Screening for Palliative Care Needs: Pilot Data From German Comprehensive Cancer Centers

2021 ◽  
pp. OP.20.00698
Author(s):  
Carmen Roch ◽  
Maria Heckel ◽  
Birgitt van Oorschot ◽  
Bernd Alt-Epping ◽  
Mitra Tewes
Keyword(s):  
Palliative Care ◽  
Human Resources ◽  
Structural Characteristics ◽  
Physical Symptoms ◽  
Screening Tools ◽  
Current Status ◽  
Care Needs ◽  
Cancer Centers ◽  
Comprehensive Cancer Centers ◽  
Palliative Care Needs

PURPOSE: Guidelines recommend several screening tools to identify patients with complex palliative needs. This diversity and lack of structural recommendations offer a wide scope for implementing screening. Against this background, the current status of implementation at German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid has not yet been investigated. METHODS: e-mail survey of the 17 hospital sites of the 13 CCCs. The questionnaire asked for structural characteristics of the centers as well as preconditions of the screening process. Structurally established screening procedures (one item) and standardized workflows, modes of performance, screening tools (four items), modes of training how to screen, and responsibilities (two items) were assessed. RESULTS: In a 2-month period, 15 hospital sites responded; seven hospital sites conducted a palliative care needs (PCN) screening. Only one hospital site carried out PCN screening in almost all oncology departments, but only with the distress thermometer. Other hospital sites determined palliative needs by assessing physical symptoms using the Integrated Palliative Care Outcome Scale or the Minimal Documentation System, and two hospital sites combined tools to determine both physical and psychological stress. The type of screening varied from paper-pencil–based to tablet computer–based documentation. The main barriers to implementation were identified as a lack of human resources and a lack of structural conditions. CONCLUSION: There is a lack of consensus among palliative care specialists and oncologists in the CCCs supported by the German Cancer Aid in PCN screening as well as of structured guidelines and the professional association. Structural requirements should be adapted to these needs, which include both technical and human resources. A combined psycho-oncologic and palliative care screening might help to formulate best practice recommendations.

scholarly journals 188 Identification of patients with potential palliative care needs: a systematic review of screening tools in primary care

2020 ◽  
Author(s):  
Yousuf ElMokhallalati ◽  
Stephen H Bradley ◽  
Emma Chapman ◽  
Lucy Ziegler ◽  
Fliss EM Murtagh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Palliative Care ◽  
Screening Tools ◽  
Care Needs ◽  
Palliative Care Needs

scholarly journals Palliative care in Brasil: present and future

2019 ◽  
Vol 65 (6) ◽  
pp. 796-800
Author(s):  
Cledy Eliana dos Santos ◽  
Luciana Silveira Campos ◽  
Newton Barros ◽  
José Américo Serafim ◽  
Daniel Klug ◽  
...  
Keyword(s):  
Palliative Care ◽  
Human Resources ◽  
Brazilian Population ◽  
Support Network ◽  
Service Needs ◽  
Care Needs ◽  
Growth Projection ◽  
Minimum Estimate ◽  
Definition Of ◽  
Palliative Care Needs

SUMMARY OBJECTIVE: To estimate the human resources and services needed to meet the demand of the Brazilian population who would benefit from palliative care, based on the population growth projection for 2040. METHODS: Population and mortality estimates and projections were obtained from the Brazilian Institute of Geography and Statistics. Service needs were estimated based on literature data. RESULTS: The expected increase in the Brazilian population for 2000-2040 is 31.5%. The minimum estimate of patients with palliative care needs was 662,065 in 2000 and 1,166,279 in 2040. The staff required for each hundred thousand inhabitants would increase from 1,734 to 2,282, the number of doctors needed would increase from 4,470 to 6,274, and the number of nurses from 8,586 to 11,294, for the same period. CONCLUSION: The definition of a national strategy predicting the increasing palliative care needs of the population is necessary. The expansion of the support network for chronic and non-transmissible diseases is necessary, but the training of existing human resources at all levels of attention to perform palliative actions can be a feasible alternative to minimize the suffering of the population.

