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Yildiz B, van der Heide A, Bakan M, Iversen GS, Haugen DF, McGlinchey T, Smeding R, Ellershaw J, Fischer C, Simon J, Vibora-Martin E, Ruiz-Torreras I, Goossensen A. Facilitators and barriers of implementing end-of-life care volunteering in a hospital in five European countries: the iLIVE study. BMC Palliat Care 2024; 23:88. [PMID: 38561727 PMCID: PMC10985898 DOI: 10.1186/s12904-024-01423-5] [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: 07/11/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND End-of-life (EoL) care volunteers in hospitals are a novel approach to support patients and their close ones. The iLIVE Volunteer Study supported hospital volunteer coordinators from five European countries to design and implement an EoL care volunteer service on general wards in their hospitals. This study aimed to identify and explore barriers and facilitators to the implementation of EoL care volunteer services in the five hospitals. METHODS Volunteer coordinators (VCs) from the Netherlands (NL), Norway (NO), Slovenia (SI), Spain (ES) and United Kingdom (UK) participated in a focus group interview and subsequent in-depth one-to-one interviews. A theory-inspired framework based on the five domains of the Consolidated Framework for Implementation Research (CFIR) was used for data collection and analysis. Results from the focus group were depicted in radar charts per hospital. RESULTS Barriers across all hospitals were the COVID-19 pandemic delaying the implementation process, and the lack of recognition of the added value of EoL care volunteers by hospital staff. Site-specific barriers were struggles with promoting the service in a highly structured setting with many stakeholders (NL), negative views among nurses on hospital volunteering (NL, NO), a lack of support from healthcare professionals and the management (SI, ES), and uncertainty about their role in implementation among VCs (ES). Site-specific facilitators were training of volunteers (NO, SI, NL), involving volunteers in promoting the service (NO), and education and awareness for healthcare professionals about the role and boundaries of volunteers (UK). CONCLUSION Establishing a comprehensive EoL care volunteer service for patients in non-specialist palliative care wards involves multiple considerations including training, creating awareness and ensuring management support. Implementation requires involvement of stakeholders in a way that enables medical EoL care and volunteering to co-exist. Further research is needed to explore how trust and equal partnerships between volunteers and professional staff can be built and sustained. TRIAL REGISTRATION NCT04678310. Registered 21/12/2020.
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Affiliation(s)
- Berivan Yildiz
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Misa Bakan
- Research Department, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Grethe Skorpen Iversen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - Tamsin McGlinchey
- Palliative Care Unit, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Ruthmarijke Smeding
- Palliative Care Unit, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - John Ellershaw
- Palliative Care Unit, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Eva Vibora-Martin
- CUDECA Institute for Training and Research in Palliative Care, CUDECA Hospice Foundation, Malaga, Spain
| | - Inmaculada Ruiz-Torreras
- CUDECA Institute for Training and Research in Palliative Care, CUDECA Hospice Foundation, Malaga, Spain
| | - Anne Goossensen
- Informal Care and Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
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Hjorth NE, Hufthammer KO, Sigurdardottir K, Tripodoro VA, Goldraij G, Kvikstad A, Haugen DF. Hospital care for the dying patient with cancer: does an advance care planning invitation influence bereaved relatives' experiences? A two country survey. BMJ Support Palliat Care 2024; 13:e1038-e1047. [PMID: 34848559 PMCID: PMC10850660 DOI: 10.1136/bmjspcare-2021-003116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/13/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Advance care planning (ACP) is not systematically performed in Argentina or Norway. We used the post-bereavement survey of the ERANet-LAC International Care Of the Dying Evaluation (CODE) project (2017-2020) to examine the proportion of relatives who were offered an ACP conversation, the proportion of those not offered it who would have wanted it and whether the outcomes differed between those offered a conversation and those not. METHODS Relatives after cancer deaths in hospitals answered the CODE questionnaire 6-8 weeks post bereavement, by post (Norway) or interview (Argentina). Two additional questions asked if the relative and patient had been invited to a conversation about wishes for the patient's remaining lifetime, and, if not invited, whether they would have wanted such a conversation. The data were analysed using mixed-effects ordinal regression models. RESULTS 276 participants (Argentina 98 and Norway 178) responded (56% spouses, 31% children, 68% women, age 18-80+). Fifty-six per cent had been invited, and they had significantly more positive perceptions about care and support than those not invited. Sixty-eight per cent of the participants not invited would have wanted an invitation, and they had less favourable perceptions about the care, especially concerning emotional and spiritual support. CONCLUSIONS Relatives who had been invited to a conversation about wishes for the patient's remaining lifetime had more positive perceptions about patient care and support for the relatives in the patient's final days of life. A majority of the relatives who had not been invited to an ACP conversation would have wanted it.
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Affiliation(s)
- Nina Elisabeth Hjorth
- Faculty of Medicine, Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
- Specialist Palliative Care Team, Department of Anaesthesia and Surgical Services, Haukeland University Hospital, Bergen, Norway
| | | | - Katrin Sigurdardottir
- Specialist Palliative Care Team, Department of Anaesthesia and Surgical Services, Haukeland University Hospital, Bergen, Norway
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Vilma Adriana Tripodoro
- Pallium Latinoamérica, Buenos Aires, Argentina
- Instituto de Investigaciones Medicas Alfredo Lanari, University of Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Goldraij
- Internal Medicine/Palliative Care Program, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Anne Kvikstad
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Palliative Medicine Unit, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Dagny Faksvåg Haugen
- Faculty of Medicine, Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Mayland CR, Keetharuth AD, Mukuria C, Haugen DF. Validation of 'Care Of the Dying Evaluation' (CODE TM) within an international study exploring bereaved relatives' perceptions about quality of care in the last days of life. J Pain Symptom Manage 2022; 64:e23-e33. [PMID: 35257928 DOI: 10.1016/j.jpainsymman.2022.02.340] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 12/01/2022]
Abstract
CONTEXT Assessing quality of care provided during the dying phase using validated tools aids quality assurance and recognizes unmet need. OBJECTIVE To assess construct validity and internal consistency of 'Care Of the Dying Evaluation' (CODETM) within an international context. METHODS Post-bereavement survey (August 2017 to September 2018) using CODETM. Respondents were next-of-kin to adult patients (≥ 18 years old) with cancer who had an 'expected' death within 22 study site hospitals in 7 countries: Argentina, Brazil, Germany, Norway, Poland, United Kingdom, Uruguay. Exploratory and Confirmatory Factor Analysis (EFA and CFA) were conducted, and internal reliability was assessed using Cronbach alpha (α). Known group validity was assessed by ability to discriminate quality of care based in place (Palliative Care Units (PCUs)) and country (Poland, where most deaths were in PCUs) of care. Differences were quantified using effect sizes (ES). RESULTS A 914 CODETM questionnaires completed (54% response rate). 527 (58%) male deceased patients; 610 (67%) next-of-kin female who were most commonly the 'spouse/partner' (411, 45%). EFA identified 4 factors: 'Overall care,' 'Communication and support,' 'Trust, respect and dignity,' and 'Symptom management' with good reliability scores (α = 0.628 - 0.862). CFA confirmed the 4-factor model; these were highly correlated and a bifactor model showed acceptable fit. The ES for quality of care in PCU's was 0.727; ES for Poland was 0.657, supporting the sensitivity of CODETM to detect differences. CONCLUSION Within an international context, good evidence supports the validity and reliability of CODETM for assessing the quality of care provided in the last days of life.
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Affiliation(s)
- Catriona R Mayland
- Yorkshire Cancer Research Senior Clinical Research Fellow and Honorary Consultant in Palliative Medicine (C.R.M.), University of Sheffield, Honorary Clinical Fellow, University of Liverpool, Liverpool, UK.
| | - Anju D Keetharuth
- School of Health and Related Research (A.D.K., C.M.), University of Sheffield, Sheffield, UK
| | - Clara Mukuria
- School of Health and Related Research (A.D.K., C.M.), University of Sheffield, Sheffield, UK
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway (D.F.H.), Haukeland University Hospital, and Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
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McGlinchey T, Mason SR, Smeding R, Goosensen A, Ruiz-Torreras I, Haugen DF, Bakan M, Ellershaw JE. ILIVE Project Volunteer study. Developing international consensus for a European Core Curriculum for hospital end-of-life-care volunteer services, to train volunteers to support patients in the last weeks of life: A Delphi study. Palliat Med 2022; 36:652-670. [PMID: 34666562 PMCID: PMC9006393 DOI: 10.1177/02692163211045305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Volunteers make a huge contribution to the health and wellbeing of the population and can improve satisfaction with care especially in the hospice setting. However, palliative and end-of-life-care volunteer services in the hospital setting are relatively uncommon. The iLIVE Volunteer Study, one of eight work-packages within the iLIVE Project, was tasked with developing a European Core Curriculum for End-of-Life-Care Volunteers in hospital. AIM Establish an international consensus on the content of a European Core Curriculum for hospital end-of-life-care volunteer services which support patients in the last weeks of life. DESIGN Delphi Process comprising the following three stages:1. Scoping review of literature into palliative care volunteers.2. Two rounds of Delphi Questionnaire.3. Nominal Group Meeting. SETTING/PARTICIPANTS Sixty-six participants completed the Round 1 Delphi questionnaire; 75% (50/66) took part in Round 2. Seventeen participants attended the Nominal Group Meeting representing an international and multi-professional group including, clinicians, researchers and volunteer coordinators from the participating countries. RESULTS The scoping review identified 88 items for the Delphi questionnaire. Items encompassed organisational issues for implementation and topics for volunteer training. Three items were combined and one item added in Round 2. Following the Nominal Group Meeting 53/87 items reached consensus. CONCLUSION Key items for volunteer training were agreed alongside items for implementation to embed the end-of-life-care volunteer service within the hospital. Recommendations for further research included in-depth assessment of the implementation and experiences of end-of-life-care volunteer services. The developed European Core Curriculum can be adapted to fit local cultural and organisational contexts.
