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Recommending Early Integration Of Palliative Care — Does It Work?
J. Gaertner, J. Wolf, S. Frechen, U. Klein, D. Scheicht, M. Hellmich, K. Toepelt, Jan-Peter Glossmann, C. Ostgathe, M. Hallek, R. Voltz
Published 2011 · Medicine
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BackgroundIn 2006, our comprehensive cancer center decided to implement early integration (EI) of palliative care (PC) by (a) literally adopting the WHO definition of PC into cancer care guidelines and (b) providing a PC consulting team (PCST) to provide EI on in- and outpatient wards. The experience with this approach was assessed to identify shortcomings.MethodsA retrospective systematic chart analysis of a 2-year period was performed.ResultsA total of 862 patients were treated (May 2006–April 2008). Many patients consulted by the PCST for the first time were already in a reduced performance status (ECOG 3 & 4: 40%) or experiencing burdening symptoms (i.e., dyspnoea 27%). After the first year (period A; “getting started”), the overall prevalence of symptoms identified on first PC contact decreased from seven to three, (p < 0.001) as well as surrogate measures for advanced disease (i.e., frailty: from 63% to 33%; CI: [−36%; −23%], p < 0.001).ConclusionSurrogate measures (symptom burden, performance status) indicate that PC was integrated earlier in the course of the disease after a 1-year phase of “getting started” with EI. Yet, the WHO recommendation alone was too vague to successfully trigger EI of PC. Therefore, the authors advocate the provision of disease specific guidelines to institutionalize EI of PC. Such guidelines have been developed for 19 different malignancies and are presented separately.
This paper references
Late referrals to palliative care units in Japan: nationwide follow-up survey and effects of palliative care team involvement after the Cancer Control Act.
T. Morita (2009)
Prozesse und Interventionen auf den deutschen Palliativstationen
L. Radbruch (2003)
Validierung der neuen Fassung des Minimalen Dokumentationssystems (MIDOS2) für Patienten in der Palliativmedizin
S. Stiel (2010)
On third base but not home yet.
E. Bruera (2008)
Can guidelines be integrated into everyday practice? The NCCN in year 4. National Comprehensive Cancer Network.
C. McNeil (1999)
Influence of physicians’ life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries
J. Cohen (2008)
NCCN clinical practice guidelines in oncology: palliative care.
M. Levy (2009)
Mainstreaming palliative care.
V. Periyakoil (2007)
Who uses palliative care
von Gunten Cf (2009)
On Third Base but not Home Yet
V. Periyakoil (2008)
Phase I versus palliative care: striking the right balance.
L. Schapira (2009)
R Development Cor (2009)
Differential palliative care issues in patients with primary and secondary brain tumours
C. Ostgathe (2009)
Palliative cancer care a decade later: accomplishments, the need, next steps -- from the American Society of Clinical Oncology.
F. Ferris (2009)
Identifying factors affecting utilization of an inpatient palliative care service: a physician survey.
C. Snow (2009)
Statistics with confidence
M. Smithson (2000)
Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care.
E. Bruera (2010)
Current Status of Palliative Care—Clinical Implementation, Education, and Research
M. Grant (2009)
「緩和ケア」として行われた介入と副次的評価項目であることの限界 (論文を読み,理解する--Early palliative care for patients with metastatic non-small-cell lung cancer)
森田 達也 (2011)
Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care.
M. Yedidia (2007)
Are We Putting the Cart Before the Horse
J. H. Roenn (2009)
R. Twycross (2002)
[Validation of the new version of the minimal documentation system (MIDOS) for patients in palliative care : the German version of the edmonton symptom assessment scale (ESAS)].
S. Stiel (2010)
Statistics with Confidence:Statistics with Confidence
R. Cleary (2003)
Implementing WHO recommendations for palliative care into routine lung cancer therapy: a feasibility project.
J. Gaertner (2010)
Palliative Medicine. Impact.
von Gunten Cf (2008)
[What is the profile of palliative care in Germany. Results of a representative survey].
L. Radbruch (2004)
Integrating palliative care into comprehensive cancer care.
J. Abrahm (2012)
The impact of palliative care consultation on symptom assessment, communication needs, and palliative interventions in pediatric patients with cancer.
D. Zhukovsky (2009)
WORLD HEALTH ASSEMBLY
J. Turner (1984)
This paper is referenced by
Instruments to evaluate complexity in end-of-life care
Maria Luisa Martín-Roselló (2018)
Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease
N. Siouta (2016)
Oncological and Palliative Care for Patients with Lung Cancer and Patients with Breast Cancer: Two Opposite Ends of a Spectrum
Norbert Frickhofen (2015)
Provision of palliative care and pain management services for oncology patients.
P. Marchetti (2013)
Early palliative care for patients with advanced cancer: how to make it work?
J. Gaertner (2013)
Factors associated with supportive care needs in glioma patients in the neuro-oncological outpatient setting
M. Renovanz (2017)
Palliative care consultation service and palliative care unit: why do we need both?
J. Gaertner (2012)
Supportive Care Needs and Distress Levels of Patien ts Undergoing Radiotherapy
N. Uysal (2019)
Current performance and future trends in health care sciences and services research
Q. Yao (2014)
Palliative care needs, symptoms, and treatment intensity along the disease trajectory in medical oncology outpatients: a retrospective chart review
J. Bükki (2013)
Integrated care in cancer: What is it, how is it used and where are the gaps? A textual narrative literature synthesis
L. J. Cortis (2017)
Integration of oncology and palliative care: a systematic review.
D. Hui (2015)
Integrierte onkologische und palliativmedizinische Patientenbetreuung
Karin Oechsle (2012)
The evidence of early specialist palliative care on patient and caregiver outcomes.
Claude Chidiac (2018)
Early palliative care and its translation into oncology practice in Canada: barriers and challenges.
K. Fassbender (2015)
Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians
A. Coym (2020)
Clinical trials in palliative care: a systematic review of their methodological characteristics and of the quality of their reporting
Raquel Bouça-Machado (2017)
Onkologie für die Palliativmedizin
B. Alt-Epping (2015)
Mehr vom Deutschen Krebskongress 2014
D. Berger (2014)
The impact of early palliative care on the quality of care during the last days of life: what does the evidence say?
Sofia C Zambrano (2016)
Inpatient palliative care: a nationwide analysis.
J. Gaertner (2013)
Early implementation of palliative care can improve patient outcomes.
P. Glare (2013)
Challenges in defining ‘palliative care’ for the purposes of clinical trials
C. Bausewein (2012)
What is palliative care? Perceptions of healthcare professionals
Birgitta Wallerstedt (2019)
Early Palliative Care—Health services research and implementation of sustainable changes: the study protocol of the EVI project
C. Meffert (2015)
Perceptions of and Attitudes Toward Death, Dying, Grief, and the Finitude of Life-A Representative Survey Among the General Public in Germany.
J. Strupp (2019)
Palliative care in chronic obstructive pulmonary disease.
E. J. Lilly (2016)
To what degree is palliative care integrated in guidelines and pathways for adult cancer patients in Europe: a systematic literature review
K. van Beek (2016)
Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective
Helene Åvik Persson (2018)
Early integration of palliative care in hospitals: A systematic review on methods, barriers, and outcome.
Karen Marie Dalgaard (2014)
Supportive/palliative care in cancer patients: quo vadis?
J. Klastersky (2015)
Standardizing integration of palliative care into comprehensive cancer therapy—a disease specific approach
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