams were trained, and used the outcome measures in daily practice. Team members were mainly nurses and physicians. To investigate their feedback, we used a multi-method qualitative design consisting of focus groups with SOPC-team members (n = 14), field notes of meetings and conversations with the SOPC teams. In an iterative process, we analysed the findings using qualitative content analysis and refined use of the outcome measures.
Results
We found that integrating patient and caregiver outcome measures into daily care routines in SOPC is feasible. To improve feasibility, acceptability and appropriateness, the resulting burden on patients and relatives should be kept to a minimum, the usefulness of the measures must be understood, they should be used considerately, and administration must be manageable. We removed ZBI-7 from the set of measures as a result of feedback on its content and wording.
Conclusions
SOPC-team members have reservations about the implementation of PROM in SOPC, but with appropriate adjustments, its application in daily care is feasible, accepted and perceived as appropriate. Previous to use, SOPC-team members should be trained in how to apply the measures, in the design of manageable processes that include integration into electronic documentation systems, and in ongoing evaluation and support. They should also be taught how useful the measures can be.
Trial registration
May 19th, 2017, German Clinical Trials Register DRKS-ID: DRKS00012421.
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Sandham MH, Hedgecock EA, Siegert RJ, Narayanan A, Hocaoglu MB, Higginson IJ. Intelligent Palliative Care Based on Patient-Reported Outcome Measures. J Pain Symptom Manage 2022; 63:747-757. [PMID: 35026384 DOI: 10.1016/j.jpainsymman.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 12/31/2022]
Abstract
CONTEXT The growth of patient reported outcome measures data in palliative care provides an opportunity for machine learning to identify patterns in patient responses signifying different phases of illness. OBJECTIVES The study will explore if machine learning and network analysis can identify phases in patient palliative status through symptoms reported on the Integrated Palliative Care Outcome Scale (IPOS). METHODS A partly cross-sectional and partially longitudinal observational study was undertaken using the Australasian Karnofsky Performance Scale (AKPS); Integrated Palliative Care Outcome Scale (IPOS); Phase of Illness (POI). Patient palliative records (n = 1507, 65% stable, 20% unstable, 9% deteriorating, 2% terminal) from 804 adult patients enrolled in a New Zealand palliative care service were analysed using a combination of statistical, machine learning and network analysis techniques. RESULTS Data from IPOS showed considerable variation with phase. Also, network analysis showed clear associations between items by phase. Six machine learning techniques identified the most important variables for predicting possible transition between phases of illness. Network analysis for all patients showed that Poor Appetite and Loss of Energy were central IPOS items, with Loss of Energy linked to Drowsiness, Shortness of Breath and Lack of Mobility on the one hand, and Poor Appetite linked to Nausea, Vomiting, Constipation and Sore and Dry Mouth on the other. CONCLUSION These preliminary results, when coupled with the latest technological developments in mobile apps and wearable technology, could point the way to increased use of digital therapeutics in continuous palliative care monitoring.
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Affiliation(s)
- Margaret H Sandham
- School of Clinical Sciences (M.S., R.S.), Auckland University of Technology, Auckland, New Zealand.
| | - Emma A Hedgecock
- Specialty Medicine and Health of Older People, Waitemata District Health Board, Private Bag (E.A.H.), Takapuna, New Zealand
| | - Richard J Siegert
- School of Clinical Sciences (M.S., R.S.), Auckland University of Technology, Auckland, New Zealand
| | - Ajit Narayanan
- School of Engineering, Computer and Mathematical Sciences (A.N.), Auckland University of Technology, Auckland, New Zealand
| | - Mevhibe B Hocaoglu
- Cicely Saunders Institute of Palliative Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (M.B.H., I.J.H.), King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (M.B.H., I.J.H.), King's College London, London, UK
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Sirati Nir M, Rassouli M, Ebadi A, Moosavi S, Pakseresht M, Hasan Shiri F, Souri H, Nasiri M, Karami M, Fereidouni A, Barasteh S. Psychometric Properties of the Persian Version of Palliative Care Outcome Scale (POS) in Adult Patients With Cancer. Front Psychol 2022; 13:858684. [PMID: 35602695 PMCID: PMC9122042 DOI: 10.3389/fpsyg.2022.858684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Measuring the outcomes of palliative care plays an important role to improve the quality, efficiency, and availability of these services in patients with cancer. Using valid, reliable, and culturally appropriate tools has a considerable role to measure these outcomes. This study aimed to assess the psychometric properties of the translated version of the Palliative care Outcome Scale (POS). Methods This methodological study was conducted in two outpatient clinics related to Shohada Tajrish and Baqiyatallah hospitals in Tehran in 2019-2020. The translation was done using the Forward-Backward approach after gaining permission from the developer. Face validity was tested with 10 patients with cancer through cognitive interviewing, as well as content validity with four experts. Construct validity was performed by (n = 203) exploratory factor analysis and confirmation (N = 150). To assess the reliability, internal consistency was assessed by using Cronbach's alpha coefficient, and relative stability was assessed using the interclass correlation coefficient (ICC). Furthermore, interpretability and ceiling and floor effects were assessed. Results A total of 353 patients with cancer under palliative care were included in the study. Then, three psychological (30%), physical (12.25%), and social factors (12.08%) with a cumulative variance of 54.34% were extracted in exploratory factor analysis. Confirmatory factor analysis showed that the model has a good fit of information. Cronbach's alpha coefficient for scale was 0.719. Furthermore, the ICC was 0.812. The scale was interpretable, and ceiling and floor effects were 0%. Conclusion Persian version of the POS was evaluated as a valid and reliable tool. Therefore, it can be used by the clinician to monitor the consequences of palliative care in Iranian cancer patients.