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Affiliation(s)
| | - Stephen R Mason
- Palliative Care Unit, University of Liverpool, Liverpool, UK
| | | | - Anne Goosensen
- University of Humanistic Studies, Utrecht, The Netherlands
| | | | - Dagny Faksvåg Haugen
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Haukeland University Hospital, Bergen, Norway
| | - Miša Bakan
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia
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Kørner H, Guren MG, Larsen IK, Haugen DF, Søreide K, Kørner LR, Søreide JA. Characteristics and fate of patients with rectal cancer not entering a curative-intent treatment pathway: A complete nationwide registry cohort of 3,304 patients. Eur J Surg Oncol 2022; 48:1831-1839. [DOI: 10.1016/j.ejso.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/03/2022] [Accepted: 04/19/2022] [Indexed: 11/11/2022] Open
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Goldraij G, Tripodoro VA, Aloisio M, Castro SA, Gerlach C, Mayland CR, Haugen DF. One chance to get it right: improving clinical handovers for better symptom control at the end of life. BMJ Open Qual 2021; 10:bmjoq-2021-001436. [PMID: 34588188 PMCID: PMC8483039 DOI: 10.1136/bmjoq-2021-001436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/28/2021] [Accepted: 09/13/2021] [Indexed: 11/03/2022] Open
Abstract
Poor communication contributes to morbidity and mortality, not only in general medical care but also at the end oflife. This leads to issues relating to symptom control and quality of care. As part of an international project focused on bereaved relatives' perceptions about quality of end-of-life care, we undertook a quality improvement (QI) project in a general hospital in Córdoba city, Argentina.By using two iterative QI cycles, we launched an educational process and introduced a clinical mnemonic tool, I-PASS, during ward handovers. The introduction of the handover tool was intended to improve out-of-hours care.Our clinical outcome measure was ensuring comfort in at least 60% of dying patients, as perceived by family carers, during night shifts in an oncology ward during the project period (March-May 2019). As process-based measures, we selected the proportion of staff completing the I-PASS course (target 60%) and using I-PASS in at least 60% of handovers. Participatory action research was the chosen method.During the study period, 13/16 dying patients were included. We received 23 reports from family carers about the level of patient comfort during the previous night.Sixty-five per cent of healthcare professionals completed the I-PASS training. The percentage of completed handovers increased from 60% in the first Plan-Do-Study-Act (PDSA) cycle to 68% in the second one.The proportion of positive reports about patient comfort increased from 63% (end of the first PDSA cycle) to 87% (last iterative analysis after 3 months). Moreover, positive responses to 'Did doctors and nurses do enough for the patient to be comfortable during the night?' increased from 75% to 100% between the first and the second QI cycle.In conclusion, we achieved the successful introduction and staff training for use of the I-PASS tool. This led to improved perceptions by family carers, about comfort for dying patients.
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Affiliation(s)
- Gabriel Goldraij
- Internal Medicine/Palliative Care Program, Hospital Privado Universitario de Córdoba, Córdoba, Argentina .,Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Vilma Adriana Tripodoro
- Department of Palliative Care, Instituto de Investigaciones Medicas Alfredo Lanari, Buenos Aires, Argentina.,Institute Pallium Latinoamérica, Buenos Aires, Argentina
| | - Melisa Aloisio
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina.,Palliative Care Program, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Sandra Analía Castro
- Palliative Care Program, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Christina Gerlach
- Interdisciplinary Palliative Care Unit, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Palliative Care, Heidelberg University Hospital, Heidelberg, Germany
| | - Catriona Rachel Mayland
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK.,Palliative Care Institute, University of Liverpool, Liverpool, UK
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
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Sigurdardottir V, Edenbrandt CM, Hirvonen O, Jespersen BA, Haugen DF. Nordic Specialist Course in Palliative Medicine: Evaluation and Impact on the Development of Palliative Medicine in the Nordic Countries: A Survey among Participants from Seven Courses 2003-2017. J Palliat Med 2021; 24:1858-1862. [PMID: 34415780 DOI: 10.1089/jpm.2021.0310] [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] [Indexed: 11/12/2022] Open
Abstract
Background: The five Nordic Associations for palliative medicine (PM) have since 2003 organized a common specialist course for six weeks in two years. Aim: To describe the course: participants, evaluations, impact on participants' careers, and on the development of PM in the Nordic countries. Methods: Information on participants taken from the course archive and national registries. A web survey sent to graduates from the courses 2003-2013 (n = 150) and 2013-2017 (n = 72). Results: Mean age at course start was 46.9 years; 66% were women. Mean overall evaluation score 5.7 (range 5.4-6.0, max 7.0). Survey response rate 84% (n = 186); 80% of respondents were working in PM, the majority as leaders, >90% engaged in teaching PM. About 40% were active in PM associations, lobbying, and guideline development. Conclusion: The Nordic Specialist Course in PM has had a profound impact on the participants' postcourse careers, influencing the development of PM in the Nordic countries.
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Affiliation(s)
- Valgerdur Sigurdardottir
- Department of Medicine, University of Iceland, Reykjavik, Iceland
- Palliative Care Unit, Landspitali-National University Hospital, Kopavogur, Iceland
| | | | - Outi Hirvonen
- Palliative Care Center, Turku University Hospital, Turku, Finland
- Department of Clinical Oncology, University of Turku, Turku, Finland
| | - Bodil Abild Jespersen
- Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
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Haugen DF, Hufthammer KO, Gerlach C, Sigurdardottir K, Hansen MIT, Ting G, Tripodoro VA, Goldraij G, Yanneo EG, Leppert W, Wolszczak K, Zambon L, Passarini JN, Saad IAB, Weber M, Ellershaw J, Mayland CR. Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relatives' Survey within Seven Countries. Oncologist 2021; 26:e1273-e1284. [PMID: 34060705 PMCID: PMC8265351 DOI: 10.1002/onco.13837] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/19/2020] [Accepted: 05/13/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recognized disparities in quality of end-of-life care exist. Our aim was to assess the quality of care for patients dying from cancer, as perceived by bereaved relatives, within hospitals in seven European and South American countries. MATERIALS AND METHODS A postbereavement survey was conducted by post, interview, or via tablet in Argentina, Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next of kin to cancer patients were asked to complete the international version of the Care Of the Dying Evaluation (i-CODE) questionnaire 6-8 weeks postbereavement. Primary outcomes were (a) how frequently the deceased patient was treated with dignity and respect, and (b) how well the family member was supported in the patient's last days of life. RESULTS Of 1,683 potential participants, 914 i-CODE questionnaires were completed (response rate, 54%). Approximately 94% reported the doctors treated their family member with dignity and respect "always" or "most of the time"; similar responses were given about nursing staff (94%). Additionally, 89% of participants reported they were adequately supported; this was more likely if the patient died on a specialist palliative care unit (odds ratio, 6.3; 95% confidence interval, 2.3-17.8). Although 87% of participants were told their relative was likely to die, only 63% were informed about what to expect during the dying phase. CONCLUSION This is the first study assessing quality of care for dying cancer patients from the bereaved relatives' perspective across several countries on two continents. Our findings suggest many elements of good care were practiced but improvement in communication with relatives of imminently dying patients is needed. (ClinicalTrials.gov Identifier: NCT03566732). IMPLICATIONS FOR PRACTICE Previous studies have shown that bereaved relatives' views represent a valid way to assess care for dying patients in the last days of their life. The Care Of the Dying Evaluation questionnaire is a suitable tool for quality improvement work to help determine areas where care is perceived well and areas where care is perceived as lacking. Health care professionals need to sustain high quality communication into the last phase of the cancer trajectory. In particular, discussions about what to expect when someone is dying and the provision of hydration in the last days of life represent key areas for improvement.
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Affiliation(s)
- Dagny Faksvåg Haugen
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | | | - Christina Gerlach
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Katrin Sigurdardottir
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Marit Irene Tuen Hansen
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Grace Ting
- Academic Palliative and End-of-Life Care Department, Royal Liverpool University Hospital, Liverpool
| | - Vilma Adriana Tripodoro
- Pallium Latinoamérica, Buenos Aires, Argentina.,Instituto de Investigaciones Médicas Alfredo Lanari, University of Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Goldraij
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba, Argentina
| | | | - Wojciech Leppert
- Department of Palliative Medicine, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland.,Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Lair Zambon
- Department of Internal Medicine, Campinas State University, Campinas, Brazil
| | | | | | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - John Ellershaw
- Academic Palliative and End-of-Life Care Department, Royal Liverpool University Hospital, Liverpool.,Palliative Care Unit, University of Liverpool, Liverpool
| | - Catriona Rachel Mayland
- Academic Palliative and End-of-Life Care Department, Royal Liverpool University Hospital, Liverpool.,Palliative Care Unit, University of Liverpool, Liverpool.,Department of Oncology and Metabolism, University of Sheffield, Sheffield
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Zambrano SC, Haugen DF, van der Heide A, Tripodoro VA, Ellershaw J, Fürst CJ, Voltz R, Mason S, Daud ML, De Simone G, Kremeike K, Halfdanardottir SI, Sigurdardottir V, Johnson J, Allan S, Hafeez H, Simões C, Sigurdardottir KR, Rasmussen BH, Williamson P, Eychmüller S. Development of an international Core Outcome Set (COS) for best care for the dying person: study protocol. BMC Palliat Care 2020; 19:184. [PMID: 33256786 PMCID: PMC7706044 DOI: 10.1186/s12904-020-00654-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In contrast to typical measures employed to assess outcomes in healthcare such as mortality or recovery rates, it is difficult to define which specific outcomes of care are the most important in caring for dying individuals. Despite a variety of tools employed to assess different dimensions of palliative care, there is no consensus on a set of core outcomes to be measured in the last days of life. In order to optimise decision making in clinical practice and comparability of interventional studies, we aim to identify and propose a set of core outcomes for the care of the dying person. METHODS Following the COMET initiative approach, the proposed study will proceed through four stages to develop a set of core outcomes: In stage 1, a systematic review of the literature will identify outcomes measured in existing peer reviewed literature, as well as outcomes derived through qualitative studies. Grey literature, will also be included. Stage 2 will allow for the identification and determination of patient and proxy defined outcomes of care at the end of life via quantitative and qualitative methods at an international level. In stage 3, from a list of salient outcomes identified through stages 1 and 2, international experts, family members, patients, and patient advocates will be asked to score the importance of the preselected outcomes through a Delphi process. Stage 4 consists of a face-to-face consensus meeting of international experts and patient/family representatives in order to define, endorse, and propose the final Core Outcomes Set. DISCUSSION Core Outcome Sets aim at promoting uniform assessment of care outcomes in clinical practice as well as research. If consistently employed, a robust set of core outcomes for the end of life, and specifically for the dying phase, defined by relevant stakeholders, can ultimately be translated into best care for the dying person. Patient care will be improved by allowing clinicians to choose effective and meaningful treatments, and research impact will be improved by employing internationally agreed clinically relevant endpoints and enabling accurate comparison between studies in systematic reviews and/or in meta-analyses.