Early palliative care: current status of integration within German comprehensive cancer centers

2017 ◽  
Vol 25 (8) ◽  
pp. 2577-2580 ◽  
Author(s):  
Julia Berendt ◽  
Stephanie Stiel ◽  
Friedemann Nauck ◽  
Christoph Ostgathe
Keyword(s):  
Palliative Care ◽  
Current Status ◽  
Cancer Centers ◽  
Early Palliative Care ◽  
Comprehensive Cancer Centers

scholarly journals Family Physicians’ Perspectives on Their Role in Palliative Care: A Double Focus Group in Portugal

2021 ◽  
Vol 18 (14) ◽  
pp. 7282
Author(s):  
Carlos Seiça Cardoso ◽  
Filipe Prazeres ◽  
Beatriz Xavier ◽  
Bárbara Gomes
Keyword(s):  
Palliative Care ◽  
Focus Group ◽  
Training Programs ◽  
Family Physicians ◽  
Holistic Approach ◽  
Physical Symptoms ◽  
Care Needs ◽  
Focus Group Study ◽  
Organizational Barriers ◽  
Palliative Care Needs

Background: Aggravated by the COVID-19 pandemic, the provision of palliative care for patients with palliative care needs emerges as a necessity more than ever. Most are managed in primary care by their family physicians (FP). This study aimed to understand the perspectives of specialist and trainee FPs about their role in palliative care. Methods: we conducted a double focus-group study consisting of two separate online focus-groups, one with FP specialists (n = 9) and one with FP trainees (n = 10). Results: FPs already gather two fundamental skills for the provision of palliative care: the capacity to identify patients’ needs beyond physical symptoms and the recognition that the patient belongs to a familiar, psychosocial, and even spiritual environment. They perceive their role in palliative care to be four-fold: early identification of patients with palliative care needs, initial treatment, symptom management, and patient advocacy. Participants recognized the need for palliative care training and provided suggestions for training programs. Conclusion: FPs share a holistic approach and identify multiple roles they can play in palliative care, from screening to care and advocacy. Organizational barriers must be addressed. Short training programs that combine theory, practice, and experiential learning may further the potential for FPs to contribute to palliative care.

Seventeen years of progress for supportive care services: A resurvey of National Cancer Institute–designated comprehensive cancer centers

2014 ◽  
Vol 13 (4) ◽  
pp. 917-925 ◽  
Author(s):  
Sheila L. Hammer ◽  
Karen Clark ◽  
Marcia Grant ◽  
Matthew J. Loscalzo
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
National Cancer Institute ◽  
Advisory Council ◽  
Current Status ◽  
Distress Screening ◽  
Cancer Centers ◽  
Care Services ◽  
Comprehensive Cancer Centers ◽  
Question Survey

AbstractObjective:We replicated a 1994 study that surveyed the state of supportive care services due to changes in the field and the increased need for such services. We provide an updated assessment, comparing the changes that have occurred and describing the current status of supportive care services in comprehensive cancer settings.Method:We used Coluzzi and colleague's 60-question survey from their 1995 Journal of Clinical Oncology article to frame the 98-question survey employed in the current study. Medical and palliative care directors for the 2011 National Cancer Institute (NCI) comprehensive cancer centers were surveyed regarding their supportive care services and their subjective review of the overall effectiveness of the services provided.Results:We achieved a 76% response rate (n = 31). The data revealed increases in the number of cancer beds in the hospitals, the degree of integration of supportive care services, the availability of complementary services, and the number of pain and palliative care services offered. There was also an overall shift toward centers becoming more patient centered, as 65% reported now having a patient and family advisory council. Our findings revealed a growing trend to offer distress screening for both outpatients and inpatients. Medical and palliative care directors' evaluations of the supportive care services they offered also significantly improved. However, the results revealed an ongoing gap in services for end-of-life care and timely referrals for hospice services.Significance of results:Overall, both the quantity and quality of supportive care services in the surveyed NCI-designated cancer centers has improved.