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Affiliation(s)
- Masoud Sirati Nir
- Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Soolmaz Moosavi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Pakseresht
- School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Fatemeh Hasan Shiri
- Department of Anesthesiology, Faculty of Paramedical, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Souri
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Morteza Nasiri
- Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Karami
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Fereidouni
- Department of Operating Room Technology, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Salman Barasteh
- Health Management Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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A systematic review and recommendations for prom instruments for older people with frailty in emergency care. J Patient Rep Outcomes 2022; 6:30. [PMID: 35362836 PMCID: PMC8975986 DOI: 10.1186/s41687-022-00438-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The current service metrics used to evaluate quality in emergency care do not account for specific healthcare outcome goals for older people living with frailty. These have previously been classified under themes of ‘Autonomy’ and ‘Functioning’. There is no person-reported outcome measure (PROM) for older people with frailty and emergency care needs. This study aimed to identify and co-produce recommendations for instruments potentially suitable for use in this population.
Methods In this systematic review, we searched six databases for PROMs used between 2010 and 2021 by older people living with frailty receiving acute hospital care. Studies were reviewed against predefined eligibility criteria and appraised for quality using the COSMIN Risk of Bias checklist. Data were extracted to map instrument constructs against an existing framework of acute healthcare outcome goals. Instrument face and content validity were assessed by lay collaborators. Recommendations for instruments with potential emergency care suitability were formed through co-production. Results Of 9392 unique citations screened, we appraised the full texts of 158 studies. Nine studies were identified, evaluating nine PROMs. Quality of included studies ranged from ‘doubtful’ to ‘very good’. Most instruments had strong evidence for measurement properties. PROMs mainly assessed ‘Functioning’ constructs, with limited coverage of ‘Autonomy’. Five instruments were considered too burdensome for the emergency care setting or too specific for older people living with frailty. Conclusions Four PROMs were recommended as potentially suitable for further validation with older people with frailty and emergency care needs: COOP/WONCA charts, EuroQol, McGill Quality of Life (Expanded), and Palliative care Outcome Scale. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00438-x.
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Byrne A, Torrens-Burton A, Sivell S, Moraes FY, Bulbeck H, Bernstein M, Nelson A, Fielding H. Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers. Cochrane Database Syst Rev 2022; 1:CD013440. [PMID: 34988973 PMCID: PMC8733789 DOI: 10.1002/14651858.cd013440.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Primary malignant brain tumours can have an unpredictable course, but high-grade gliomas typically have a relentlessly progressive disease trajectory. They can cause profound symptom burden, affecting physical, neurocognitive, and social functioning from an early stage in the illness. This can significantly impact on role function and on the experiences and needs of informal caregivers. Access to specialist palliative and supportive care early in the disease trajectory, for those with high-grade tumours in particular, has the potential to improve patients' and caregivers' quality of life. However, provision of palliative and supportive care for people with primary brain tumours - and their informal caregivers - is historically ill-defined and ad hoc, and the benefits of early palliative interventions have not been confirmed. It is therefore important to define the role and effectiveness of early referral to specialist palliative care services and/or the effectiveness of other interventions focused on palliating disease impact on people and their informal caregivers. This would help guide improvement to service provision, by defining those interventions which are effective across a range of domains, and developing an evidence-based model of integrated supportive and palliative care for this population. OBJECTIVES To assess the evidence base for early palliative care interventions, including referral to specialist palliative care services compared to usual care, for improving outcomes in adults diagnosed with a primary brain tumour and their carers. SEARCH METHODS We conducted searches of electronic databases, CENTRAL, MEDLINE, CINAHL, Web of Science, and PsycINFO (last searched 16 November 2021). We conducted searches to incorporate both qualitative and quantitative search terms. In addition to this, we searched for any currently recruiting trials in ClinicalTrials.gov and in the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and undertook citation tracking via Scopus. We also handsearched reference lists of potentially eligible systematic review articles to identify any other relevant studies, contacted experts in the field and searched key authors via Web of Science and searched SIGLE (System of Information on Grey Literature in Europe). SELECTION CRITERIA We included studies looking at early referral to specialist palliative care services - or early targeted palliative interventions by other healthcare professionals - for improving quality of life, symptom control, psychological outcomes, or overall survival as a primary or secondary outcome measure. Studies included randomised controlled trials (RCTs), non-randomised studies (NRS), as well as qualitative and mixed-methods studies where both qualitative and quantitative data were included. Participants were adults with a confirmed radiological and/or histological diagnosis of a primary malignant brain tumour, and/or informal adult carers (either at individual or family level) of people with a primary malignant brain tumour. