scholarly journals Forging a New Frontier: Providing Palliative Care to People With Cancer in Rural and Remote Areas

2020 ◽  
Vol 38 (9) ◽  
pp. 963-973 ◽  
Author(s):  
Marie Bakitas ◽  
Kristen Allen Watts ◽  
Emily Malone ◽  
J. Nicholas Dionne-Odom ◽  
Susan McCammon ◽  
...  
Keyword(s):  
Palliative Care ◽  
Best Practices ◽  
Cancer Care ◽  
Care Delivery ◽  
Academic Community ◽  
Rural And Remote ◽  
Delivery Methods ◽  
Community Based ◽  
Early Palliative Care ◽  
Care Models

Mounting evidence supports oncology organizations’ recommendations of early palliative care as a cancer care best practice for patients with advanced cancer and/or high symptom burden. However, few trials on which these best practices are based have included rural and remote community-based oncology care. Therefore, little is known about whether early palliative care models are applicable in these low-resource areas. This literature synthesis identifies some of the challenges of integrating palliative care in rural and remote cancer care. Prominent themes include being mindful of rural culture; adapting traditional geographically based specialty care delivery models to under-resourced rural practices; and using novel palliative care education delivery methods to increase community-based health professional, layperson, and family palliative expertise to account for limited local specialty palliative care resources. Although there are many limitations, many rural and remote communities also have strengths in their capacity to provide high-quality care by capitalizing on close-knit, committed community practitioners, especially if there are receptive local palliative and hospice care champions. Hence, adapting palliative care models, using culturally appropriate novel delivery methods, and providing remote education and support to existing community providers are promising advances to aid rural people to manage serious illness and to die in place. Reformulating health policy and nurturing academic-community partnerships that support best practices are critical components of providing early palliative care for everyone everywhere.

scholarly journals Cancerpedia: A Framework for Implementing Comprehensive Cancer Centres

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 244s-244s
Author(s):  
N. Abdelmutti ◽  
A. Chudak ◽  
M. Merali ◽  
T. Sullivan ◽  
M. Escaf ◽  
...  
Keyword(s):  
Palliative Care ◽  
Best Practices ◽  
Cancer Care ◽  
Care Delivery ◽  
Cancer Control ◽  
System Level ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Centers ◽  
Comprehensive Cancer Centers

Background and context: Comprehensive cancer centers or programs form a nucleus of cancer care delivery. Although there are frameworks for population cancer control, no similar published framework exists for cancer centers. Aim: We sought to develop a framework for designing and implementing a comprehensive cancer center or program within the context of a population-based model of cancer control that spans diagnosis, treatment, supportive care, and palliative care as well as integration with primary care and the community. Strategy/Tactics: The framework was constructed with the patient at the center and provides a system-level perspective as well as a granular view of the fundamental resources and structures needed to build and maintain individual cancer centers and programs. Due to its breadth, we focused the framework on essential information while linking to a wide range of vetted publications that detail additional standards, guidelines and best practices. Program/Policy process: “Cancerpedia” emerged as a cohesive framework for the delivery of high-quality cancer care within and beyond the cancer center. It provides an overview of the cancer control and care delivery framework, describes cancer care services (e.g., radiotherapy, chemotherapy, palliative care) and details infrastructure and core services (e.g., physical facilities, human resources). In addition to these services, the framework presents guidelines for governance that ensure oversight and quality, describes the critical need for integrating education and research and presents the best practices for engaging in philanthropy. Cancerpedia also outlines the role of the comprehensive cancer center in integration with the community and influencing policy and regulation. Over 30 chapters provide a detailed description of each element and include a description of the service or function, resources requirements such as people, equipment and facilities, management structures, quality performance guidelines and future trends in innovation. Outcomes: To our knowledge, no comparable published framework exists as a reference for developing comprehensive cancer centers. Cancerpedia was designed to serve as a global public good and is adaptable and applicable to diverse contexts and healthcare environments. It is relevant to high-, middle- and low-income countries alike and provides a reference point from which to structure a plan for growth. What was learned: While it is important to describe the various elements required for cancer care delivery, it is critical to consider and address the integration and interdependencies of these various elements. Future opportunities for learning include seeking input from a global audience to gauge the utility and applicability of Cancerperdia to local contexts.