scholarly journals Palliative care needs of patients living with end-stage kidney disease not treated with renal replacement therapy: An exploratory qualitative study from Blantyre, Malawi

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Maya J. Bates ◽  
Alex Chitani ◽  
Gavin Dreyer
Keyword(s):  
Palliative Care ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Qualitative Study ◽  
Replacement Therapy ◽  
Physical Symptoms ◽  
End Stage Kidney Disease ◽  
Care Needs ◽  
End Stage ◽  
Palliative Care Needs

Background: The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is increasing rapidly but the palliative care needs of patients living with ESKD are not well described. Resource limitations at both health system and patient level act as major barriers to patients receiving renal replacement therapy (RRT) in the form of dialysis. We undertook an exploratory qualitative study to describe the palliative care needs of patients with ESKD who were not receiving RRT, at a government teaching hospital in Blantyre, Malawi.Methods: A qualitative, explorative and descriptive design was used. Study participants were adults aged > 18 years with an estimated glomerular filtration rate < 15 ml/min on two separate occasions, three months apart, who either chose not to have or were not deemed suitable for RRT. Data were collected by means of semi-structured interviews.Results: In October and November 2013, interviews were conducted with 10 adults (7 women with median age of 60.5 years). All were hypertensive and four were on treatment for HIV. Four themes emerged from the data: changes in functional status because of physical symptoms, financial challenges impacting hospital care, loss of role within the family and the importance of spiritual and cultural beliefs.Conclusion: This study reports on four thematic areas which warrant further quantitative and qualitative studies both in Malawi and other low-resource settings, where a growing number of patients with ESKD unable to access RRT will require palliative care in the coming years.

scholarly journals Do screening tools assess palliative care needs and 12-month mortality in patients admitted to hepatology in-patient wards?

2021 ◽  
pp. flgastro-2020-101709
Author(s):  
Joseph Low ◽  
Catherine Carroll ◽  
Jo Wilson ◽  
Rachel Craig ◽  
Shree Vadera ◽  
...  
Keyword(s):  
Palliative Care ◽  
Predictive Value ◽  
Screening Tools ◽  
Clinical Judgement ◽  
Care Needs ◽  
Discriminatory Ability ◽  
Survival Status ◽  
Care Indicator ◽  
Sensitivity Specificity ◽  
Palliative Care Needs

BackgroundMany liver patients have unmet palliative care needs, but liver clinicians are unclear whom to refer to specialist palliative care (SPC). The Supportive and Palliative Care Indicator Tool (SPICT) and the Bristol Prognostic Screening Tool (BPST) could help identify suitable patients, but neither has been tested for this role. This study evaluated their role as screening tools for palliative care needs and for predicting 12-month mortality.MethodsA case note review of hepatology in-patients, who were not peritransplant and post-transplant status, was conducted in one tertiary unit. Main outcomes were clinical judgement of need for SPC referral, BPST scores, SPICT attribution of caseness and 12-month survival status. Discriminatory ability of tools was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic (AUROC) curve.Results117 medical notes were reviewed for survival analysis, 47 of which were additionally assessed for suitability for SPC referral, using clinical judgement. SPICT (sensitivity=93%; PPV=93%; AUROC=0.933) and BPST (sensitivity=59%, PPV=79%, AUROC=0.693) demonstrated excellent and good performance, respectively, in predicting patients’ need for SPC referral. SPICT and BPST only had moderate ability at predicting death at 12 months (PPV: 54% and 56%, respectively).ConclusionSPICT and BPST show potential as screening tools for identifying patients for referral to SPC. Further work is needed to determine how to implement these tools in a clinical setting.

scholarly journals Where do general practitioners find patients with possible palliative care needs?