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodological procedures for data extraction, management, and analysis. We used GRADE to assess the certainty of the evidence for symptom control, i.e. cognitive function. MAIN RESULTS We identified 9748 references from the searches, with 8337 remaining after duplicates were removed. After full-text review, we included one trial. There were no studies of early specialist palliative care interventions or of early, co-ordinated generalist palliative care approaches. The included randomised trial addressed a single symptom area, focusing on early cognitive rehabilitation, administered within two weeks of surgery in a mixed brain tumour population, of whom approximately half had a high-grade glioma. The intervention was administered individually as therapist-led computerised exercises over 16 one-hour sessions, four times/week for four weeks. Sessions addressed several cognitive domains including time orientation, spatial orientation, visual attention, logical reasoning, memory, and executive function. There were no between-group differences in outcome for tests of logical-executive function, but differences were observed in the domains of visual attention and verbal memory. Risk of bias was assessed and stated as high for performance bias and attrition bias but for selective reporting it was unclear whether all outcomes were reported. We considered the certainty of the evidence, as assessed by GRADE, to be very low. AUTHORS' CONCLUSIONS Currently there is a lack of research focusing on the introduction of early palliative interventions specifically for people with primary brain tumours, either as co-ordinated specialist palliative care approaches or interventions focusing on a specific aspect of palliation. Future research should address the methodological shortcomings described in early palliative intervention studies in other cancers and chronic conditions. In particular, the specific population under investigation, the timing and the setting of the intervention should be clearly described and the standardised palliative care-specific components of the intervention should be defined in detail.
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Affiliation(s)
- Anthony Byrne
- Cardiff and Vale University Health Board, Llandough Hospital, Penarth, UK
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Torrens-Burton
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Fabio Ynoe Moraes
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Kingston, Canada
| | | | - Mark Bernstein
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Helen Fielding
- Palliative Medicine, Abertawe Bro Morgannwg University Health Board, Swansea, UK
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Dawson B, McConvey K, Gofton TE. When to initiate palliative care in neurology. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:105-125. [PMID: 36055710 DOI: 10.1016/b978-0-323-85029-2.00011-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Life-limiting and life-threatening neurologic conditions often progress slowly. Patients live with a substantial symptom burden over a long period of time, and there is often a high degree of functional and cognitive impairment. Because of this, the most appropriate time to initiate neuropalliative care is often difficult to identify. Further challenges to the incorporation of neuropalliative care include communication barriers, such as profound dysarthria or language impairments, and loss of cognitive function and decision-making capacity that prevent shared decision making and threaten patient autonomy. As a result, earlier initiation of at least some components of palliative care is paramount to ensuring patient-centered care while the patient is still able to communicate effectively and participate as fully as possible in their medical care. For these reasons, neuropalliative care is also distinct from palliative care in oncology, and there is a growing evidence base to guide timely initiation and integration of neuropalliative care. In this chapter, we will focus on when to initiate palliative care in patients with life-limiting, life-threatening, and advanced neurologic conditions. We will address three main questions, which patients with neurologic conditions will benefit from initiation of palliative care, what aspects of neurologic illness are most amenable to neuropalliative care, and when to initiate neuropalliative care?
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Affiliation(s)
- Benjamin Dawson
- Department of Clinical Neurologic Sciences, Western University, London, ON, Canada
| | - Kayla McConvey
- Department of Clinical Neurologic Sciences, Western University, London, ON, Canada
| | - Teneille E Gofton
- Department of Clinical Neurologic Sciences, Western University, London, ON, Canada.
