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Di Lorenzo S, Mozzi L, Salmaso F, Silvagni C, Soffientini S, Valenti V, Zagonel V. A multicentre survey on the perception of palliative care among health professionals working in haematology. Support Care Cancer 2024; 32:253. [PMID: 38536470 PMCID: PMC10973048 DOI: 10.1007/s00520-024-08452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/20/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Patients with haematologic malignancies have less access to palliative care and are referred later than patients with solid tumours. We developed a survey to investigate this phenomenon, with the intention of analysing palliative care perceptions among health professionals who treat haematology patients and identifying barriers and facilitators to referrals to palliative care services. METHODS This was a multicentre exploratory descriptive web-based survey. A questionnaire was administered to 320 medical and nursing staff members from five Italian haematological units and San Marino's hospital to investigate their perception of palliative care. Quantitative and qualitative analyses were performed. RESULTS A total of 142/320 healthcare professionals completed the survey, achieving a 44% response rate. Most of the respondents supported the integration of haematology and palliative care and were aware of the role of palliative care. Despite this, only half had an in-hospital palliative care team, and only a few had previously attended a specific training course. The majority agreed with palliative care referral when the prognosis was less than 3 months or when the symptoms were incoercible and with blood transfusions even in the last stages of the disease. Many considered the presence of an in-hospital palliative care team or a case manager, as well as structured palliative care training, as fundamental facilitators of palliative care referrals. CONCLUSION These results showed that healthcare professionals in haematology generally hold a favourable attitude and a high interest in integrating palliative care into their patients' care. The low referral rate could depend on clinical, cultural, and organisational issues.
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Affiliation(s)
- Sara Di Lorenzo
- Clinical Hematology and Bone Marrow Transplant and Cellular Therapies Center, Carlo Melzi", Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Lisa Mozzi
- Clinical Hematology, Azienda Ospedaliera Ulss 8 Berica, "St. Bortolo" Hospital, Vicenza, Italy
| | - Flavia Salmaso
- Palliative Care Unit, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
| | - Claudia Silvagni
- Continuity of Care Center, Istituto Per La Sicurezza Sociale, Cailungo, Republic of San Marino
| | - Silvia Soffientini
- Integrated Home Care Unit, AULLS 6 Euganea - Terme Colli District, Padua, Italy
| | - Vanessa Valenti
- Palliative Care Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), "Dino Amadori", Via P. Maroncelli 40, Meldola, FC, 47014, Italy.
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
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Kaiser U, Vehling-Kaiser U, Hoffmann A, Fiedler M, Hofbauer A, Rechenmacher M, Benning A, Koller M, Kaiser F. The complex intervention day hospice - a quality-assured study on the implementation, realization, and benefits with model character for Germany (IMPULS) using the example of "Day hospice Adiuvantes". BMC Palliat Care 2024; 23:18. [PMID: 38229069 DOI: 10.1186/s12904-024-01346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/05/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Currently, a conclusive experience on the uniform implementation and benefits of day hospice structures and interventions is lacking in Germany. The following questions should be clarified: (1) Which structural conditions and interventional measures should be established in day hospices from the point of view of patients, relatives, and specialist staff?; (2) Are the planned structures or interventions feasible and implementable under real conditions and accepted by patients, relatives, and staff?; (3) How can a final implementation and intervention catalog for day hospices be designed?; (4) Is this final catalog of services feasible, reasonable, economical, and effective under everyday conditions in day hospices? METHODS We planned to perform a multistage investigation, guided by the Medical Research Council Framework for the development and evaluation of complex interventions. In Stage 1, an initial theoretical construct on structures and interventions will be established through an extensive literature and guideline review on day hospices and through qualitative interviews. In a nominal group process, we will create a catalog of offers. In Stage 2, feasibility testing is conducted in a single-day hospice under real-life conditions using quantitative quality indicators and qualitative interviews. Structures and interventions can be adapted here if necessary. In a second nominal group process, a final structure and offer catalog is created, which is then implemented in Stage 3 in the day hospice under investigation and evaluated under real daily conditions through a process and effectiveness test. For this purpose, qualitative and quantitative quality indicators will be used and a comparative cohort of patients who are not cared for in the day hospice - but in the same network structure (oncology-palliative care network Lower Bavaria) - is examined. DISCUSSION Finally, the initial statements on the reasonable and realizable structures or interventions in day hospices and their benefits in daily real-life conditions as well as possible optimization processes shall be made. TRIAL REGISTRATION The study was retrospectively registered in the German Clinical Trials Register (DRKS-ID DRKS00031613, registration date April 04, 2023) and the display portal of the Center for Clinical Trials of the University Hospital Regensburg (Z-2022-1734-6, registration date July 01, 2023).