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Affiliation(s)
- Sofia C Zambrano
- University Center for Palliative Care, Department of Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.
| | | | | | | | | | | | - Raymond Voltz
- Department of Palliative Care, Universitätsklinikum Köln (AöR), Köln, Germany
| | | | | | | | - Kerstin Kremeike
- Department of Palliative Care, Universitätsklinikum Köln (AöR), Köln, Germany
| | | | | | | | - Simon Allan
- Arohanui Hospice, Palmerston North, New Zealand
| | - Haroon Hafeez
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Peshawar, Pakistan
| | - Catarina Simões
- Palliative Care Team H. Luz Arrábida, Vila Nova de Gaia, Portugal
| | | | | | | | - Steffen Eychmüller
- University Center for Palliative Care, Department of Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
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Kvåle K, Haugen DF, Synnes O. Patients' illness narratives-From being healthy to living with incurable cancer: Encounters with doctors through the disease trajectory. Cancer Rep (Hoboken) 2020; 3:e1227. [PMID: 32671998 PMCID: PMC7941441 DOI: 10.1002/cnr2.1227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/07/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Narrative medicine emphasizes how stories can increase the understanding of patients' experiences and give important insights into how patients interpret and strive to make meaning in the situation they find themselves in. AIM The aim of this study was to gain insight into the illness narratives of cancer patients, from the day they suspected that something was wrong until living with incurable cancer. METHODS AND RESULTS Six men and seven women, aged 47 to 79 years, diagnosed with metastatic cancer and undergoing chemotherapy with life-prolonging intent in an oncology outpatient clinic, were asked to tell their illness stories as freely as possible, without guiding questions. Stories were tape recorded, transcribed, and analyzed by a thematic narrative analysis. Encounters with doctors through the disease trajectory were highlighted by all narrators. Several informants described poor communication and consequences in the form of "doctors delay" and substandard psychosocial care. Continuity in follow-up and the physician's ability or inability to break bad news and adapt information to the patient's wishes and preferences were particularly emphasized. CONCLUSION A key finding was the importance of the doctor's role throughout the whole trajectory. A good doctor-patient relationship was characterized by continuity of care in follow-up, and trust acquired over time, based on the physician's thorough medical knowledge combined with sensitive communication and empathy.
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Affiliation(s)
- Kirsti Kvåle
- Department of Postgraduate StudiesVID Specialized UniversityBergenNorway
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western NorwayHaukeland University HospitalBergenNorway
- Department of Clinical Medicine K1University of BergenBergenNorway
| | - Oddgeir Synnes
- Centre of Diaconal and Professional PracticeVID Specialized UniversityOsloNorway
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11
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Sigurdardottir KR, Hjermstad MJ, Filbet M, Tricou C, McQuillan R, Costantini M, Autelitano C, Bennett MI, Haugen DF. Pilot testing of the first version of the European Association for Palliative Care basic dataset: A mixed methods study. Palliat Med 2019; 33:832-849. [PMID: 31023149 DOI: 10.1177/0269216319844439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inadequate description of palliative care cancer patients in research studies often leads to results having limited generalizability. To standardize the description of the sample, the European Association for Palliative Care basic data set was developed, with 31 core demographic and disease-related variables. AIM To pilot test the data set to check acceptability, comprehensibility and feasibility. DESIGN International, multi-centre pilot study at nine study sites in five European countries, using mixed methods. SETTING/PARTICIPANTS Adult cancer patients and staff in palliative care units, hospices and home care. RESULTS In all, 191 patients (544 screened) and 190 health care personnel were included. Median time to fill in the patient form was 5 min and the health care personnel form was 7 min. Ethnicity was the most challenging item for patients and requires decisions at a national level about whether or how to include. Health care personnel found weight loss, principal diagnosis, additional diagnoses and stage of non-cancer diseases most difficult to respond to. Registration of diagnoses will be changed from International Statistical Classification of Diseases and Related Health Problems, 10th version code to a predefined list, while weight loss and stage of non-cancer diseases will be removed. The pilot study has led to rewording of items, improvement in response options and shortening of the data set to 29 items. CONCLUSION Pilot testing of the first version of the European Association for Palliative Care basic data set confirmed that patients and health care personnel understand the questions in a consistent manner and can answer within an acceptable timeframe. The pilot testing has led to improvement, and the new version is now subject to further testing.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- 1 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,2 European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,3 Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Marianne J Hjermstad
- 2 European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marilene Filbet
- 4 Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Colombe Tricou
- 4 Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | | | - Massimo Costantini
- 6 Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Autelitano
- 7 Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michael I Bennett
- 8 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Dagny Faksvåg Haugen
- 1 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,9 Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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12
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Kotlinska-Lemieszek A, Klepstad P, Haugen DF. Clinically Significant Drug-Drug Interactions Involving Medications Used for Symptom Control in Patients With Advanced Malignant Disease: A Systematic Review. J Pain Symptom Manage 2019; 57:989-998.e1. [PMID: 30776538 DOI: 10.1016/j.jpainsymman.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 11/23/2022]
Abstract
CONTEXT Most patients with advanced malignant disease need to take several drugs to control symptoms. This treatment raises risks of serious adverse effects and drug-drug interactions (DDIs). OBJECTIVES To identify studies reporting clinically significant DDIs involving medications used for symptom control, other than opioids used for pain management, in adult patients with advanced malignant disease. METHODS Systematic review with searches in Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials, from the start of the databases (Embase from 1980) through June 21, 2018. In addition, reference lists of relevant full-text articles were hand-searched. RESULTS Of 9699 retrieved citations, 462 were considered potentially eligible. After full-text reading, 29 were included in the final analysis, together with 13 articles from reference lists. The 42 included publications were case reports, letters to the Editor, and one retrospective study. Drugs most often involved were antiepileptics, antidepressants, corticosteroids, and nonopioid analgesics. Clinical manifestations of identified DDIs included sedation, respiratory depression, serotonin syndrome, neuroleptic malignant syndrome, delirium, seizures, ataxia, liver and kidney failure, bleeding, cardiac arrhythmias, rhabdomyolysis, and others. The most common mechanisms eliciting DDIs were alteration of CYP450-dependent metabolism and overstimulation of serotonin receptors in the central nervous system. CONCLUSION Drugs used for symptom control in patients with advanced cancer may cause serious DDIs. Although there is limited evidence for the risk of clinically significant DDIs, physicians treating patients with cancer should try to limit polypharmacy, avoid drug combinations with a high risk of DDIs, and closely monitor patients for adverse drug reactions.
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Affiliation(s)
- Aleksandra Kotlinska-Lemieszek
- Palliative Medicine Chair and Department, Karol Marcinkowski University of Medical Sciences, Poznan, Poland; Hospice Palium, University Hospital of the Lord's Transfiguration, Poznan, Poland.
| | - Pål Klepstad
- Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care Western Norway, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
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13
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Mayland CR, Gerlach C, Sigurdardottir K, Hansen MIT, Leppert W, Stachowiak A, Krajewska M, Garcia-Yanneo E, Tripodoro VA, Goldraij G, Weber M, Zambon L, Passarini JN, Saad IB, Ellershaw J, Haugen DF. Assessing quality of care for the dying from the bereaved relatives' perspective: Using pre-testing survey methods across seven countries to develop an international outcome measure. Palliat Med 2019; 33:357-368. [PMID: 30628867 PMCID: PMC6376606 DOI: 10.1177/0269216318818299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: The provision of care for dying cancer patients varies on a global basis. In order to improve care, we need to be able to evaluate the current level of care. One method of assessment is to use the views from the bereaved relatives. AIM: The aim of this study is to translate and pre-test the ‘Care Of the Dying Evaluation’ (CODETM) questionnaire across seven participating countries prior to conducting an evaluation of current quality of care. DESIGN: The three stages were as follows: (1) translation of CODE in keeping with standardised international principles; (2) pre-testing using patient and public involvement and cognitive interviews with bereaved relatives; and (3) utilising a modified nominal group technique to establish a common, core international version of CODE. SETTING/PARTICIPANTS: Hospital settings: for each country, at least five patient and public involvement representatives, selected by purposive sampling, fed back on CODETM questionnaire; and at least five bereaved relatives to cancer patients undertook cognitive interviews. Feedback was collated and categorised into themes relating to clarity, recall, sensitivity and response options. Structured consensus meeting held to determine content of international CODE (i-CODE) questionnaire. RESULTS: In total, 48 patient and public involvement representatives and 35 bereaved relatives contributed to the pre-testing stages. No specific question item was recommended for exclusion from CODETM. Revisions to the demographic section were needed to be culturally appropriate. CONCLUSION: Patient and public involvement and bereaved relatives’ perceptions helped enhance the face and content validity of i-CODE. A common, core international questionnaire is now developed with key questions relating to quality of care for the dying.
