Clinician Roles in Early Integrated Palliative Care for Patients with Advanced Cancer: A Qualitative Study

Back, Anthony L.; Park, Elyse R.; Greer, Joseph A.; Jackson, Vicki A.; Jacobsen, Juliet; Gallagher, Emily R.; Temel, Jennifer S.

doi:10.1089/jpm.2014.0146

Cited by 85 publications

(86 citation statements)

References 14 publications

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“…18 Analysis of other data from this study confirms that palliative care visits have distinct features from oncology clinic visits, and that the roles of each clinician are complementary in the care of patients with advanced cancer. 19 Evidence also suggests that patients say very different things to their oncologist than they say to their palliative care clinician.…”

Section: The Workforcesupporting

confidence: 58%

“…19 Evidence also suggests that patients say very different things to their oncologist than they say to their palliative care clinician. [18][19][20] Furthermore, oncologists who already have experience collaborating with palliative care specialists tend to describe how helpful it is to have another expert available for managing complex cases or very time-consuming psychosocial issues. 21 Moreover, oncology trainees do not receive adequate training in many of these areas, such as complex pain management skills, lending further support to the notion that palliative care clinicians are uniquely-trained, and possess additional expertise in these areas beyond that which a typical hematologist/oncologist provides.…”

Section: The Workforcementioning

confidence: 99%

“…21,38 Additionally, patients may engage in different conversations with different clinicians, focusing on cancer with the cancer specialist, and other issues like pain or psychosocial distress with the palliative care specialist. [18][19][20] We also lack data to suggest that providers of primary palliative care can meet the higher-level specialty palliative care needs. Indeed, evidence suggests that oncology trainees lack competence at core specialty palliative care tasks, like doing basic opioid conversions.…”

Section: "Patients Will Think I'm Giving Up" or "Patients Don't Likementioning

confidence: 99%

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When and why should patients with hematologic malignancies see a palliative care specialist?

2015

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Palliative care is a multidisciplinary approach to symptom management, psychosocial support, and assistance in treatment decision-making for patients with serious illness and their families. It emphasizes well-being at any point along the disease trajectory, regardless of prognosis. The term "palliative care" is often incorrectly used as a synonym for end-of-life care, or "hospice care". However, palliative care does not require a terminal diagnosis or proximity to death, a misconception that we will address in this article. Multiple randomized clinical trials demonstrate the many benefits of early integration of palliative care for patients with cancer, including reductions in symptom burden, improvements in quality-of-life, mood, and overall survival, as well as improved caregiver outcomes. Thus, early concurrent palliative care integrated with cancer-directed care has emerged as a standard-of-care practice for patients with cancer. However, patients with hematologic malignancies rarely utilize palliative care services, despite their many unmet palliative care needs, and are much less likely to use palliative care compared to patients with solid tumors. In this article, we will define "palliative care" and address some common misconceptions regarding its role as part of high-quality care for patients with cancer. We will then review the evidence supporting the integration of palliative care into comprehensive cancer care, discuss perceived barriers to palliative care in hematologic malignancies, and suggest opportunities and triggers for earlier and more frequent palliative care referral in this population. Learning Objectives• Describe the differences between "palliative care," "hospice care," and "end-of-life care" • List the major benefits of early palliative care as reported in the major randomized trials done to date • Recognize specific scenarios and indications that warrant specialist palliative care consultation for patients with hematologic malignanciesPalliative care is specialized medical care for people facing a serious illness, 1 like a hematologic malignancy. The term "palliative care" is sometimes incorrectly used as a synonym for end-of-life care, or "hospice care"; however, palliative care requires neither a terminal diagnosis nor proximity to death; a misconception that we will address in the first section of this article. Rather, a growing body of evidence highlights that patients with cancer derive many benefits from palliative care including reductions in symptom burden, 2 improvements in quality-of-life and mood, 3,4 improved survival, 4,5 as well as improved caregiver outcomes 6 ; this is true even for those receiving active cancer treatment. However, patients with hematologic malignancies are much less likely to access palliative care services than patients with solid tumors, 7,8 despite growing evidence of many unmet palliative care needs in this population. 9 This discrepancy suggests a need for more education about palliative care in the hematology community, and more efforts to adap...