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Rukavina K, McConvey V, Ray Chaudhuri K, Miyasaki J. Parkinson's disease and Covid-19: Is there an impact of ethnicity and the need for palliative care. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 165:229-249. [PMID: 36208902 PMCID: PMC9042419 DOI: 10.1016/bs.irn.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Under the traditional models of care for People with Parkinson's Disease (PD, PwP), many of their needs remain unmet and a substantial burden of motor and non-motor symptoms they experience may not be tackled sufficiently. An introduction of palliative care (PC) interventions early in the course of PD offers profound benefits: it may improve quality of life of patients, their families and caregivers through the prevention and relief of medical symptoms, while, at the same time, emphasizing their emotional needs and spiritual wellbeing, establishing goals of care, and engaging in the advance care planning (ACP). The ongoing Coronavirus Disease 2019 (Covid-19) pandemic poses an unprecedented set of challenges for PwP and has in many ways (both directly and indirectly) magnified their suffering, thus rapidly raising the demand for PC interventions. Covid-19, as well as the repercussions of prolonged mobility restrictions and limited health-care access might exacerbate the severity of PD motor symptoms and interact negatively with a range of non-motor symptoms, with a detrimental effect on quality of life. Greater motor disability, higher amount of levodopa-induced motor fluctuations with an increased daily off-time, fatigue, anxiety, depression, sleep disturbances, pain and worsening of cognitive complaints might dominate the clinical presentation in PwP during the Covid-19 pandemic, alongside raising psychological and spiritual concerns and anticipatory grief. Here, we aim to provide a foundation for pragmatic and clinically orientated PC approach to improve quality of life and relieve suffering of PwP in the context of the current, ongoing Covid-19 pandemic.
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Paiva BSR, Valentino TCDO, Mingardi M, de Oliveira MA, Franco JO, Salerno MC, Palocci H, de Melo TC, Paiva CE. Translation, Validity and Internal Consistency of the Quality of Dying and Death Questionnaire for Brazilian families of patients that died from cancer: a cross-sectional and methodological study. SAO PAULO MED J 2022; 141:e202285. [PMID: 36417658 PMCID: PMC10065093 DOI: 10.1590/1516-3180.2022.0085.r2.09082022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Quality of Dying and Death Questionnaire (QoDD) may prove to be an important evaluation tool in the Brazilian context, and, therefore, can contribute to a more precise evaluation of the dying and death process, improving and guiding the end-of-life patient care. OBJECTIVE To translate and cross-culturally adapt the QoDD into Brazilian Portuguese and measure its validity (convergent and known-groups) and internal consistency. DESIGN AND SETTING A cross-sectional, methodological study was conducted at the Hospital de Câncer de Barretos, Brazil. METHODS A total of 78 family caregivers participated in this study. Semantic, cultural, and conceptual equivalences were evaluated using the content validity index. The construct validity was assessed through convergent validation and known groups analysis [presence of family members at the place of death; feel at peace with dying; and place of death (hospital versus home; hospital versus Palliative Care)]. Internal consistency was evaluated using Cronbach's alpha. RESULTS The questionnaire was translated into Brazilian Portuguese and presented evidence of a clear understanding of its content. Cronbach's alpha values were ≥ 0.70, except for the domains of treatment preference (α = 0.686) and general concerns (α = 0.599). The convergent validity confirmed a part of the previously hypothesized correlations between the Palliative Care Outcome Scale-Brazil (POS-Br) total scores and the QoDD domain scores. The QoDD-Br domains could distinguish the patients who died in palliative care and general wards. CONCLUSION The QoDD-Br is a culturally adapted valid instrument, and may be used to assess the quality of death of cancer patients.