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Affiliation(s)
- Catriona Rachel Mayland
- 1 Palliative Care Institute, Cancer Research Centre, University of Liverpool, Liverpool, UK.,2 Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Christina Gerlach
- 3 Interdisciplinary Palliative Care Unit, Department of Medicine, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katrin Sigurdardottir
- 4 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,5 Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | - Wojciech Leppert
- 7 Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland.,8 Department of Quality of Life Research, Medical University of Gdansk, Gdansk, Poland
| | | | | | | | - Vilma Adriana Tripodoro
- 11 Pallium Latinoamérica, Buenos Aires, Argentina.,12 Instituto de Investigaciones Medicas Alfredo Lanari, University of Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Goldraij
- 13 Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Martin Weber
- 3 Interdisciplinary Palliative Care Unit, Department of Medicine, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lair Zambon
- 14 Department of Internal Medicine, Campinas State University, Campinas, Brazil
| | | | | | - John Ellershaw
- 1 Palliative Care Institute, Cancer Research Centre, University of Liverpool, Liverpool, UK.,16 Academic Palliative and End-of-Life Care Department, Royal Liverpool University Hospital, Liverpool, UK
| | - Dagny Faksvåg Haugen
- 4 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,6 Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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14
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Hjorth NE, Haugen DF, Schaufel MA. Advance care planning in life-threatening pulmonary disease: a focus group study. ERJ Open Res 2018; 4:00101-2017. [PMID: 29796390 PMCID: PMC5958273 DOI: 10.1183/23120541.00101-2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/24/2018] [Indexed: 11/27/2022] Open
Abstract
Advance care planning (ACP) is a communication process for mapping a patient's wishes and priorities for end-of-life care. In preparation for the introduction of ACP in Norway, we wanted to explore the views of Norwegian pulmonary patients on ACP. We conducted four focus group interviews in a Norwegian teaching hospital, with a sample of 13 patients suffering from chronic obstructive pulmonary disease, lung cancer or lung fibrosis. Analysis was by systematic text condensation. Participants' primary need facing end-of-life communication was “the comforting safety”, implying support, information and transparency, with four underlying themes: 1) provide good team players; 2) offer conversations with basic information; 3) seize the turning point; and 4) balance transparency. Good team players were skilled communicators knowledgeable about treatment and the last phase of life. Patients preferred dialogues at the time of diagnosis and at different “turning points” in the disease trajectory and being asked carefully about their needs for communication and planning. Transparency was important, but difficult to balance. ACP for patients with life-threatening pulmonary disease should rest upon an established patient–doctor/nurse relationship and awareness of turning points in the patient's disease progression. Individually requested and tailored information can support and empower patients and their relatives. Advance care planning may increase patients' feeling of “a comforting safety”, meeting their need for support, information and transparencyhttp://ow.ly/DMQJ30jdIPt
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Affiliation(s)
- Nina Elisabeth Hjorth
- Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway.,Palliative Care Team, Centre for Pain Management and Palliative Care, Haukeland University Hospital, Bergen, Norway
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,Dept of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - Margrethe Aase Schaufel
- Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Research Unit for General Practice, Uni Research Health, Bergen, Norway
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15
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Jaatun EAA, Fallon M, Kofod-Petersen A, Halvorsen K, Haugen DF. Users' perceptions on digital visualization of neuropathic cancer-related pain. Health Informatics J 2017; 25:683-700. [PMID: 28747078 DOI: 10.1177/1460458217720392] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality pain management implies a thorough pain assessment with structured communication between patients and healthcare providers. Pain distribution is an important dimension of cancer pain. Assessment of pain distribution is commonly performed on a pain body map. This study explores how a computerized pain body map may function as a communication tool and visualize pain in patients with advanced cancer. In previous studies, we have developed a tablet-based computerized pain body map for use in cancer patients. The aim of this study was to adapt the computerized pain body map program to patients with neuropathic cancer-related pain, and to develop a separate interface for healthcare providers. We also wanted to investigate the perceived usefulness of this system among patients and healthcare providers. Both patients and healthcare providers perceived that the visualization of pain in the computerized pain body map system had potential to be a positive contribution to clinical pain management, and to improve collaboration between healthcare providers.
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Affiliation(s)
- Ellen Anna Andreassen Jaatun
- Norwegian University of Science and Technology, Norway; St. Olavs Hospital, Trondheim University Hospital, Norway
| | | | - Anders Kofod-Petersen
- Norwegian University of Science and Technology, Norway; The Alexandra Institute, Denmark
| | | | - Dagny Faksvåg Haugen
- Norwegian University of Science and Technology, Norway; Haukeland University Hospital, Norway; University of Bergen, Norway
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16
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Groeneveld EI, Cassel JB, Bausewein C, Csikós Á, Krajnik M, Ryan K, Haugen DF, Eychmueller S, Gudat Keller H, Allan S, Hasselaar J, García-Baquero Merino T, Swetenham K, Piper K, Fürst CJ, Murtagh FE. Funding models in palliative care: Lessons from international experience. Palliat Med 2017; 31:296-305. [PMID: 28156188 PMCID: PMC5405831 DOI: 10.1177/0269216316689015] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. AIM To assess national models and methods for financing and reimbursing palliative care. DESIGN Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. RESULTS Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. CONCLUSION Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.
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Affiliation(s)
- E Iris Groeneveld
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - J Brian Cassel
- 2 School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Claudia Bausewein
- 3 Department of Palliative Medicine, Munich University Hospital, Ludwigs-Maximilians-University Munich, Munich, Germany
| | - Ágnes Csikós
- 4 PTE ÁOK Családorvostani Intézet, Hospice-Palliativ Tanszék, Pécs, Hungary
| | - Malgorzata Krajnik
- 5 Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Karen Ryan
- 6 Saint Francis Hospice and Mater Hospital, Dublin, Ireland
| | - Dagny Faksvåg Haugen
- 7 Regional Centre of Excellence for Palliative Care, Haukeland University Hospital, Bergen, Norway.,8 Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | | | | | - Simon Allan
- 11 Arohanui Hospice, Palmerston North, New Zealand
| | - Jeroen Hasselaar
- 12 Department of Anesthesiology, Pain and Palliative Care, RadboudUMC, Nijmegen, The Netherlands
| | - Teresa García-Baquero Merino
- 13 Viceconsejería de Asistencia Sanitaria, Consejería de Sanidad de Madrid, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Kate Swetenham
- 14 Southern Adelaide Palliative Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Kym Piper
- 15 Finance & Corporate Services, South Australia Health, Adelaide, SA, Australia
| | - Carl Johan Fürst
- 16 Palliativa Utvecklingscentrum, Lund University and Region Skåne, Lund, Sweden
| | - Fliss Em Murtagh
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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17
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Abstract
In the end stages of life, drug treatment goals shift to symptom control and quality of life and as such changes in drug utilization are expected. The aim of this paper is to review the extent to which costs are considered in drug utilization research at the end of life, with a particular focus on the outcome measures being used. This systematic review identified seven studies across varied settings studies reporting both drug utilization and medication cost outcome measures. The main factors identified that impacted medication use and cost were the time period considered and the provision of specialist palliative care services. Combining drug utilization and medication cost outcomes is critical for the allocation of healthcare resources and the development of a sound health policy.
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Affiliation(s)
- Lisa Pont
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , North Ryde , Australia
| | - Kristian Jansen
- b Research Unit for General Practice, Uni Research Health, University of Bergen , Bergen , Norway.,c Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
| | - Margrete Aase Schaufel
- b Research Unit for General Practice, Uni Research Health, University of Bergen , Bergen , Norway.,d Department of Thoracic Medicine , Haukeland University Hospital , Bergen , Norway
| | - Dagny Faksvåg Haugen
- e Regional Centre of Excellence for Palliative Care, Haukeland University Hospital , Bergen , Norway.,f Department of Clinical Medicine , University of Bergen , Bergen , Norway
| | - Sabine Ruths
- b Research Unit for General Practice, Uni Research Health, University of Bergen , Bergen , Norway.,c Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
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18
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Hjermstad MJ, Kaasa S, Caraceni A, Loge JH, Pedersen T, Haugen DF, Aass N. Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer. BMJ Support Palliat Care 2016; 6:344-52. [PMID: 27342412 DOI: 10.1136/bmjspcare-2015-000887] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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: 03/11/2015] [Accepted: 05/31/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Breakthrough cancer pain (BTP) represents a treatment challenge. Objectives were to examine the prevalence and characteristics of BTP in an international sample of patients with cancer, and to investigate the relationship between BTP and quality of life (QoL). METHODS This was an observational cross-sectional multicentre study. Participating patients completed self-report questionnaires on a touch-screen laptop computer, including the Brief Pain Inventory, Alberta Breakthrough Pain Assessment Tool (ABPAT) and European Organisation for Research and Treatment of Cancer 30-item Core Quality of Life Questionnaire (EORTC QLQ-C30). The study was performed in 17 centres in 8 countries and involved 4 languages (Norwegian, Italian, German and English). RESULTS Records from a convenience sample of 978 patients with advanced cancer were analysed; mean age was 62.2 years, 48.3% were women and 84.4% had metastatic disease. A total of 296 patients (30%) had no pain, defined as worst pain in the past 24 hours <1 on a 0-10 scale. Of the 682 patients with a pain score ≥1, 393 (58%) reported no BTP on the screening item, while 289 (30%) confirmed flare ups of BTP. Patients with BTP reported significantly higher pain intensity scores (<0.001) than patients without BTP; 57.1% of patients rated BTP at its worst as being severe: ≥7 on a 0-10 scale. Time from onset to peak intensity was <10 min for 42.9%, and average time to pain relief was 27.1 min. BTP was commonly triggered by medication wearing off (28%). Patients with BTP had significantly worse mean outcomes on 10 of 15 functional and symptom scales of the EORTC QLQ-C30 (<0.001). Severe pain intensity in the last week was a powerful predictor of BTP (OR 4.1) and poor QoL (OR 1.9). CONCLUSIONS BTP is highly prevalent with prolonged episodes despite analgaesics, and has a pervasive impact on QoL. Patients reporting high pain intensity should be carefully evaluated for BTP and efficacy of analgaesic treatment, to provide optimal pain management and improve QoL. TRIAL REGISTRATION NUMBER NCT00972634; Results.
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Affiliation(s)
- Marianne Jensen Hjermstad
- Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stein Kaasa
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Augusto Caraceni
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS, Istituto Nazionale Dei Tumori, Milano, Italy
| | - Jon H Loge
- Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Tore Pedersen
- Bjørknes University College, Oslo, Norway National Institute of Occupational Health, Oslo, Norway
| | - Dagny Faksvåg Haugen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - Nina Aass
- Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
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19
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Sommerbakk R, Haugen DF, Tjora A, Kaasa S, Hjermstad MJ. Barriers to and facilitators for implementing quality improvements in palliative care - results from a qualitative interview study in Norway. BMC Palliat Care 2016; 15:61. [PMID: 27422410 PMCID: PMC4947264 DOI: 10.1186/s12904-016-0132-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation of quality improvements in palliative care (PC) is challenging, and detailed knowledge about factors that may facilitate or hinder implementation is essential for success. One part of the EU-funded IMPACT project (IMplementation of quality indicators in PAlliative Care sTudy) aiming to increase the knowledge base, was to conduct national studies in PC services. This study aims to identify factors perceived as barriers or facilitators for improving PC in cancer and dementia settings in Norway. METHODS Individual, dual-participant and focus group interviews were conducted with 20 employees working in different health care services in Norway: two hospitals, one nursing home, and two local medical centers. Thematic analysis with a combined inductive and theoretical approach was applied. RESULTS Barriers and facilitators were connected to (1) the innovation (e.g. credibility, advantage, accessibility, attractiveness); (2) the individual professional (e.g. motivation, PC expertise, confidence); (3) the patient (e.g. compliance); (4) the social context (e.g. leadership, culture of change, face-to-face contact); (5) the organizational context (e.g. resources, structures/facilities, expertise); (6) the political and economic context (e.g. policy, legislation, financial arrangements) and (7) the implementation strategy (e.g. educational, meetings, reminders). Four barriers that were particular to PC were identified: the poor general condition of patients in need of PC, symptom assessment tools that were not validated in all patient groups, lack of PC expertise and changes perceived to be at odds with staff's philosophy of care. CONCLUSION When planning an improvement project in PC, services should pay particular attention to factors associated with their chosen implementation strategy. Leaders should also involve staff early in the improvement process, ensure that they have the necessary training in PC and that the change is consistent with the staff's philosophy of care. An important consideration when implementing a symptom assessment tool is whether or not the tool has been validated for the relevant patient group, and to what degree patients need to be involved when using the tool.