Where Patients With Cancer Die: A Population-Based Study, 1990 to 2012

2018 ◽  
Vol 34 (4) ◽  
pp. 224-231 ◽  
Author(s):  
Roger W. Hunt ◽  
Katina D’Onise ◽  
Anh-Minh Thi Nguyen ◽  
Kamalesh Venugopal
Keyword(s):  
Palliative Care ◽  
Nursing Homes ◽  
Care Delivery ◽  
Young Patients ◽  
Population Based ◽  
Place Of Death ◽  
Patients With Cancer ◽  
Metropolitan Hospital ◽  
Care Models ◽  
At Home

Aims:To describe changes in the place of death of patients with cancer from 1990 to 2012, and to identify issues for their end-of-life care.Materials and Methods:Population-based descriptive study, with analyses of place of death patterns, using the South Australian Cancer Registry records of 86 257 patients with cancer who died from 1990 to 2012.Results:From 1990 to 2012, the proportion of cancer deaths in hospital decreased from 63.4% to 50.9%, and in nursing homes increased from 8.2% to 22.5%. After the year 2000, the proportions in hospices and at home were both below 15%. Multivariate analyses showed that young patients with cancer were more likely to die in a hospice or at home, compared to elderly patients with cancer who were more likely to die in a nursing home; the likelihood of dying in a hospice increased with socioeconomic status; patients with a short survival time or a hematological malignancy were more likely to die in a metropolitan hospital.Conclusions:Compared to most other countries, the proportion of cancer deaths at home was low, and many patients would not have died at their preferred place. The trend for more cancer deaths to occur in nursing homes is likely to continue, but nursing homes generally lack the resources and skilled staff to provide quality palliative care. Models of palliative care delivery should take account of patient preferences, the growth of terminal cancer care in nursing homes, and apparent inequities.

Mortality among referrals to a community-based intermediate care team

2017 ◽  
Vol 9 (3) ◽  
pp. 263-266
Author(s):  
Bharath Lakkappa ◽  
Sanjay Shah ◽  
Stephen Rogers ◽  
Leanne Helen Holman
Keyword(s):  
Palliative Care ◽  
Care Team ◽  
Intermediate Care ◽  
Care Needs ◽  
Community Based ◽  
Care Services ◽  
Palliative Care Teams ◽  
Care Models ◽  
End Stage ◽  
Palliative Care Needs

ObjectivesIntermediate care services have been introduced to help mitigate unnecessary hospital demand and premature placement in long-term residential care. Many patients are elderly and/or with complex comorbidities, but little consideration has been given to the palliative care needs of patients referred to intermediate care services. The objective of this study is to determine the proportion of patients referred to a community-based intermediate care team who died during care and up to 24 months after discharge and so to help inform the development of supportive and palliative care in this setting.MethodsA retrospective cohort study of all 4770 adult patients referred to Northamptonshire Intermediate Care Team (ICT) between 11 April 2010 and 10 April 2011.ResultsOf 4770 patients referred, 60% were 75 years or older and 32% were 85 years of age or older. 4.0% of patients died during their ICT stay and 11% within 30 days of discharge. At the end of 12 months, 25% of the patients had died, increasing to 32% before the end of the second year. About 34% of all deaths occurred during the ICT stay or within 30 days of discharge, and a further 46% by the end of the first year. Male gender and higher age were associated with greater likelihood of death.ConclusionsIt is important for ICT clinicians to consider immediate and longer-term palliative care needs among patients referred to ICTs. Care models involving ICTs and palliative care teams working together could enable more people with end-stage non-cancer illnesses to die at home.

scholarly journals Comparison of Palliative Care Models in Idiopathic Pulmonary Fibrosis