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Affiliation(s)
- Bianca Sakamoto Ribeiro Paiva
- PhD. Researcher and Professor, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
| | - Talita Caroline de Oliveira Valentino
- MSc. Nurse and Doctoral Student, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
| | - Mirella Mingardi
- RN. Nurse and Master's Student, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
| | - Marco Antonio de Oliveira
- MSc. Biostatistics, Palliative Care and Quality of Life
Research Group (GPQual), Postgraduate Program, Hospital de Câncer de Barretos,
Barretos (SP), Brazil
| | - Julia Onishi Franco
- MD. Physician, Dr. Paulo Prata, School of Health Sciences of
Barretos and Palliative Care and Quality of Life Research Group (GPQual),
Postgraduate Program, Hospital de Câncer de Barretos, Barretos (SP),
Brazil
| | - Michelle Couto Salerno
- RN. Research Nurse, Palliative Care and Quality of Life
Research Group (GPQual), Postgraduate Program, Hospital de Câncer de Barretos,
Barretos (SP), Brazil
| | - Helena Palocci
- MD. Physician, Dr. Paulo Prata, School of Health Sciences of
Barretos and Palliative Care and Quality of Life Research Group (GPQual),
Postgraduate Program, Hospital de Câncer de Barretos, Barretos (SP),
Brazil
| | - Tais Cruz de Melo
- MD. Physician, Dr. Paulo Prata, School of Health Sciences of
Barretos and Palliative Care and Quality of Life Research Group (GPQual),
Postgraduate Program, Hospital de Câncer de Barretos, Barretos (SP),
Brazil
| | - Carlos Eduardo Paiva
- PhD. Physician and Professor, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
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Leeper H, Cooper D, Armstrong T. Palliative Care Intervention Trials for Adults Living With Progressive Central Nervous System Diseases and Their Caregivers: A Systematic Review. J Pain Symptom Manage 2022; 63:e88-e110. [PMID: 34147576 PMCID: PMC8683574 DOI: 10.1016/j.jpainsymman.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Interest in implementing palliative care for adults living with progressive central nervous system diseases (PCNSD) and their caregivers is increasing. OBJECTIVES To inform evidence-based practice and future research by critically evaluating randomized clinical trials (RCTs) investigating palliative care interventions (PCIs) for adults living with PCNSD and their caregivers using self-reported outcomes and the patient- and caregiver-reported outcome measures employed. METHODS A systematic search using PRISMA methods of EMBASE, PubMed, Scopus, Web of Science databases using index and keyword methods for articles published from inception through February 28, 2021 was performed. RCTs investigating PCI as their primary aim using patient- and/or caregiver-reported outcomes to assess PCI effectiveness in adults living with PCNSD and their caregivers were included for qualitative synthesis. RESULTS Five RCTs met criteria and used 21 unique outcome measures. Pooled patient diagnoses included multiple sclerosis, motor neuron disease and movement disorders, primarily Parkinson's Disease. All five RCTs assessed PCI effectiveness on patient symptom burden and caregiver burden, and three RCTs used patient QOL as a primary outcome. Overall risk of bias was low. Pooled positive findings were limited to very modest changes in patient QOL, specific physical symptoms and caregiver burden. Most outcome measures lacked clinimetric responsiveness to detect change whether caused by disease or an intervention to the patient or caregiver. CONCLUSION Sparse, low-certainty evidence for PCI impact on patient QOL, symptom burden and caregiver burden indicate future research should consider refining study populations, interventions, outcomes assessed and outcome measures to detect any change due to PCI.
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Affiliation(s)
- HeatherE Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland.
| | - Diane Cooper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland
| | - TerriS Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland
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Kebebew T, Mavhandu-Mudzusi AH, Mosalo A. A cross-sectional assessment of symptom burden among patients with advanced cervical cancer. BMC Palliat Care 2021; 20:190. [PMID: 34920716 PMCID: PMC8684193 DOI: 10.1186/s12904-021-00883-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background The increasing burden of chronic non-communicable diseases in developing countries is driving attention to palliative care services. Identification of disease-specific symptoms of concern and their prevalence will guide designing, monitoring, and evaluating palliative care programmes. This study assessed the burden of symptoms and problems among patients with advanced cervical cancer. Methods This research followed a cross-sectional study design to quantitatively review the symptom burden among patients diagnosed with advanced cervical cancer attending treatment at Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia from January to July 2019. Symptoms were assessed using a patient-reported, seven-day recall Integrated Palliative Care Outcome Scale (IPOS) version III. Frequency, median and mean scores with a standard deviation were used in the descriptive analysis whereas t-test and one-way analysis of variance were used for comparisons. Results There were 385 patients with advanced cervical cancer, stage IIB-IVB, successfully interviewed. The median age was 50 years, the majority were illiterate (63.1%) and in marital union (62.3%). Over 50% of the patients experienced pain, weakness, poor appetite, constipation, limited mobility, and dry mouth. The burdens of emotional symptoms such as patient anxiety, family anxiety, and patient depression were also prevalent at 79.7%, 82.3%, and 47.0%, respectively. Patients who are illiterate, at a higher stage of the disease, not currently in marriage, and who received palliative radiotherapy bear a higher symptom burden. Conclusion Patients with advanced cervical cancer bear a high symptom burden. Early initiation of palliative care is recommended to alleviate the concerning symptoms, and to improve patients’ quality of life.