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Affiliation(s)
- Ragni Sommerbakk
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology and St. Olavs Hospital, Trondheim University Hospital, P.O. Box 8905, N-7491, Trondheim, Norway. .,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology and St. Olavs Hospital, Trondheim University Hospital, P.O. Box 8905, N-7491, Trondheim, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Aksel Tjora
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology and St. Olavs Hospital, Trondheim University Hospital, P.O. Box 8905, N-7491, Trondheim, Norway.,Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology and St. Olavs Hospital, Trondheim University Hospital, P.O. Box 8905, N-7491, Trondheim, Norway.,Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway
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Hjermstad MJ, Aass N, Aielli F, Bennett M, Brunelli C, Caraceni A, Cavanna L, Fassbender K, Feio M, Haugen DF, Jakobsen G, Laird B, Løhre ET, Martinez M, Nabal M, Noguera-Tejedor A, Pardon K, Pigni A, Piva L, Porta-Sales J, Rizzi F, Rondini E, Sjøgren P, Strasser F, Turriziani A, Kaasa S. Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research. BMJ Support Palliat Care 2016; 8:456-467. [PMID: 27246166 DOI: 10.1136/bmjspcare-2015-000997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 02/05/2016] [Accepted: 05/10/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Palliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes. METHODS This was an international prospective multicentre study with a single web-based survey on PC organisation, services and academics and patients' self-reported symptoms collected at baseline and monthly thereafter, with concurrent registrations of medical data by healthcare providers. Participants were patients ≥18 enrolled in a PC programme. RESULTS 30 centres in 12 countries participated; 24 hospitals, 4 hospices, 1 nursing home, 1 home-care service. 22 centres (73%) had PC in-house teams and inpatient and outpatient services. 20 centres (67%) had integral chemotherapy/radiotherapy services, and most (28/30) had access to general medical or oncology inpatient units. Physicians or nurses were present 24 hours/7 days in 50% and 60% of centres, respectively. 50 centres (50%) had professorships, and 12 centres (40%) had full-time/part-time research staff. Data were available on 1698 patients: 50% females; median age 66 (range 21-97); median Karnofsky score 70 (10-100); 1409 patients (83%) had metastatic/disseminated disease; tiredness and pain in the past 24 hours were most prominent. During follow-up, 1060 patients (62%) died; 450 (44%) <3 months from inclusion and 701 (68%) within 6 months. ANOVA and χ2 tests showed that hospice/nursing home patients were significantly older, had poorer performance status and had shorter survival compared with hospital-patients (p<.0.001). CONCLUSIONS There is a wide variation in PC services and patients across Europe. Detailed characterisation is the first step in improving PC services and research. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT01362816.
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Affiliation(s)
- M J Hjermstad
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Oslo, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - N Aass
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - F Aielli
- Medical Oncology Department, University of L'Aquila, L'Aquila, Italy
| | - M Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - C Brunelli
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Pain Therapy and Rehabilitation Unit, Department of Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Caraceni
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Pain Therapy and Rehabilitation Unit, Department of Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Cavanna
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - K Fassbender
- Cross Cancer Institute, Regional Cancer Centre Northern Alberta, Edmonton, Alberta, Canada
| | - M Feio
- Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - D F Haugen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - G Jakobsen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - B Laird
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - E T Løhre
- Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M Martinez
- Clínica Universidad de Navarra, Pamplona, Spain
| | - M Nabal
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | - K Pardon
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - A Pigni
- Pain Therapy and Rehabilitation Unit, Department of Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Piva
- Unità di Cure Palliative Azienda Ospedaliera San Paolo, Milan, Italy
| | - J Porta-Sales
- Palliative Care Service, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), WeCare Chair: end of life care, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - F Rizzi
- U.O. Complessa Cure Palliative e Terapia del Dolore Istituti Clinici di Perfezionamento, Milan, Italy
| | - E Rondini
- Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - P Sjøgren
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - F Strasser
- Oncological Palliative Medicine, Oncology Department, Internal Medicine & Palliative Centre Cantonal Hospital, St. Gallen, Switzerland
| | - A Turriziani
- Hospice Villa Speranza, Università Cattolica S. Cuore, Rome, Italy
| | - S Kaasa
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Kotlinska-Lemieszek A, Klepstad P, Haugen DF. Clinically significant drug-drug interactions involving opioid analgesics used for pain treatment in patients with cancer: a systematic review. Drug Des Devel Ther 2015; 9:5255-67. [PMID: 26396499 PMCID: PMC4577251 DOI: 10.2147/dddt.s86983] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Opioids are the most frequently used drugs to treat pain in cancer patients. In some patients, however, opioids can cause adverse effects and drug-drug interactions. No advice concerning the combination of opioids and other drugs is given in the current European guidelines. OBJECTIVE To identify studies that report clinically significant drug-drug interactions involving opioids used for pain treatment in adult cancer patients. DESIGN AND DATA SOURCES Systematic review with searches in Embase, MEDLINE, and Cochrane Central Register of Controlled Trials from the start of the databases (Embase from 1980) through January 2014. In addition, reference lists of relevant full-text papers were hand-searched. RESULTS Of 901 retrieved papers, 112 were considered as potentially eligible. After full-text reading, 17 were included in the final analysis, together with 15 papers identified through hand-searching of reference lists. All of the 32 included publications were case reports or case series. Clinical manifestations of drug-drug interactions involving opioids were grouped as follows: 1) sedation and respiratory depression, 2) other central nervous system symptoms, 3) impairment of pain control and/or opioid withdrawal, and 4) other symptoms. The most common mechanisms eliciting drug-drug interactions were alteration of opioid metabolism by inhibiting the activity of cytochrome P450 3A4 and pharmacodynamic interactions due to the combined effect on opioid, dopaminergic, cholinergic, and serotonergic activity in the central nervous system. CONCLUSION Evidence for drug-drug interactions associated with opioids used for pain treatment in cancer patients is very limited. Still, the cases identified in this systematic review give some important suggestions for clinical practice. Physicians prescribing opioids should recognize the risk of drug-drug interactions and if possible avoid polypharmacy.
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Affiliation(s)
- Aleksandra Kotlinska-Lemieszek
- Palliative Medicine Chair and Department, University Hospital of the Lord’s Transfiguration, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Pål Klepstad
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesiology and Intensive Care Medicine, St Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Regional Centre of Excellence for Palliative Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
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22
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Haugen DF. Første danske lærebok i palliativ medisin. Tidsskriftet 2015. [DOI: 10.4045/tidsskr.15.0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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23
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Janberidze E, Hjermstad MJ, Haugen DF, Sigurdardottir KR, Løhre ET, Lie HC, Loge JH, Kaasa S, Knudsen AK. How are patient populations characterized in studies investigating depression in advanced cancer? Results from a systematic literature review. J Pain Symptom Manage 2014; 48:678-98. [PMID: 24681108 DOI: 10.1016/j.jpainsymman.2013.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/22/2013] [Accepted: 12/12/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Prevalence rates of depression in patients with advanced cancer vary considerably. This may be because of heterogeneous samples and use of different assessment methods. Adequate sample descriptions and consistent use of measures are needed to be able to generalize research findings and apply them to clinical practice. OBJECTIVES Our objective was twofold: First, to investigate which clinically important variables were used to describe the samples in studies of depression in patients with advanced cancer; and second, to examine the methods used for assessing and classifying depression in these studies. METHODS PubMed, PsycINFO, Embase, and CINAHL were searched combining search term groups representing "depression," "palliative care," and "advanced cancer" covering 2007-2011. Titles and abstracts were screened, and relevant full-text articles were evaluated independently by two authors. Information on 32 predefined variables on cancer disease, treatment, sociodemographics, depression-related factors, and assessment methods was extracted from the articles. RESULTS After removing duplicates, 916 citations were screened of which 59 articles were retained. Age, gender, and stage of the cancer disease were the most frequently reported variables. Depression-related variables were rarely reported, for example, antidepressant use (17%) and previous depressive episodes (12%). Only 25% of the studies assessed and classified depression according to a validated diagnostic system. CONCLUSION Current practice for describing sample characteristics and assessing depression varies greatly between studies. A more standardized practice is recommended to enhance the generalizability and utility of findings. Stakeholders are encouraged to work toward a common standard for sample descriptions.
