Comparing Specialty and Primary Palliative Care Interventions: Analysis of a Systematic Review

Ernecoff, Natalie C.; Check, Devon K.; Bannon, Megan; Hanson, Laura C.; Dionne‐Odom, J. Nicholas; Corbelli, Jennifer; Klein‐Fedyshin, Michele; Schenker, Yael; Zimmermann, Camilla; Arnold, Robert M.; Kavalieratos, Dio

doi:10.1089/jpm.2019.0349

Cited by 57 publications

(42 citation statements)

References 66 publications

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“…A stratified analysis of care delivery across illness trajectories comparing delivery by generalist and specialist palliative care practitioners would help identify further gaps in access to specialized palliative care and its associated benefits. 1,5,6,13,48 However, a description of the real-world delivery of palliative care is important to identify gaps in care and likely strengthens the generalizability of the study to care provided in other similar health care systems. Third, the study did not measure delivery of palliative care by health care practitioners other than physicians, which may include nurse practitioners or social workers.…”

Section: Limitationsmentioning

confidence: 99%

Comparison of Palliative Care Delivery in the Last Year of Life Between Adults With Terminal Noncancer Illness or Cancer

et al. 2021

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Section: Limitationsmentioning

confidence: 99%

Comparison of Palliative Care Delivery in the Last Year of Life Between Adults With Terminal Noncancer Illness or Cancer

et al. 2021

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“…However, the comparative effectiveness of different types of palliative homecare on potentially aggressive interventions at the end-of-life has been less studied so far. In the literature we found a subsequent analysis 11 of a meta-analysis, 6 that delivers an indirect comparison between specialized palliative care (not differentiating between hospital-based and homecare) and primary palliative care. As a result, both types of palliative care improve patients’ quality of life and clinical outcomes, such as symptom management.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of two types of palliative home care in cancer and non-cancer patients: A retrospective population-based study using claims data

et al. 2021

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Background: Comparative effectiveness of different types of palliative homecare is sparsely researched internationally—despite its potential to inform necessary decisions in palliative care infrastructure development. In Germany, specialized palliative homecare delivered by multi-professional teams has increased in recent years and factors beyond medical need seem to drive its involvement and affect the application of primary palliative care, delivered by general practitioners who are supported by nursing services. Aim: To compare effectiveness of primary palliative care and specialized palliative homecare in reducing potentially aggressive interventions at the end-of-life in cancer and non-cancer. Design: Retrospective population-based study with claims data from 95,962 deceased adults in Germany in 2016 using multivariable regression analyses. Settings/participants: Patients having received primary palliative care or specialized palliative homecare (alone or in addition to primary palliative care), for at least 14 days before death, differentiating between cancer and non-cancer patients. Results: Rates of potentially aggressive interventions in most indicators were higher in primary palliative care than in specialized palliative homecare ( p < 0.01), in both cancer and non-cancer patients: death in hospital (odds ratio (OR) 4.541), hospital care (OR 2.720), intensive care treatment (OR 6.749), chemotherapy (OR 2.173), and application of a percutaneous endoscopic gastrostomy (OR 4.476), but not for parenteral nutrition (OR 0.477). Conclusion: Specialized palliative homecare is more strongly associated with reduction of potentially aggressive interventions than primary palliative care in the last days of life. Future research should identify elements of specialized palliative homecare applicable for more effective primary palliative care, too. German Clinical Trials Register (DRKS00014730).

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“…[17] Although government prioritization of palliative care is a promising development and it is recognized that primary care can contribute to addressing the majority of palliative care needs in the population, [18] there remains a lack of conceptual clarity around certain aspects, including the differentiation of primary and specialist levels of palliative care, what they are comprised of and when each is needed. [19,20] The phrase palliative approach has gained traction due to connotations of activities or tasks (not just philosophy) applicable to all care professionals (not just palliative care specialists) in a manner consistent with the philosophy of palliative care, regardless of whether care is labelled or approached as such. [19] [21] Sawatzky and colleagues identi ed three overarching themes delineating a palliative approach: (1) upstream orientation towards the needs of people who have life-limiting conditions and their families, (2) adaptation of palliative care knowledge and expertise, (3) operationalization of a palliative approach through integration into systems and models of care that do not specialize in palliative care.…”

Section: Introductionmentioning

confidence: 99%

Frequency of Providing a Palliative Approach to Care in Family Practice: A Chart Review and Perceptions of Healthcare Practitioners in Canada

Gallagher

Carter-Ramirez

Boese

et al. 2021

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Background: Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate their clinicians’ perceptions of the results.Methods: We conducted a descriptive study of deceased patients in an interprofessional team family practice. We integrated conceptual models of a palliative approach to create a chart review tool to capture a palliative approach in the last year of life and assessed a global rating of whether a palliative approach was provided. Clinicians completed a questionnaire before learning the results and after, on perceptions of how often they believed a palliative approach was provided by the team.Results: Among 79 patients (mean age at death 73 years, 54% female) cancer and cardiac diseases were the top conditions responsible for death. One-quarter of patients were assessed as having received a palliative approach. 53% of decedents had a documented discussion about goals of care, 41% had nurse involvement, and 15.2% had a discussion about caregiver well-being. These indicators had the greatest discrimination between a palliative approach or not. Agreement that elements of a palliative approach were provided decreased significantly on the clinician questionnaire from before to after viewing the results. Conclusions: This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement.

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Comparing Specialty and Primary Palliative Care Interventions: Analysis of a Systematic Review

Cited by 57 publications

References 66 publications

Comparison of Palliative Care Delivery in the Last Year of Life Between Adults With Terminal Noncancer Illness or Cancer

Comparison of Palliative Care Delivery in the Last Year of Life Between Adults With Terminal Noncancer Illness or Cancer

Effectiveness of two types of palliative home care in cancer and non-cancer patients: A retrospective population-based study using claims data

Frequency of Providing a Palliative Approach to Care in Family Practice: A Chart Review and Perceptions of Healthcare Practitioners in Canada

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