2021 ◽  
Vol 11 (19) ◽  
pp. 9028
Author(s):  
Sarah Younus ◽  
Jeffrey A. Bakal ◽  
Janice Richman-Eisenstat ◽  
Ghadah Alrehaili ◽  
Sharina Aldhaheri ◽  
...  
Keyword(s):  
Palliative Care ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Symptom Management ◽  
Care Delivery ◽  
Referral Criteria ◽  
Location Of Death ◽  
Specialist Referral ◽  
Care Models ◽  
Eol Care

Introduction: Palliative care (PC) is recommended in idiopathic pulmonary fibrosis (IPF) patients but poorly implemented. Integration of PC into routine management by pulmonologists may improve overall and end-of-life (EOL) care, but the optimal model of PC delivery is unknown. Objective: To describe three PC care delivery models and their impact on EOL; the Multidisciplinary Collaborative ILD clinic, Edmonton, Canada (EC) and the Bristol ILD Service, UK (BC) that provide primary level PC; and the Queen’s University ILD Clinic, Kingston, Canada (QC), which refers IPF patients to a specialist PC Clinic using specific referral criteria. Methods: A multicenter retrospective observational study of IPF patients receiving care in the identified clinics (2012–2018) was designed. Demographics; PC delivery, including symptom management; advance care planning (ACP); and location of death data were examined. Results: 298 IPF patients were included (EC 95, BC 84, and QC 119). Median age was 71 years with 74% males. Overall, 63% (188) patients received PC. Primary PC approach in EC and BC led to more patients receiving PC (98% EC, 94% BC and 13% QC (p < 0.001/<0.001)) with earlier initiation compared to QC. Associated higher rates of non-pharmacologic dyspnea management [98% EC, 94% BC, and 2% QC (p < 0.001/<0.001); opioids (45% EC and BC, and 23% QC (p < 0.001/<0.001)); and ACP (100% EC and BC, and 13% QC patients (p < 0.001/<0.001))] were observed. Median follow up (IQR) was 16 months (5–28) with 122 deaths (41%). Primary PC model in EC and BC decedents was associated with more PC delivery (91% EC, 92% BC and 19% QC (p < 0.001)) with more symptoms management, oxygen, and opiate use than QC (p < 0.001; p = 0.04; p = 0.01). EOL discussions occurred in 73% EC, 63% BC, and 4% QC decedents (p = 0.001). Fifty-nine% (57) died at home or hospice and 38% (36) in hospitals. Concordance rate between preferred and actual location of death was 58% in EC (0.29 (−0.02–0.51)) and 37% in BC models (−0.11 (−0.20–0.15)). Conclusions: Primary PC approach for IPF is feasible in ILD clinics with concurrent disease management and can improve access to symptom management, ACP, PC and EOL care. Reliance on PC specialist referral for PC initiation outside of the ILD clinic can result in delayed care.

scholarly journals Palliative Care Early and Systematic (PaCES): Assessing Patient and Caregiver Preferences for Early Palliative Care Delivery in Rural Alberta

2018 ◽  
Vol 56 (6) ◽  
pp. e123-e124
Author(s):  
Janet Vandale ◽  
Robin Gray ◽  
Shelley Raffin Bouchal ◽  
Patricia Biondo ◽  
Maclean Thiessen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Early Palliative Care

Patterns of healthcare utilization in patients with newly diagnosed advanced lung cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18386-e18386
Author(s):  
Emily Miller Ray ◽  
Sharon Peacock Hinton ◽  
Katherine Elizabeth Reeder-Hayes
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Intensive Care ◽  
Healthcare Utilization ◽  
Cancer Care ◽  
Care Delivery ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Newly Diagnosed ◽  
Index Hospitalization