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Affiliation(s)
- Elene Janberidze
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Katrin Ruth Sigurdardottir
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway; Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Erik Torbjørn Løhre
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon Håvard Loge
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway; National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Sigurdardottir KR, Oldervoll L, Hjermstad MJ, Kaasa S, Knudsen AK, Løhre ET, Loge JH, Haugen DF. How are palliative care cancer populations characterized in randomized controlled trials? A literature review. J Pain Symptom Manage 2014; 47:906-914.e17. [PMID: 24018205 DOI: 10.1016/j.jpainsymman.2013.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/05/2013] [Accepted: 06/14/2013] [Indexed: 02/08/2023]
Abstract
CONTEXT The difficulties in defining a palliative care patient accentuate the need to provide stringent descriptions of the patient population in palliative care research. OBJECTIVES To conduct a systematic literature review with the aim of identifying which key variables have been used to describe adult palliative care cancer populations in randomized controlled trials (RCTs). METHODS The data sources used were MEDLINE (1950 to January 25, 2010) and Embase (1980 to January 25, 2010), limited to RCTs in adult cancer patients with incurable disease. Forty-three variables were systematically extracted from the eligible articles. RESULTS The review includes 336 articles reporting RCTs in palliative care cancer patients. Age (98%), gender (90%), cancer diagnosis (89%), performance status (45%), and survival (45%) were the most frequently reported variables. A large number of other variables were much less frequently reported. CONCLUSION A substantial variation exists in how palliative care cancer populations are described in RCTs. Few variables are consistently registered and reported. There is a clear need to standardize the reporting. The results from this work will serve as the basis for an international Delphi process with the aim of reaching consensus on a minimum set of descriptors to characterize a palliative care cancer population.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.
| | - Line Oldervoll
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Røros Rehabilitation Centre, Røros, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Erik Torbjørn Løhre
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jon Håvard Loge
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; National Resource Centre for Late Effects After Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Jaatun EAA, Hjermstad MJ, Gundersen OE, Oldervoll L, Kaasa S, Haugen DF. Development and testing of a computerized pain body map in patients with advanced cancer. J Pain Symptom Manage 2014; 47:45-56. [PMID: 23856098 DOI: 10.1016/j.jpainsymman.2013.02.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/25/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Pain localization is an important part of pain assessment. Development of pain tools for self-report should include expert and patient input, and patient testing in large samples. OBJECTIVES To develop a computerized pain body map (CPBM) for use in patients with advanced cancer. METHODS Three studies were conducted: 1) an international expert survey and a pilot study guiding the contents and layout of the CPBM, 2) clinical testing in an international symptom assessment study in eight countries and 17 centers (N = 533), and 3) comparing patient pain markings on computer and paper body maps (N = 92). RESULTS Study 1: 22 pain experts and 28 patients participated. A CPBM with anterior and posterior whole body views was developed for marking pain locations, supplemented by pain intensity ratings for each location. Study 2: 533 patients (286 male, 247 female, mean age 62 years) participated; 80% received pain medication and 81% had metastatic disease. Eighty-five percent completed CPBM as intended. Mean ± SD number of marked pain locations was 1.8 ± 1.2. Aberrant markings (15%) were mostly related to software problems. No differences were found regarding age, gender, cognitive/physical performance, or previous computer experience. Study 3: 70% of the patients had identical markings on the computer and paper maps. Only four patients had completely different markings on the two maps. CONCLUSION This first version of CPBM was well accepted by patients with advanced cancer. However, several areas for improvement were revealed, providing a basis for the development of the next version, which is subject to further international testing.
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Affiliation(s)
- Ellen Anna Andreassen Jaatun
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Otolaryngology and Head and Neck Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway.
| | - Odd Erik Gundersen
- Department of Computer and Information Science, Norwegian University of Science and Technology, Trondheim, Norway; Verdande Technology AS, Trondheim, Norway
| | - Line Oldervoll
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Research Centre for Health Promotion and Resources, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Affiliation(s)
- Hartwig Kørner
- Department of GI Surgery, Stavanger University Hospital, Stavanger, Norway; Regional Centre of Excellence for Palliative Care Western Norway, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine 1, University of Bergen, Bergen, Norway.
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Abstract
BACKGROUND The criteria for refraining from cardiopulmonary resuscitation in palliative care cancer patients are based on patients' right to refuse treatment and the duty of the treating personnel not to exacerbate their suffering and not to administer futile treatment. When is cardiopulmonary resuscitation futile in these patients? METHOD Systematic literature searches were conducted in PubMed for the period 1989-2010 on the results of in-hospital cardiopulmonary resuscitation in advanced cancer patients and on factors that affected the results of CPR when special mention was made of cancer. The searches yielded 333 hits and 18 included articles: four meta-analyses, eight retrospective clinical studies, and six review articles. RESULTS Cancer patients had a poorer post-CPR survival than non-cancer patients. Survival declined with increasing extent of the cancer disease. Widespread and therapy-resistant cancer disease coupled with a performance status lower than WHO 2 or a PAM score (Pre-Arrest Morbidity Index) of above 8 was regarded as inconsistent with survival after cardiopulmonary resuscitation. INTERPRETATION Cardiopulmonary resuscitation is futile for in-hospital cancer patients with widespread incurable disease and poor performance status.
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Haugen DF. Historien om pasientene ingen ville ha. Tidsskriftet 2013. [DOI: 10.4045/tidsskr.13.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Gomes B, Higginson IJ, Calanzani N, Cohen J, Deliens L, Daveson BA, Bechinger-English D, Bausewein C, Ferreira PL, Toscani F, Meñaca A, Gysels M, Ceulemans L, Simon ST, Pasman HRW, Albers G, Hall S, Murtagh FEM, Haugen DF, Downing J, Koffman J, Pettenati F, Finetti S, Antunes B, Harding R. Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann Oncol 2012; 23:2006-2015. [PMID: 22345118 DOI: 10.1093/annonc/mdr602] [Citation(s) in RCA: 365] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences for place of death cross-nationally. METHODS A telephone survey of a random sample of individuals aged ≥16 in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We determined where people would prefer to die if they had a serious illness such as advanced cancer, facilitating circumstances, personal values and experiences of illness, death and dying. RESULTS Of 9344 participants, between 51% (95% CI: 48% to 54%) in Portugal and 84% (95% CI: 82% to 86%) in the Netherlands would prefer to die at home. Cross-national analysis found there to be an influence of circumstances and values but not of experiences of illness, death and dying. Four factors were associated with a preference for home death in more than one country: younger age up to 70+ (Germany, the Netherlands, Portugal, Spain), increased importance of dying in the preferred place (England, Germany, Portugal, Spain), prioritizing keeping a positive attitude (Germany, Spain) and wanting to involve family in decisions if incapable (Flanders, Portugal). CONCLUSIONS At least two-thirds of people prefer a home death in all but one country studied. The strong association with personal values suggests keeping home care at the heart of cancer EoLC.
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Affiliation(s)
- B Gomes
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
| | - I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - N Calanzani
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - J Cohen
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - L Deliens
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Palliative Care Center of Expertise, VU University Medical Center, Amsterdam, the Netherlands; End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - B A Daveson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - D Bechinger-English
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - C Bausewein
- Deutsche Gesellschaft für Palliativmedizin, Berlin, Germany; King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - P L Ferreira
- Centre for Health Studies and Research, University of Coimbra (CEISUC), Coimbra, Portugal
| | - F Toscani
- Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni ONLUS, Cremona, Italy
| | - A Meñaca
- Barcelona Centre for International Health Research (CRESIB-Hospital Clínic), Universitat de Barcelona, Barcelona, Spain
| | - M Gysels
- Barcelona Centre for International Health Research (CRESIB-Hospital Clínic), Universitat de Barcelona, Barcelona, Spain
| | | | - S T Simon
- Center for Palliative Medicine and Clinical Trials Unit, University Hospital Cologne, Cologne, Germany; Institute of Palliative Care (ipac), Oldenburg, Germany
| | - H R W Pasman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Palliative Care Center of Expertise, VU University Medical Center, Amsterdam, the Netherlands
| | - G Albers
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Palliative Care Center of Expertise, VU University Medical Center, Amsterdam, the Netherlands
| | - S Hall
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - F E M Murtagh
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - D F Haugen
- European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Haukeland University Hospital, Bergen, Norway
| | - J Downing
- Formerly African Palliative Care Association (APCA), Kampala, Uganda
| | - J Koffman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - F Pettenati
- Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni ONLUS, Cremona, Italy
| | - S Finetti
- Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni ONLUS, Cremona, Italy
| | - B Antunes
- Centre for Health Studies and Research, University of Coimbra (CEISUC), Coimbra, Portugal; King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - R Harding
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
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Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, De Conno F, Fallon M, Hanna M, Haugen DF, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni M, Mercadante S, Nabal M, Pigni A, Radbruch L, Reid C, Sjogren P, Stone PC, Tassinari D, Zeppetella G. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 2012; 13:e58-68. [PMID: 22300860 DOI: 10.1016/s1470-2045(12)70040-2] [Citation(s) in RCA: 758] [Impact Index Per Article: 63.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Here we provide the updated version of the guidelines of the European Association for Palliative Care (EAPC) on the use of opioids for the treatment of cancer pain. The update was undertaken by the European Palliative Care Research Collaborative. Previous EAPC guidelines were reviewed and compared with other currently available guidelines, and consensus recommendations were created by formal international expert panel. The content of the guidelines was defined according to several topics, each of which was assigned to collaborators who developed systematic literature reviews with a common methodology. The recommendations were developed by a writing committee that combined the evidence derived from the systematic reviews with the panellists' evaluations in a co-authored process, and were endorsed by the EAPC Board of Directors. The guidelines are presented as a list of 16 evidence-based recommendations developed according to the Grading of Recommendations Assessment, Development and Evaluation system.
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Affiliation(s)
- Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Affiliation(s)
- Stein Kaasa
- EPCRC Project Coordinator, European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Trondheim, and Department of Oncology, Trondheim University Hospital, Trondheim, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Sigurdardottir KR, Haugen DF, Bausewein C, Higginson IJ, Harding R, Rosland JH, Kaasa S. A pan-European survey of research in end-of-life cancer care. Support Care Cancer 2010; 20:39-48. [PMID: 21116654 PMCID: PMC3223572 DOI: 10.1007/s00520-010-1048-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 11/11/2010] [Indexed: 12/04/2022]
Abstract
Background To date, there is no coordinated strategy for end-of-life (EOL) cancer care research in Europe. The PRISMA (Reflecting the Positive Diversities of European Priorities for Research and Measurement in End-of-life Care) project is aiming to develop a programme integrating research and measurement in EOL care. This survey aimed to map and describe present EOL cancer care research in Europe and to identify priorities and barriers. Material and methods A questionnaire of 62 questions was developed and 201 researchers in 41 European countries were invited to complete it online in May 2009. An open invitation to participate was posted on the internet. Results Invited contacts in 36 countries sent 127 replies; eight additional responses came through websites. A total of 127 responses were eligible for analysis. Respondents were 69 male and 58 female, mean age 49 (28–74) years; 85% of the scientific team leaders were physicians. Seventy-one of 127 research groups were located in a teaching hospital or cancer centre. Forty-five percent of the groups had only one to five members and 28% six to ten members. Sixty-three of 92 groups reported specific funding for EOL care research. Seventy-five percent of the groups had published papers in journals with impact factor ≤5 in the last 3 years; 8% had published in journals with impact factor >10. Forty-four out of 90 groups reported at least one completed Ph.D. in the last 3 years. The most frequently reported active research areas were pain, assessment and measurement tools, and last days of life and quality of death. Very similar areas—last days of life and quality of death, pain, fatigue and cachexia, and assessment and measurement tools—were ranked as the most important research priorities. The most important research barriers were lack of funding, lack of time, and insufficient knowledge/expertise. Conclusions Most research groups in EOL care are small. The few large groups (14%) had almost half of the reported publications, and more than half of the current Ph.D. students. There is a lack of a common strategy and coordination in EOL cancer care research and a great need for international collaboration. Electronic supplementary material The online version of this article (doi:10.1007/s00520-010-1048-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, 7006, Trondheim, Norway.