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Section: The Workforcesupporting

confidence: 58%

Section: The Workforcementioning

confidence: 99%

Section: "Patients Will Think I'm Giving Up" or "Patients Don't Likementioning

confidence: 99%

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When and why should patients with hematologic malignancies see a palliative care specialist?

2015

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“…The Influence of Doctor-Patient Communication on Health Outcomes to plan the best supportive care (Back et al 2014). Specific training was found to have a positive influence: if physicians were trained to detect psychological distress, the patients' anxiety decreased significantly (Girgis et al 2009).…”

Section: Enabling Treatment-related Emotionsmentioning

confidence: 99%

The Influence of Doctor-Patient Communication on Health Outcomes: A Systematic Review

Riedl

Schüßler

2017

Zeitschrift für Psychosomatische Medizin und Psychotherapie

126

111

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Zusammenfassung Der Einfluss dertion gathering, or patient education). We conducted a systematic review including publications from 2000 to 2015 to gather further empirical support. Methods: A systematic review was carried out (with information drawn mainly from Medline, Embase, Cochrane, PsychLit, and Psyndex) to identify RCTs as well as controlled and uncontrolled studies in clinical adult samples. Studies with psychiatric samples and psychologicalpsychotherapeutic interventions were excluded. Results: A total of 17 RCTs, 17 controlled studies, and 8 qualitative studies met the inclusion criteria. The quality of the RCTs and controlled studies was satisfying. In the doctor-patient relationship (building), 60% of the studies showed a positive effect on objective health parameters. Information gathering and provision (patient education) were the most investigated domains with unequivocally positive effects. Communication (skills) showed improved results and enabled treatment-related emotions and behavior. Two studies included an economical evaluation with reduced healthcare costs. Conclusions: A systematic review revealed different domains of the doctor-patient relationship and communication with convincing effects regarding different objective and subjective health outcomes.

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“…In addition, the earlier integration of Palliative Care with standard cancer care may improve the survival and the quality of life (QOL), and lessen psychological conditions, ICU length of stay, duration of mechanical ventilation and the use of unbeneficial treatments [11][12][13]. In this study, our goals were to evaluate the impact of poor prognosis patients admitted to the ICU on their family members' emotional disorders during ICU and at 3 months follow up.…”

Section: Journal Of Intensive and Critical Care Issn 2471-8505mentioning

confidence: 99%

The Impact of Poor Prognostic Patients Admitted to the Intensive Care Unit on Family Member's Emotional Disorders

Fumis¹,

Martins²,

Schettino³

2016

Intensive & Crit Care

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Background: Having a loved one admitted to the ICU is an extraordinarily stressful event, principally with poor prognosis and when death may occur. Aim:To evaluate the impact of poor prognosis patients admitted in the ICU on their family member's emotional disorders. Design and setting:Prospective study conducted in a 22-bed mixed ICU in a tertiary hospital in Sao Paulo, Brazil. Family members completed the Hospital Anxiety and Depression Scale 48 hours post-admission. Family members answered the HADS, the Impact of Event Scale by phone at 30-days and 90-days after ICU discharge.Results: 95/575 patients admitted at the ICU were defined as poor prognostic patients. Poor prognostic patients required more mechanical ventilation (50.0% vs. 32.9%, p=0.002), tracheotomy (11.6% vs. 5.0%, p=0.014), vasopressors (54.7% vs. 36.8%, p=0.001), remained longer under mechanical ventilation (7 [3-15] vs. 3 [2-6] days, p=0.030) and stay longer at ICU (8 [5-18] vs. 4 [3-8], p<0.001) when compared with non-poor prognosis patients. They also had high mortality at ICU (32.6%), 30-days (60.0%) and 90-days (73.5%) and we also observed an intense emotional suffering among their respective family members during and after ICU discharge. Conclusion:Family members of poor prognosis patients admitted to the ICU were more likely to suffer with symptoms of anxiety, depression and post traumatic distress. Their loved ones needed more aggressive treatments during ICU and had higher mortality in a short time.

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Clinician Roles in Early Integrated Palliative Care for Patients with Advanced Cancer: A Qualitative Study

Cited by 85 publications

References 14 publications

When and why should patients with hematologic malignancies see a palliative care specialist?

When and why should patients with hematologic malignancies see a palliative care specialist?

The Influence of Doctor-Patient Communication on Health Outcomes: A Systematic Review

The Impact of Poor Prognostic Patients Admitted to the Intensive Care Unit on Family Member's Emotional Disorders

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