BJGP Open ◽  
2020 ◽  
pp. BJGPO.2020.0100
Author(s):  
Bert Leysen ◽  
Bart Van den Eynden ◽  
Johan Wens
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Screening Tools ◽  
Future Research ◽  
Care Needs ◽  
Summary Table ◽  
Cross Sectional ◽  
Early Palliative Care ◽  
Family Practices ◽  
Palliative Care Needs

Background: For general practitioners (GPs) to implement early palliative care, the first step is to identify patients with palliative care needs, e.g. with a no-response to the Surprise Question (SQ) (not surprised if a patient would die within a year). Aim: To describe setting-specific screening results of patients eligible for early palliative care in family practices, here defined as patients aged 45 years with a GPs’ no-answer to the SQ. Design and setting: Secondary analysis. Cross-sectional descriptive study in family practices in 5 Belgian areas. Methods: GPs were recruited by targeted sampling. As a first part of an implementation research project, participating GPs provided demographic information about themselves and also provided a response to the SQ for all patients who came to the practice in ten consecutive office days. A summary table describing the gender, age, location of contact (surgery, patient’s home, or nursing home) of the patients was provided by each GP. Results: 56 GPs provided complete data for the practice summary tables. In total 9,150 patients were described (all ages, all settings), of which 506 patients (6%) had a SQ-no-as-answer. The distribution of SQ-no-as-answer patients per setting was 152/7659 (2%) patients seen in family practice surgeries, 139/998 (14%) patients seen in their homes, and 215/493 (44%) patients seen innursing homes. Conclusions: There was quite a large number of SQ-no-as-answer patients, with possible palliative care needs. To enhance implementation of early palliative care, future research should compare results of SQ and other screening tools with palliative care symptoms assessments.

Palliative care in the emergency department

2015 ◽  
Author(s):  
Paul L. DeSandre ◽  
Karen May
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Rapid Assessment ◽  
Physical Symptoms ◽  
Care Needs ◽  
Advanced Illness ◽  
Complex Needs ◽  
Life Threatening ◽  
Access To Medical Care ◽  
Palliative Care Needs

The emergency department provides immediate access to medical care for patients and families in crisis. As the proportion of elderly in our populations increases, complications related to advanced illness will likely drive increasing numbers of patients with palliative care needs into emergency departments. In addition to immediately life-threatening situations, severe physical symptoms, psychological distress, social upheaval, or even an unrecognized spiritual crisis near death can overwhelm patients or their caregivers, who come to the emergency department hoping for relief from their suffering. Emergency clinicians must rapidly assess these complex needs while negotiating interventions with effective and efficient communications. This chapter addresses several of these essential clinician skills for effective primary palliative care in the emergency department. These include rapid assessment of patients with palliative care needs, titration of opioids for pain emergencies, efficiently establishing goals of care, skilful and empathic death disclosure, and a structured approach to involving family presence during cardiopulmonary resuscitation.

scholarly journals Identification of patients with potential palliative care needs: A systematic review of screening tools in primary care

2020 ◽  
Vol 34 (8) ◽  
pp. 989-1005 ◽  
Author(s):  
Yousuf ElMokhallalati ◽  
Stephen H Bradley ◽  
Emma Chapman ◽  
Lucy Ziegler ◽  
Fliss EM Murtagh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Palliative Care ◽  
Functional Decline ◽  
Screening Tools ◽  
Care Needs ◽  
Early Access ◽  
Wide Range ◽  
Registration Number ◽  
Palliative Care Needs

Background: Despite increasing evidence of the benefits of early access to palliative care, many patients do not receive palliative care in a timely manner. A systematic approach in primary care can facilitate earlier identification of patients with potential palliative care needs and prompt further assessment. Aim: To identify existing screening tools for identification of patients with advanced progressive diseases who are likely to have palliative care needs in primary healthcare and evaluate their accuracy. Design: Systematic review (PROSPERO registration number CRD42019111568). Data sources: Cochrane, MEDLINE, Embase and CINAHL were searched from inception to March 2019 Results: From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs. The tools are based on a wide range of general and disease-specific indicators. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential palliative care needs with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99%. Conclusion: The ability of current screening tools to identify patients with advanced progressive diseases who are likely to have palliative care needs in primary care is limited. Further research is needed to identify standardised screening processes that are based not only on predicting mortality and deterioration but also on anticipating the palliative care needs and predicting the rate and course of functional decline. This would prompt a comprehensive assessment to identify and meet their needs on time.

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