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Haugen DF, Hjermstad MJ, Hagen N, Caraceni A, Kaasa S. Assessment and classification of cancer breakthrough pain: A systematic literature review. Pain 2010; 149:476-482. [DOI: 10.1016/j.pain.2010.02.035] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 01/19/2010] [Accepted: 02/19/2010] [Indexed: 01/30/2023]
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Sigurdardottir KR, Haugen DF, van der Rijt CCD, Sjøgren P, Harding R, Higginson IJ, Kaasa S. Clinical priorities, barriers and solutions in end-of-life cancer care research across Europe. Report from a workshop. Eur J Cancer 2010; 46:1815-22. [PMID: 20456947 DOI: 10.1016/j.ejca.2010.03.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/16/2010] [Indexed: 11/18/2022]
Abstract
AIM The PRISMA project is aiming to co-ordinate research priorities, measurement and practice in end-of-life (EOL) care in Europe. As part of PRISMA we undertook a questionnaire survey and a subsequent workshop to (1) identify clinical priorities for EOL care research in Europe and propose a future research agenda and (2) identify barriers to EOL care research, and possibilities and solutions to improve the research. METHODS Thirty participants selected among the principally medical survey responders from 25 European countries attended. Twenty-six answered a preparatory pre-workshop questionnaire based on the survey results. Group work was a main part of the workshop. RESULTS Consensus was reached on the following priorities for EOL cancer care research in Europe: symptomatology, issues related to care of the dying, and policy and organisation of services. Methodology was regarded important in all areas, including assessment/measurement and classification. Symptom research should particularly emphasise pain, fatigue, cachexia, delirium and breathlessness. Research should move from descriptive to interventional studies. The lack of consensus on definitions and outcomes was identified as a substantial research barrier. Other barriers were related to capacity and funding, environment and culture and knowledge transfer and dissemination. These areas are interrelated and should not be addressed in isolation. CONCLUSION Consensus was obtained on priority areas and research nature for EOL care research in the next years, and a model for addressing barriers was developed.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- Dept. of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, St Olavs Hospital, N-7006 Trondheim, Norway.
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Fyllingen EH, Oldervoll LM, Loge JH, Hjermstad MJ, Haugen DF, Sigurdardottir KR, Paulsen O, Kaasa S. Computer-based assessment of symptoms and mobility in palliative care: feasibility and challenges. J Pain Symptom Manage 2009; 38:827-36. [PMID: 19833476 DOI: 10.1016/j.jpainsymman.2009.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 04/30/2009] [Accepted: 05/14/2009] [Indexed: 11/16/2022]
Abstract
The aims of the study were to explore the ability of cancer patients who are primarily receiving palliative care to use a touchscreen computer for assessment of symptoms and mobility and to investigate which factors predicted the need for assistance during the assessment. Before the main data collection, a pilot study was conducted to explore the preferences of these patients toward using such a computerized assessment tool. Patients were recruited from nine different inpatient and outpatient palliative care and general cancer clinics in Norway. The patients responded to 60 items on symptoms and mobility directly on the computer. In the pilot study (n=20), 11 patients (55.0%) preferred computerized assessment over paper and pencil, whereas five (25.0%) had no preference. In the main data collection, 370 patients (52.7% men with mean age 62 years and mean Karnofsky Performance Status score of 70) completed the assessment. Eighty-six patients (23.2%) required assistance. Patients requiring assistance were significantly older, had worse performance status, and poorer cognitive function than those not requiring assistance. Predictors for requiring assistance were age (P<0.001) and performance status (P<0.001). Because higher age and worse performance status resulted in more need of assistance, assessment tools should be short and user-friendly to ensure good compliance in frail patients.
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Affiliation(s)
- Even Hovig Fyllingen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Abstract
At present, there is no universally accepted cancer pain assessment tool for use in palliative care (PC). The European Palliative Care Research Collaborative (EPCRC), therefore, aims to develop an international consensus-based computerised pain assessment tool. As part of this process, we have performed (1) a literature review on pain assessment tools for use in the PC and (2) an international expert survey to gain information on the relevant dimensions for pain assessment in PC. 230 publications were identified, only six met the inclusion criteria. Three further articles were identified through manual searching, totalling 11 different pain assessment tools. Nine tools were multidimensional. Pain intensity was assessed in seven, using various numerical/verbal rating scales (NRS/VRS); five tools focused on pain management. Three publications did not identify the rationale for the need to develop a new tool, and the selection procedure for items/dimensions was not described in six tools. Patient and/or professional expert groups were involved in the development of five tools and only two tools were extensively validated or cross-culturally tested. Thirty-two experts (71%) completed the expert survey and identified 'intensity', 'temporal pattern', 'relief/exacerbation', 'pain quality' and 'location' as the five most relevant dimensions. Most preferred assessment of 'pain intensity' was by NRS rather than VRS. Time windows extending 24 h were regarded as less relevant. Development of PC pain assessment tools seems to be a continuous process, which does not adhere to systematic guidelines, thus does not contribute to a universally accepted tool. No tool contained all relevant dimensions as defined by the experts. Many tools focused on particular dimensions, suggesting that specific research interests may drive the tool development process. Extensive literature reviews, expert and patient input and clinical studies are a needed approach in the development of a new consensus-based pain assessment tool.
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Affiliation(s)
- M J Hjermstad
- Department of Oncology, Ullevaal University Hospital, Oslo.
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Kaasa S, Loge JH, Fayers P, Caraceni A, Strasser F, Hjermstad MJ, Higginson I, Radbruch L, Haugen DF. Symptom Assessment in Palliative Care: A Need for International Collaboration. J Clin Oncol 2008; 26:3867-73. [DOI: 10.1200/jco.2007.15.8881] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This article describes the research strategy for the development of a computerized assessment tool as part of a European Union (EU)–funded project, the European Palliative Care Research Collaborative (EPCRC). The EPCRC is funded through the Sixth Framework Program of the EU with major objectives to develop a computer-based assessment and classification tool for pain, depression, and cachexia. A systematic approach will be applied for the tool development with emphasis on multicultural and multilanguage challenges across Europe. The EPCRC is based on a long lasting collaboration within the European Association for Palliative Care Research Network. The ongoing change in society towards greatly increased use of communication as well as information transfer via digital systems will rapidly change the health care system. Therefore, patient-centered outcome assessment tools applicable for both clinic and research should be developed. Report of symptoms via digital media provides a start for face-to-face communication, treatment decisions, and assessment of treatment effects. The increased use of electronic media for exchange of information may facilitate the development and use of electronic assessment tools and decision-making systems in oncology. In the future, patients may find that a combination of a face-to-face interview plus a transfer of information of subjective symptoms by electronic means will optimize treatment.
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Affiliation(s)
- Stein Kaasa
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Jon Håvard Loge
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Peter Fayers
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Augusto Caraceni
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Florian Strasser
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Marianne Jensen Hjermstad
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Irene Higginson
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Lukas Radbruch
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Dagny Faksvåg Haugen
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Abstract
BACKGROUND AND AIMS Palliative medicine is not recognized as a medical specialty in any of the five Nordic countries, but there is a great need for physicians with specialty qualifications to serve on an increasing number of palliative care services. The Associations for Palliative Medicine in the five countries agreed to develop a common Nordic course on a specialty level. RESULTS A theoretical training course in six modules in two years was developed, based on the British palliative medicine curriculum and including a limited research project and a written exam. Twenty-two out of 30 students completed the first course as scheduled in 2005, and five more have obtained their course diploma later. The evaluation from the students showed very satisfactory personal experiences and subjective learning outcomes, and a positive influence on the overall development of palliative care in the respective countries. CONCLUSION The Nordic Specialist Course in Palliative Medicine has proved a successful Nordic collaboration and may form the basis for a full specialist training programme.
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Affiliation(s)
- D F Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.
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Haugen DF. [Cooperation about palliation]. Tidsskr Nor Laegeforen 2007; 127:2217. [PMID: 17828312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
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Abstract
Palliative care (PC) in Norway has evolved in close cooperation between the health authorities and health care professionals. A number of official reports and national plans have promoted a stepwise development of PC services on all levels of the public health care system: tertiary care, with palliative medicine units in university hospitals coupled with research groups and regional Units of Service Development; secondary care, with hospital-based consult teams, inpatient units, and outpatient clinics; and primary care, with home care and designated PC units in nursing homes. The regional Units of Service Development are specifically assigned to research, education, and audit, as well as to development and coordination of services. PC has been closely linked to cancer care and included in the national cancer strategy. Starting the organizational development at the tertiary level has been crucial for educational and audit purposes, and has provided an excellent basis for networking. The Norwegian strategy for PC has resulted in rapidly increasing quantity and quality of services, but several challenges are still pending. Further improvement of the financial reimbursement system is needed, in particular concerning the funding for PC units in nursing homes. There are also challenges related to expertise and training, including establishing a program for palliative nursing and getting palliative medicine recognized as a medical specialty.
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Affiliation(s)
- Stein Kaasa
- Palliative Medicine Unit, Department of Oncology, St Olavs Hospital, Trondheim, Norway.
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Abstract
PURPOSE Pain severely impairs health-related quality of life and is a feared symptom among cancer patients. Unfortunately, patients often do not receive optimal care. We wanted to evaluate the quality of cancer pain treatment in Norwegian hospitals. PATIENTS AND METHODS A one-day prevalence study targeting hospitalised cancer patients above 18 years of age was performed. A questionnaire based on the Brief Pain Inventory was used, and additional information regarding sex, age, diagnosis, break through pain (BTP), and treatment was included. RESULTS Fifty two percent of the included patients stated having cancer related pain (n=453), and mean pain during the previous 24 hours for these patients was NRS 3.99 (Numeric Rating scale 1-10). Presence of metastasis, occurrence of BTP, and abnormal skin sensibility in the area of pain were associated with higher pain scores. Forty two percent of all patients used opioids. However, these patients still had higher pain scores, more episodes of BTP, and more influence of the pain on daily life functions than average. Thirty percent of patients with severe pain (NRS>or=5) did not use opioids, and some of these patients did not receive any analgesics at all. CONCLUSION Although most cancer patients receive an acceptable pain treatment in Norwegian hospitals, there are patients who are not adequately managed. Lack of basic knowledge and individual systematic symptom assessment may be reasons for the underuse of analgesics and the resulting unnecessary suffering among the cancer patients.