e18386 Background: Advanced lung cancer (ALC) is a symptomatic disease that is often diagnosed in the context of hospitalization. The index hospitalization may be a window of opportunity to improve cancer care delivery. We aimed to define the frequency of ALC diagnosis associated with hospitalization and the relationship to subsequent cancer care and readmissions. Methods: We identified patients in the SEER-Medicare database with: ALC (stage IIIB-IV non-small cell or small cell), diagnosed 2007 to 2013; with continuous enrollment in Medicare from 6 months prior to lung cancer diagnosis through death or 12/2014; and an index hospitalization within 7 days of their ALC diagnosis. Our primary outcomes of interest were 30-day re-hospitalization and emergency department (ED) use. We examined: utilization of services during index hospitalization, including intensive care and oncology or palliative care consultation; discharge destination; receipt of systemic therapy; and hospice enrollment. Results: Fifty-four percent (n = 28,976) of ALC patients had an index hospitalization, with 90% of those having their cancer diagnosed while hospitalized. During their index hospitalization, 16% had oncology consultation, and 6% had palliative care (PC) consultation. Thirty-three percent were in the intensive care unit. At discharge, 59% returned home, 8% died, and 11% went to hospice. Of those who survived to discharge, 69% later returned to the ED or were re-hospitalized, with 49% of re-hospitalizations and 35% of ED visits occurring within 30 days of the index hospitalization. Thirty-five percent of these patients eventually received systemic treatment for their cancer. By 180 days post-discharge, 77% had enrolled in hospice with a median of 10 days on hospice care. Conclusions: Newly diagnosed ALC patients are high risk for acute care utilization, and many patients experience a return to the hospital early in their cancer trajectory. These patients may benefit from additional health system support prior to hospital discharge to help prevent high-cost, low-value healthcare utilization.

scholarly journals Patient and caregiver experiences with advanced cancer care: a qualitative study informing the development of an early palliative care pathway

2020 ◽  
pp. bmjspcare-2020-002578
Author(s):  
Sadia Ahmed ◽  
Syeda Farwa Naqvi ◽  
Aynharan Sinnarajah ◽  
Gwen McGhan ◽  
Jessica Simon ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Cancer Care ◽  
Care Pathway ◽  
Healthcare Providers ◽  
Care Patient ◽  
Early Palliative Care ◽  
Telephone Interviews ◽  
Care Services ◽  
Life Threatening Illness

BackgroundPalliative care is an approach that improves the quality of life of patients and families facing challenges associated with life-threatening illness. In order to effectively deliver palliative care, patient and caregiver priorities need to be incorporated in advanced cancer care.AimThis study identified experiences of patients living with advanced colorectal cancer and their caregivers to inform the development of an early palliative care pathway.DesignQualitative patient-oriented study.Settings/participantsPatients receiving care at two cancer centres were interviewed using semistructured telephone interviews to explore their experiences with cancer care services received prior to a new developed pathway. Interviews were transcribed verbatim, and the data were thematically analysed.ResultsFrom our study, we identified gaps in advanced cancer care that would benefit from an early palliative approach to care. 15 patients and 7 caregivers from Edmonton and Calgary were interviewed over the phone. Participants identified the following gaps in advanced cancer care: poor communication of diagnosis, lack of communication between healthcare providers, role and involvement of the family physician, lack of understanding of palliative care and advance care planning.ConclusionsEarly palliative approaches to care should consider consistent and routine delivery of palliative care information, collaborations among different disciplines such as oncology, primary care and palliative care, and engagement of patients and family caregivers in the development of care pathways.

scholarly journals Evidence-Based Practice: Community-Based Palliative Cancer Care

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Jajang Ganjar Waluya ◽  
Nur Maziyya ◽  
Eva Nurlaela ◽  
Ita Vusfita ◽  
Ihda Al Adawiyah Mz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Cancer Care ◽  
Evidence Based Practice ◽  
Care Service ◽  
Palliative Care Service ◽  
The United States ◽  
Evidence Based ◽  
Community Based ◽  
Middle East Countries