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Affiliation(s)
- Tolcha Kebebew
- Student at University of South Africa, Ethiopia Learning Centre, Addis Ababa, Ethiopia.
| | | | - Annah Mosalo
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Sakurai H, Miyashita M, Morita T, Naito AS, Miyamoto S, Otani H, Nozato J, Yokomichi N, Imai K, Oishi A, Kizawa Y, Matsushima E. Comparison between patient-reported and clinician-reported outcomes: Validation of the Japanese version of the Integrated Palliative care Outcome Scale for staff. Palliat Support Care 2021; 19:702-708. [PMID: 33666153 DOI: 10.1017/s1478951521000018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The goal of palliative and supportive care is to improve patients' quality of life (QoL). Patient-reported outcome measures (PROMs) are the gold standard for the assessment of QoL and symptoms; however, when self-reporting is complicated, PROMs are often substituted with proxy-reported outcome measures, such as clinician-reported outcome measures. The objective of this study was to assess the validity and reliability of the Japanese version of the Integrated Palliative care Outcome Scale (IPOS) for staff (IPOS-Staff). METHODS This multicenter, cross-sectional observational study was conducted concurrently with the validation of the IPOS for patients (IPOS-Patient). Japanese adult patients with cancer and their staff were recruited. We assessed the characteristics of the patients and staff members, missing values, prevalence, and total IPOS scores. For the analysis of criterion validity, intra-rater, and inter-rater reliability, we calculated intraclass correlations (ICCs). RESULTS One hundred and forty-three patients completed the IPOS-Patient, and 79 medical staff members completed the IPOS-Staff. The most common missing values from IPOS-Staff were Family Anxiety (3.5%) and Sharing Feelings (3.5%). Over half of the patients scored themselves moderate or worse for Poor Mobility, Anxiety, and Family Anxiety, while staff members scored patients moderate or worse for Weakness, Anxiety, and Family Anxiety. For criterion validity (patient-staff agreement) as well as intra-rater and inter-rater reliability, ICCs ranged from 0.114 (Sharing Feelings) to 0.826 (Nausea), 0.720 (Anxiety) to 0.933 (Nausea), and -0.038 (Practical Problems) to 0.830 (Nausea), respectively. SIGNIFICANCE OF RESULTS The IPOS-Staff is easy to respond to; it has fair validity and reliability for physical items but poor for psycho-social items. By defining the context and objectives of its use and interpretation, the IPOS-Staff can be a useful tool for measuring outcomes in adult patients with cancer who cannot complete self-evaluations.
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Affiliation(s)
- Hiroki Sakurai
- Department of Palliative Medicine, Toranomon Hospital, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing and Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akemi Shirado Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Shingo Miyamoto
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hiroyuki Otani
- Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, Fukuoka, Japan
| | - Junko Nozato
- Department of Cancer Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Ai Oishi
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, the University of Edinburgh, Edinburgh, UK
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Eisuke Matsushima
- Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Scarfò L, Karamanidou C, Doubek M, Garani-Papadatos T, Didi J, Pontikoglou C, Ling J, Payne C, Papadaki HΑ, Rosenquist R, Stavroyianni N, Payne S, Ghia P, Natsiavas P, Maramis C, Stamatopoulos K. MyPal ADULT study protocol: a randomised clinical trial of the MyPal ePRO-based early palliative care system in adult patients with haematological malignancies. BMJ Open 2021; 11:e050256. [PMID: 34728446 PMCID: PMC8565565 DOI: 10.1136/bmjopen-2021-050256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The systematic collection of electronic patient-reported outcome (ePRO) in the routine care of patients with chronic haematological malignancies such as chronic lymphocytic leukaemia (CLL) and myelodysplasia syndromes (MDS) can constitute a very ambitious but worthwhile challenge. MyPal is a Horizon 2020 Research & Innovation Action aiming to meet this challenge and foster palliative care for patients with CLL or MDS by leveraging ePRO systems to adapt to the personal needs of patients and caregiver(s). METHODS AND ANALYSIS In this interventional randomised trial, 300 patients with CLL or MDS will be recruited across Europe. Patients will be randomly allocated to early palliative care using the MyPal system (n=150) versus standard care including general palliative care if needed (n=150). Patients in the experimental arm will be given access to the MyPal digital health platform which consists of purposely designed software available on smartphones and/or tablets. The platform entails different functionalities including physical and psychoemotional symptom reporting via regular questionnaire completion, spontaneous self-reporting, motivational messages, medication management and a personalised search engine for health information. Data on patients' activity (daily steps and sleep quality) will be automatically collected via wearable devices. ETHICS AND DISSEMINATION The integration of ePROs via mobile applications has raised ethical concerns regarding inclusion criteria, information provided to participants, free and voluntary consent, and respect for their autonomy. These have been carefully addressed by a multidisciplinary team. Data processing, dissemination and exploitation of the study findings will take place in full compliance with European Union data protection law. A participatory design was adopted in the development of the digital platform involving focus groups and discussions with patients to identify needs and preferences. The protocol was approved by the ethics committees of San Raffaele (8/2020), Thessaloniki 'George Papanikolaou' Hospital (849), Karolinska Institutet (20.10.2020), University General Hospital of Heraklion (07/15.4.2020) and University of Brno (01-120220/EK). TRIAL REGISTRATION NUMBER NCT04370457.