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Affiliation(s)
- Ulrich Kaiser
- Clinic and Polyclinic for Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
- Oncology-Palliative Care Network Landshut, Landshut, Germany
| | | | | | - Moritz Fiedler
- Oncology-Palliative Care Network Landshut, Landshut, Germany
| | | | - Michael Rechenmacher
- Clinic and Polyclinic for Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
- Center for Palliative Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Anne Benning
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Florian Kaiser
- Oncology-Palliative Care Network Landshut, Landshut, Germany.
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Freytag A, Meissner F, Krause M, Lehmann T, Jansky MK, Marschall U, Schmid A, Schneider N, Vollmar HC, Wedding U, Ditscheid B. [A regional comparison of outcomes quality and costs of general and specialized palliative care in Germany: a claims data analysis]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1135-1145. [PMID: 37535086 PMCID: PMC10539464 DOI: 10.1007/s00103-023-03746-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/23/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The main framework conditions for palliative care are set at the regional level. The scope of the forms of care used (outpatient, inpatient, general, specialized) varies widely. What is the quality of outcomes achieved by the palliative care provided on a federal states level? What are the associated costs of care? METHOD Retrospective observational study using BARMER claims data from 145,372 individuals who died between 2016 and 2019 and had palliative care in the last year of life. Regional comparison with regard to the following outcomes: proportion of palliative care patients who died in the hospital, potentially burdensome care in the last 30 days of life (ambulance calls, [intensive care] hospitalizations, chemotherapy, feeding tubes, parenteral nutrition), total cost of care (last three months), cost of palliative care (last year), and cost-effectiveness ratios. Calculation of patient/resident characteristic adjusted rates, costs, and ratios. RESULTS Federal states vary significantly with respect to the outcomes (also adjusted) of palliative care. Palliative care costs vary widely, most strongly for specialized outpatient palliative care (SAPV). Across all indicators and the cost-effectiveness ratio of total cost of care to at-home deaths, Westphalia-Lippe shows favorable results. CONCLUSION Regions with better quality and more favorable cost (ratios) can provide guidance for other regions. The extent to which the new federal SAPV agreement can incorporate the empirical findings should be reviewed. Patient-relevant outcome parameters should be given greater weight than parameters aiming at structures of care.
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Affiliation(s)
- Antje Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland.
| | - Franziska Meissner
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
| | - Markus Krause
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
| | - Thomas Lehmann
- Zentrum für Klinische Studien, Universitätsklinikum Jena, Jena, Deutschland
| | | | - Ursula Marschall
- BARMER Institut für Gesundheitssystemforschung, Wuppertal, Wuppertal, Deutschland
| | - Andreas Schmid
- Gesundheitsökonomie und -management, Rechts- und Wirtschaftswissenschaftliche Fakultät, Universität Bayreuth, Bayreuth, Deutschland
- Oberender AG, Bayreuth, Bayreuth, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Horst Christian Vollmar
- Abteilung für Allgemeinmedizin (AM RUB), Medizinische Fakultät, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Ulrich Wedding
- Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | - Bianka Ditscheid
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
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Schorderet C, Bastiaenen CHG, de Bie RA, Maréchal M, Vuilleumier N, Allet L. Development of a tool to assess environmental factors to support home care - a Delphi study. BMC Geriatr 2023; 23:501. [PMID: 37605112 PMCID: PMC10441718 DOI: 10.1186/s12877-023-04207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Living in an adequate environment suited to one's abilities and needs is an essential condition to function in daily life. However, no complete tool currently exists to provide a rapid overview of a person's environment, both material (accommodation and auxiliary means) and social (entourage and available services). Our aim was to develop a tool to identify potentially problematic environmental factors and to determine when an in-depth assessment is necessary. METHODS Health professionals experienced in home-based treatment participated in a three-round Delphi process. The first round aimed to define which items the tool should contain, the second to collect participants' opinions on a first version of the tool, and the third to collect the participants' opinions on the adapted version of the tool. RESULTS A total of 29 people participated in the first round, 21 in the second and 18 in the third. The final tool contains 205 items divided into four categories (basic information about the inhabitant and their home, inhabitant's level of independence and autonomy, home, tools and means at the inhabitant's disposition) and two annexes (stairs to access to the home, internal staircase to the dwelling). CONCLUSIONS A complete tool allowing professionals working in patients' homes to obtain an overview of the environmental factors that could represent obstacles to the independence of the inhabitant, or to the possibility of providing quality care could be developed. This tool is very complete but relatively long. To facilitate its usability, it would be relevant that a digital version to focus on individual relevant categories be elaborated.
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Affiliation(s)
- Chloé Schorderet
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland.
- Department of Epidemiology, Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, the Netherlands.
- The Sense Innovation & Research Center, Lausanne and Sion, Switzerland.