Prevalence of  cancer is estimated will increase in the next two decades. Therefore, there is a challenge for health provider to encounter treatment and caring for the patients. Especially, the cancer patients face several problems not only physical but also psychological, emotional, spiritual and social cultural aspects.This study explored the evidence-based practice on community-based palliative cancer care. Literature study is done by making a summary of published articles related to the question. The searching method used several electronic databases such as Google Scholar, Proquest, and PubMed. Articles under the keywords of “Palliative Cancer Care”, “Community”, and “Nursing” reach as much as 1.804. The inclusion criteria for this literature review were articles that have been peer-reviewed, are in full-text, in either English or Indonesian, and publication year from 2008 to 2018. Meanwhile, the exclusion criteria include those that do not follow a standardized structure of an article (consisting of Abstract, Introduction, Method, Result, Discussion, Implication, and Reference), are in the form of a review, and whose content does not answer research questions.Results: The United States of America is on the highest place regarding palliative care service, following by community-based palliative cancer implementation in Europe. Asian countries had been applying palliative care service, integrated with national health care system. In the Middle East countries, palliative care program ranks the lowest, but in implementation, they have discreetly performed community-based palliative care. In Africa, it is not the main focus in the field of health. Palliative care for cancer patients that is potential for development in Indonesia is that of family-based.Conclusion: Community-based palliative care is a variant of palliative treatment long applied and being developed in many countries in the world. In continents such as America and Europe, the implementation of palliative care ranks the highest place. In Indonesia, it is done partially and only available in hospitals or non-governmental organization. In the level of community, family-based palliative care can be developed by involving trained family members.

Interdisciplinary clinician perspectives on an embedded palliative oncology model in pediatric cancer care.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 9-9
Author(s):  
Marta Salek ◽  
Cameka Woods ◽  
Jami S. Gattuso ◽  
Belinda Neal Mandrell ◽  
Justin N. Baker ◽  
...  
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Pediatric Cancer ◽  
Cancer Care ◽  
Care Delivery ◽  
Care Model ◽  
Structured Care ◽  
Embedded Model ◽  
Clinician Perspectives ◽  
Oncology Providers

9 Background: Integration of palliative care into cancer care is recognized as best practice by international oncology and pediatrics organizations. However, optimal strategies for integration of pediatric palliative care (PPC) within cancer care remain understudied. While the majority of PPC provision for cancer patients occurs through subspeciality consultation, growing evidence suggests that models embedding PPC within cancer care have the potential to improve quality of care. Embedded models rely on partnerships with multidisciplinary clinicians, whose perspectives regarding this model are not well known. Methods: We conducted 25 focus groups with 175 clinicians in an academic pediatric cancer center, with groups stratified by discipline (physicians, advance practice providers (APPs), nurses, psychosocial providers) and by care team (hematologic malignancy, bone marrow transplant, solid tumor, brain tumor). Focus groups were led by trained research facilitators and audio-recorded for subsequent targeted content analysis to identify clinician perspectives regarding embedded PPC models. Results: Across 4 physician, 5 APP, 12 nurse, and 4 psychosocial focus groups, 25 physicians, 30 APPs, 71 nurses, and 49 psychosocial providers participated, respectively. When asked to describe features of an “ideal” PPC model, physicians, APPs, and nurses predominantly discussed care delivery and identified early integration of PPC into cancer care as a core feature of an ideal model. Physicians, nurses, and psychosocial providers also emphasized the importance of having a formalized, structured care model. The need for collaboration was the dominant theme for psychosocial providers. Clinicians in all disciplines identified potential benefits from an embedded model, including access to PPC across care settings, normalization of PPC integration, and emphasis on collaboration, teamwork, communication, and earlier PPC involvement. Physicians, APPs, and nurses anticipated similar challenges with an embedded model, including possible reticence of oncology providers and inadequate PPC staffing. Nurses, APPs, and psychosocial providers also voiced concern about potential lack of clarity in delegation of roles and responsibilities between PPC and oncology providers. Conclusions: Pediatric oncology multidisciplinary providers recognize the potential value of an embedded model for integration of PPC in the care of children with cancer. Though providers at times identified similar themes with respect to ideal PPC provision and the benefits and challenges to an embedded model, some identified priorities varied by discipline. These findings highlight the importance of integrating varied interdisciplinary perspectives when developing an embedded care model to align with priorities of diverse pediatric cancer stakeholders.

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