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Affiliation(s)
- Lydia Scarfò
- Internal Medicine, Vita Salute San Raffaele University, Milan, Italy
- Strategic Research Program on CLL, IRCCS San Raffaele Hospital, Milan, Italy
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Michael Doubek
- Department of Haematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Jana Didi
- Department of Haematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Charalampos Pontikoglou
- Department of Hematology, University of Crete School of Medicine, Heraklion, Crete, Greece
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Julie Ling
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Cathy Payne
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Helen Α Papadaki
- Department of Hematology, University of Crete School of Medicine, Heraklion, Crete, Greece
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | | | - Sheila Payne
- International Observatory on End of Life Care, University of Lancaster, Lancaster, UK
| | - Paolo Ghia
- Strategic Research Program on CLL, IRCCS San Raffaele Hospital, Milan, Italy
- Medical Oncology, Vita Salute San Raffaele University, Milan, Italy
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Christos Maramis
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
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Ellis-Smith C, Tunnard I, Dawkins M, Gao W, Higginson IJ, Evans CJ. Managing clinical uncertainty in older people towards the end of life: a systematic review of person-centred tools. BMC Palliat Care 2021; 20:168. [PMID: 34674695 PMCID: PMC8532380 DOI: 10.1186/s12904-021-00845-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022] Open
Abstract
Background Older people with multi-morbidities commonly experience an uncertain illness trajectory. Clinical uncertainty is challenging to manage, with risk of poor outcomes. Person-centred care is essential to align care and treatment with patient priorities and wishes. Use of evidence-based tools may support person-centred management of clinical uncertainty. We aimed to develop a logic model of person-centred evidence-based tools to manage clinical uncertainty in older people. Methods A systematic mixed-methods review with a results-based convergent synthesis design: a process-based iterative logic model was used, starting with a conceptual framework of clinical uncertainty in older people towards the end of life. This underpinned the methods. Medline, PsycINFO, CINAHL and ASSIA were searched from 2000 to December 2019, using a combination of terms: “uncertainty” AND “palliative care” AND “assessment” OR “care planning”. Studies were included if they developed or evaluated a person-centred tool to manage clinical uncertainty in people aged ≥65 years approaching the end of life and quality appraised using QualSyst. Quantitative and qualitative data were narratively synthesised and thematically analysed respectively and integrated into the logic model. Results Of the 17,095 articles identified, 44 were included, involving 63 tools. There was strong evidence that tools used in clinical care could improve identification of patient priorities and needs (n = 14 studies); that tools support partnership working between patients and practitioners (n = 8) and that tools support integrated care within and across teams and with patients and families (n = 14), improving patient outcomes such as quality of death and dying and satisfaction with care. Communication of clinical uncertainty to patients and families had the least evidence and is challenging to do well. Conclusion The identified logic model moves current knowledge from conceptualising clinical uncertainty to applying evidence-based tools to optimise person-centred management and improve patient outcomes. Key causal pathways are identification of individual priorities and needs, individual care and treatment and integrated care. Communication of clinical uncertainty to patients is challenging and requires training and skill and the use of tools to support practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00845-9.
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Affiliation(s)
- Clare Ellis-Smith
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
| | - India Tunnard
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - Marsha Dawkins
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.,Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.,King's College Hospital NHS Foundation Trust, London, UK
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.,Sussex Community NHS Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, UK
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Davison SN, Klarenbach S, Manns B, Schnick-Makaroff K, Buzinski R, Corradetti B, Short H, Johnson JA. Patient-reported outcome measures in the care of in-centre hemodialysis patients. J Patient Rep Outcomes 2021; 5:93. [PMID: 34637030 PMCID: PMC8511202 DOI: 10.1186/s41687-021-00365-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
Kidney failure requiring dialysis is associated with high symptom burden and low health-related quality of life (HRQL). Patient-reported outcome measures (PROMs) are standardized instruments that capture patients’ symptom burden, level of functioning, and HRQL. The routine use of PROMs can be used to monitor aspects of patients’ health that may otherwise be overlooked, inform care planning, and facilitate the introduction of treatments. Incorporating PROMs into clinical practice is an appropriate strategy to engage patients and enhance their role in decisions regarding their care and outcomes. However, the implementation of PROMs measurement and associated interventions can be challenging given the nature of clinical practice in busy hemodialysis units, the variations in organization and clinical workflow across units, as well as regional programs. Implementing PROMs and linking these with actionable treatment aids to alleviate bothersome symptoms and improve patients’ wellbeing is key to improving patients’ health. Other considerations in implementing PROMs within a hemodialysis setting include integration into electronic medical records, purchase and configuration of electronic tools (i.e., tablets), storage and disinfection of such tools, and ongoing IT resources. It is important to train clinicians on the practical elements of using PROMs, however there is also a need to engage clinicians to use PROMs on an ongoing basis. This article describes how PROMs have been implemented at in-centre hemodialysis units in Alberta, Canada, addressing each of these elements.