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Affiliation(s)
- Anders Holtan
- Department of Anaesthesia and Post-operative Care, Ullevål University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway.
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Kaasa S, Haugen DF. [The specialist field of palliative medicine]. Tidsskr Nor Laegeforen 2006; 126:326-8. [PMID: 16440041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Palliative medicine means caring for patients with incurable disease and short life expectancy, or, with the British definition, "the study and management of patients with active, progressive, far advanced disease, for whom the prognosis is limited and the focus of care is the quality of life". Palliative medicine is more than care for the dying. Today palliative medicine is regarded as integral to the treatment pathway for all patients with incurable disease. Up to now, mostly cancer patients have been offered specialist palliative care, but the international trend is to include other patient groups, especially patients with degenerative neurological disease and advanced cardiac and pulmonary disease. Palliative medicine is characterized by a focus not primarily on disease control but rather on symptom relief, social support, spiritual care, and maintenance of physical and psychological functioning and wellbeing. To reach these goals, a multi-professional approach is needed, and the doctor in charge must be highly qualified clinically and academically and willing and able to cooperate with colleagues and other healthcare professionals.
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Affiliation(s)
- Stein Kaasa
- Seksjon lindrende behandling, Kreftavdelingen, St. Olavs Hospital og Institutt for kreftforskning og molekylaer medisin, Det medisinske fakultet, Norges teknisk-naturvitenskapelige universitet, 7006 Trondheim
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Kaasa S, Haugen DF, Rosland JH. [Palliative medicine-- research and education in a new specialist field]. Tidsskr Nor Laegeforen 2006; 126:333-6. [PMID: 16440043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Palliative medicine has developed into a recognised specialty in medicine, calling for a high level of skills as well as evidence-based clinical guidelines. The undergraduate teaching in medical schools in Norway is fragmented in this area, and national minimum standards are needed. At the graduate level, teaching in palliative medicine should be included in all relevant specialties. Doctors who are fully involved in palliative medicine should have a specialised education. Recently, a Nordic Curriculum in Palliative Medicine was developed and a two-year course initiated; 30 doctors have graduated. There is a need for research in palliative care, both on the basic biological level as well as on the clinical level. National and international collaboration is needed in order to reach these goals. Nationally, there are some research groups that perform excellently. However, there is a need to strengthen research in this area. Chairs in palliative medicine will facilitate such a development and are urgently needed in all medical schools.
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Affiliation(s)
- Stein Kaasa
- Seksjon lindrende behandling, Kreftavdelingen, St. Olavs Hospital og Institutt for kreftforskning og molekylaer medisin, Det medisinske fakultet, Norges teknisk-naturvitenskapelige universitet, 7006 Trondheim
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Haugen DF, Jordhøy MS, Engstrand P, Hessling SE, Garåsen H. [Organisation of palliative care in and outside hospital]. Tidsskr Nor Laegeforen 2006; 126:329-32. [PMID: 16440042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Patients with advanced, incurable disease need easy access to qualified care. Basic palliative care should be provided in all clinical hospital departments and in community care. In addition, palliative care units in hospitals and nursing homes, and ambulatory, multidisciplinary, palliative care teams have a supportive role by providing teaching, advice, and care, also in primary care. The regional palliative care centres in university hospitals are important centres for research, skills building, and developmental work, in addition to the management of the most complex patients. Palliative care requires much collaboration, and the general practitioner has an important role. In addition, hospital-based palliative care teams are important bridges between the different levels of the health care system. The Norwegian Standard for Palliative Care gives recommendations for the organisation of palliative care at all levels, and forms the basis for this article.
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Affiliation(s)
- Dagny Faksvåg Haugen
- Kompetansesenter i lindrende behandling, Helseregion Vest, Haukeland Universitetssjukehus, 5021 Bergen.
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Kaasa S, Haugen DF. [Palliative medicine]. Tidsskr Nor Laegeforen 2006; 126:294. [PMID: 16440030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
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Aarstad HJ, Aarstad AKH, Lybak S, Monge O, Haugen DF, Olofsson J. The amount of treatment versus quality of life in patients formerly treated for head and neck squamous cell carcinomas. Eur Arch Otorhinolaryngol 2005; 263:9-15. [PMID: 16205902 DOI: 10.1007/s00405-005-0961-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Accepted: 02/21/2005] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to investigate the association between the self-reported quality of life (QoL) versus the initial TNM stage and amount of primary and recurrent tumor therapy given in a population of formerly treated head and neck squamous cell carcinoma (HNSCC) patients. We determined QoL by the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC-QLQ) C30/H&N35 by structured interview. One hundred and twenty-two patients less than 80 years old, who had been diagnosed with HNSCC in western Norway in the period from 1992 to1997, and who had survived until 2000, were identified. Of these patients, 106 were eligible to be included. Ninety-six of these patients agreed to be interviewed. For TNM stage as well as the type of therapy given (local surgery, neck dissection or radiation therapy), T stage predicted the general QoL scores. Both increased TNM stage and all given tumor therapy seemingly caused lower H&N symptom QoL scores. Of the various tumor treatments employed, neck radiation therapy and neck dissection were indicated to be the most closely associated with the H&N QoL scores. Having neck dissection performed seemingly caused impairment beyond what was explained by the initial TNM stage. In conclusion, tumor therapy to HNSCC should not be restricted due to general QoL considerations. Further study of how and when to perform neck treatment is suggested in order to avoid unnecessary reduced H&N QoL.
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Affiliation(s)
- H J Aarstad
- Section of Otolaryngology/Head and Neck Surgery, Department of Surgical Sciences, University of Bergen, Bergen, Norway.
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Aas T, Geisler S, Eide GE, Haugen DF, Varhaug JE, Bassøe AM, Thorsen T, Berntsen H, Børresen-Dale AL, Akslen LA, Lønning PE. Predictive value of tumour cell proliferation in locally advanced breast cancer treated with neoadjuvant chemotherapy. Eur J Cancer 2003; 39:438-46. [PMID: 12751373 DOI: 10.1016/s0959-8049(02)00732-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We previously reported that defects in apoptotic pathways (mutations in the TP53 gene) predicted resistance to doxorubicin monotherapy. The aim of this study was to evaluate whether cell proliferation, as assessed by mitotic frequency and Ki-67 levels, may provide additional predictive information in the same tumours and to assess any potential correlations between these markers and mutations in the TP53 gene and erbB-2 overexpression. Surgical specimens were obtained from ninety locally advanced breast cancers before commencing primary chemotherapy consisting of weekly doxorubicin (14 mg/m2) for 16 weeks. 38% of the patients had a partial response (PR) to therapy, 52% had stable disease (SD) while 10% had progressive disease (PD). Univariate analysis showed a significant association between a high cell proliferation rate (expressed as a high mitotic frequency) and resistance to doxorubicin (P = 0.001). Further analyses revealed this association to be limited to the subgroup of tumour expressing wild-type TP53 (P = 0.016), and TP53 mutation status was the only factor predicting drug resistance in the multivariate analyses. The finding that a high mitotic frequency, as well as a high Ki-67 staining, correlated to TP53 mutations (P = 0.001 for both), suggests TP53 mutations are the key predictor of drug resistance, although cell proliferation may play an additional role in tumours harbouring wild-type TP53. Regarding overall (OS) and relapse-free survival (RFS), multivariate analyses (Cox' proportional hazards regression) revealed a high histological grade and negative oestrogen receptor (ER) status to be the variables that were most strongly related to breast cancer death (P = 0.001 and P = 0.001, respectively). A key reason for this difference with respect to the factors predicting chemotherapy resistance could be due to the adjuvant use of tamoxifen in all patients harbouring ER-positive tumours.
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Affiliation(s)
- T Aas
- Department of Surgery, Haukeland University Hospital, N-5021 Bergen, Norway
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Geisler S, Lønning PE, Aas T, Johnsen H, Fluge O, Haugen DF, Lillehaug JR, Akslen LA, Børresen-Dale AL. Influence of TP53 gene alterations and c-erbB-2 expression on the response to treatment with doxorubicin in locally advanced breast cancer. Cancer Res 2001; 61:2505-12. [PMID: 11289122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
TP53 status [mutations, immunostaining, and loss of heterozygosity (LOH)], expression of c-erbB-2, bcl-2, and histological grading were correlated to the response to doxorubicin monotherapy (14 mg/m2) administered weekly to 90 patients with locally advanced breast cancer. Mutations in the TP53 gene, in particular those affecting or disrupting the loop domains L2 or L3 of the p53 protein, were associated with lack of response to chemotherapy (P = 0.063 for all mutations and P = 0.008 for mutations affecting L2/L3, respectively). Similarly, expression of c-erbB-2 (P = 0.041), a high histological grade (P = 0.023), and lack of expression of bcl-2 (P = 0.018) all predicted chemoresistance. No statistically significant association between either p53 immunostaining or TP53 LOH and response to therapy was recorded, despite the finding that both were associated with TP53 mutation status (p53 immunostaining, P < 0.001; LOH, P = 0.021). Lack of immunostaining for p53 despite mutation of the TP53 gene was particularly seen in tumors harboring nonsense mutations or deletions/splices (7 of 10 negative for staining compared with 4 of 16 with missense mutations). TP53 mutations (total/affecting L2/L3 domains) were associated with expression of c-erbB-2 (P < 0.001 for both), high histological grade (P = 0.001 and P = 0.025), and bcl-2 negativity (P = 0.003 and P = 0.002). TP53 mutations, histological grade, and expression of bcl-2 (but not LOH or c-erbB-2 expression) all predicted for relapse-free as well as breast cancer-specific survival in univariate analysis (Ps between <0.0001 and 0.0155), but only tumor grade was found to be predictive in multivariate analysis (P = 0.01 and P = 0.0007, respectively). Our data are consistent with the hypothesis that certain TP53 mutations predict for resistance to doxorubicin in breast cancer patients. However, the observation that the majority of patients with TP53 mutations affecting or disrupting the L2/L3 domains with LOH in addition (n = 12) obtained a partial response (n = 4) or stabilization of disease (n = 5) during chemotherapy suggests redundant mechanisms to compensate for loss of p53 function. Our findings are consistent with the hypothesis that other defects may act in concert with loss of p53 function, causing resistance to doxorubicin in breast cancers.
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Affiliation(s)
- S Geisler
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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