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Robert A de Bie
- Department of Epidemiology, Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, the Netherlands
| | | | | | - Lara Allet
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland
- The Sense Innovation & Research Center, Lausanne and Sion, Switzerland
- Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland
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Schorderet C, Bastiaenen CHG, Verloo H, de Bie RA, Allet L. A social network analysis to explore collaborative practice in home care: research protocol. BMC Health Serv Res 2022; 22:1174. [PMID: 36123692 PMCID: PMC9484240 DOI: 10.1186/s12913-022-08548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background The conceptualization of the home as a care environment and maintaining a high standard of care requires different professionals to collaborate. This study will explore collaborative practice in home care, needs and expectations of the stakeholders involved, and identify their roles and tasks. Secondly, it will investigate possible strategies to improve home care management and, more particularly, optimize collaborative practice in home care. Methods The study will be conducted during three distinct consecutive phases, within a multiphase mixed-methods design. Phase 1 will use a quantitative approach in which a social network analysis will be conducted to have an overview of collaborative practice in home care in French-speaking Switzerland. Phases 2 and 3 will be qualitative and focus on three different situations involving different locations (rural and urban) and different home care functioning (home care provided by agencies and home care providing by independent caregivers). In each situation, semi-structured interviews will be conducted with home care recipients and their home caregivers. In phase 2, results of phase 1’s network analysis will be discussed, such as roles, needs, and expectations of all stakeholders involved in home care. In phase 3, phase 2’s findings will be discussed and strategies to improve home care and to optimize collaborative practice will be explored. Discussion Over the past years, home care has grown considerably. Therefore, more and more different caregivers are involved in the recipients' homes. Since optimal coordination between these different caregivers is a prerequisite for quality and safe care, it is essential to investigate the existing collaborative practice and how it is functioning. This study will provide knowledge on roles, needs and expectations of different caregivers involved in home care. It will also allow for strategies to optimize collaborative practice and thus ensure comprehensive care for recipients. Finally, it will serve as a basis for future studies that can be conducted to address identified needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08548-4.
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Affiliation(s)
- Chloé Schorderet
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland. .,Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands. .,The Sense, Innovation & Research Center, Sion, Switzerland.
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland.,Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Robert A de Bie
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Lara Allet
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland.,The Sense, Innovation & Research Center, Sion, Switzerland.,Department of Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
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Joo MK, Yoo JW, Mojtahedi Z, Kim P, Hwang J, Koo JS, Kang HT, Shen JJ. Ten-year trends of utilizing palliative care and palliative procedures in patients with gastric Cancer in the United States from 2009 to 2018 - a nationwide database study. BMC Health Serv Res 2022; 22:20. [PMID: 34980097 PMCID: PMC8725552 DOI: 10.1186/s12913-021-07404-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/13/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives Little is known about the current status and the changing trends of hospitalization and palliative care consultation of patients with gastric cancer in the United States. The aim of this study was to evaluate the changing trend in the number of hospitalization, palliative care consultation, and palliative procedures in the US during a recent 10-year period using a nationwide database. Methods This was a retrospective study that analyzed the National Inpatient Sample (NIS) database of 2009–2018. Patients aged more than 18 years who were diagnosed with a gastric cancer using International Classification of Diseases (ICD)-9 and 10 codes were included. Palliative care consultation included palliative care (ICD-9, V66.7; ICD-10, Z51.5) and advanced care planning (ICD-9, V69.89; ICD-10, Z71.89). Palliative procedures included percutaneous or endoscopic bypass, gastrostomy or enterostomy, dilation, drainage, nutrition, and irrigation for palliative purpose. Results and discussion A total of 86,430 patients were selected and analyzed in this study. Using a compound annual growth rate (CAGR) approach, the annual number of hospitalizations of gastric cancer patients was found to be decreased during 2009–2018 (CAGR: -0.8%, P = 0.0084), while utilization rates of palliative care and palliative procedures increased (CAGR: 9.3 and 1.6%, respectively; P < 0.0001). Multivariable regression analysis revealed that palliative care consultation was associated with reduced total hospital charges (−$34,188, P < 0.0001). Conclusion Utilization of palliative care consultation to patients with gastric cancer may reduce use of medical resources and hospital costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07404-1.
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Affiliation(s)
- Moon Kyung Joo
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA. .,Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea.
| | - Ji Won Yoo
- Department of Internal Medicine, School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Zahra Mojtahedi
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, 89119, USA
| | - Pearl Kim
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, 89119, USA
| | - Jinwook Hwang
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA.,Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospita, Korea University College of Medicine, Ansan, Republic of Korea
| | - Ja Seol Koo
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA.,Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospita, Korea University College of Medicine, Ansan, Republic of Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jay J Shen
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, 89119, USA.
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