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Affiliation(s)
- Sara N Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, 11-113L Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Scott Klarenbach
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, 11-113L Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Braden Manns
- Department of Medicine and Department of Community Health Sciences, University of Calgary, O'Brien Institute of Public Health, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Kara Schnick-Makaroff
- Faculty of Nursing, University of Alberta, 5-295 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada
| | | | | | - Hilary Short
- Alberta PROMs and EQ-5D Research and Support Unity, School of Public Health, University of Alberta, Shing Centre for Health Research Innovation, 2-040 Li Ka, Edmonton, AB, T6G 2E1, Canada
| | - Jeffrey A Johnson
- Alberta PROMs and EQ-5D Research and Support Unity, School of Public Health, University of Alberta, Shing Centre for Health Research Innovation, 2-040 Li Ka, Edmonton, AB, T6G 2E1, Canada
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Psychometric validation and cross-cultural adaptation of the Integrated Palliative care Outcome Scale in Polish (IPOS-Pol). Palliat Support Care 2021; 20:687-693. [PMID: 34579798 DOI: 10.1017/s1478951521001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The study aimed to assess the reliability and validity of the IPOS-Pol for patient self-reporting. METHOD Patients (>18 years of age) with advanced cancer admitted to three palliative care centers (inpatient units and home-based) were recruited to a multicenter, cross-sectional, observational, prospective study. Participants provided responses to the IPOS-Pol Patient version and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care (EORTC QLQ-C15-PAL) Polish version at baseline (T1) and four to seven days later (T2). We assessed test-retest reliability, internal consistency, and construct validity of the tool. RESULTS One hundred and eighty patients were included. Test-retest reliability demonstrated no statistically significant differences in the average outcomes of the IPOS-Pol between T1 and T2 (27.2 ± 9.2 vs. 26.5 ± 8.7; p > 0.05). The intra-class correlation coefficient between T1 and T2 was r = 0.83 (p < 0.0001), the intra-class correlation coefficient for test-retest reliability of the IPOS-Pol items ranged from 0.63 to 0.84 (p < 0.0001), and the Cronbach's α coefficient for internal consistency was 0.773. The correlation coefficient between the IPOS-Pol and EORTC QLQ-C15-PAL total score was 0.79 (p < 0.001). SIGNIFICANCE OF RESULTS The patient version of the Polish adaptation of IPOS is a valid and reliable outcome measure for assessing symptoms and concerns of individuals receiving palliative care, as well as the quality of care provided.
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Bradshaw A, Santarelli M, Khamis AM, Sartain K, Johnson M, Boland J, Pearson M, Murtagh FEM. Implementing person-centred outcome measures (PCOMs) into routine palliative care: A protocol for a mixed-methods process evaluation of The RESOLVE PCOM Implementation Strategy. BMJ Open 2021; 11:e051904. [PMID: 34479939 PMCID: PMC8420722 DOI: 10.1136/bmjopen-2021-051904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Person-centred outcome measures improve quality of care and patient outcomes but are used inconsistently in palliative care practice. To address this implementation gap, we developed the 'RESOLVE Implementation Strategy'. This protocol describes a process evaluation to explore mechanisms through which this strategy does, or does not, support the implementation of outcome measures in routine palliative care practice. METHODS AND ANALYSIS Multistrand, mixed-methods process evaluation. Strand one will collect routine outcomes data (palliative Phase of Illness, Integrated Palliative care Outcomes Scale, Australia-modified Karnofsky Performance Status) to map the changes in use of outcome measures over 12 months (July 2021-July 2022). Strand two will collect survey data over the same 12-month period to explore how professionals' understandings of, skills in using and ability to build organisational practices around, outcome measures change over time. Strand three will collect interview data to understand the mechanisms underpinning/affecting our implementation strategy. Thematic framework analysis and descriptive statistics will be used to analyse qualitative and quantitative data, respectively. ETHICS AND DISSEMINATION For strand one, ethical approval has been obtained (Cambridge REC, REF: 20/EE/0188). For strands two and three, ethical approval has been obtained from Hull York Medical School ethics committee (2105). Tailored feedback of study findings will be provided to participating sites. Abstracts and papers will be submitted to national/international conferences and peer-reviewed journals. Lay and policy briefings and newsletters will be shared through patient and public involvement and project networks, plus via the project website.
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Affiliation(s)
- Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Martina Santarelli
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Assem M Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Kathryn Sartain
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jason Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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