Discrepancies between Reasons of Palliative Care Team Consultation and Palliative Care Team Activities

Hatano, Yutaka; Shikata, Yuko; Izumi, Hiroaki; Kawaguchi, Akinori

doi:10.1089/jpm.2018.0086

Cited by 8 publications

(9 citation statements)

References 27 publications

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“…Thus, it appears that including IPCC is dependent on the individual physicians' attitude. Very weak patients or patients close to death who cannot speak for themselves and express their needs and symptom burden are challenging and might have benefitted from an earlier integration of PC; not only for symptom control, but also for decision making [20][21][22]. In addition, insufficient IPCC staffing and logistical problems like short patient stays and difficulty in timing the consultation are challenging issues [23].…”

Section: Introductionmentioning

confidence: 99%

“…Despite these difficulties, IPCC has demonstrated positive effects in several areas of patient care: A multiprofessional palliative assessment covers more aspects than the ones addressed by the requesting physician [15,22], and IPCC recommendationspharmacological and non-pharmacologicalcan lead to less invasive measures which can be a relief for patients [24]. Prior studies reported pain relieve [21], but also improvement of nausea, depression, anxiety, insomnia and general well-being [5,20].…”

Section: Introductionmentioning

confidence: 99%

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Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Coym

Kanitz

Puls

et al. 2020

BMC Health Serv Res

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Background: Inpatient palliative care consultation (IPCC) teams have been established to improve care for patients with specialist palliative care (PC) needs throughout all hospital departments. The objective is to explore physicians' perceptions on the impact of IPCC, its triggers, challenges and limits, and their suggestions for future service improvements. Methods: A Qualitative study drawing on semi-structured interviews with 10 PC specialists of an IPCC team and nine IPCC requesting physicians from oncology and non-oncological departments of a university hospital. Analysis was performed using qualitative content analysis. Results: PC specialists and IPCC requesting physicians likewise considered organization of further care and symptom-burden as main reasons for IPCC requests. The main impact however was identified from both as improvement of patients' (and their caregivers') coping strategies and relief of the treating team. Mostly, PC specialists emphasized a reduction of symptom burden, and improvement of further care. Challenges in implementing IPCC were lack of time for both. PC specialists addressed requesting physicians' skepticism towards PC. Barriers for realization of IPCC included structural aspects for both: limited time, staff capacities and setting. PC specialists saw problems in implementing recommendations like disagreement towards their suggestions. All interviewees considered education in PC a sensible approach for improvement. Conclusions: IPCC show various positive effects in supporting physicians and patients, but are also limited due to structural problems, lack of knowledge, insecurity, and skepticism by the requesting physicians. To overcome some of these challenges implementation of PC education programs for all physicians would be beneficial.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Coym

Kanitz

Puls

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…In our study, 62-72% of patients reported pain versus 66% of Japanese palliative cancer patients (Sakurai et al 2019). In the German study of Erlenwein et al (2014), pain was the explicit reason for consultation with the PCT in 64% of cases, and in the Japanese study of Hatano et al (2018) pain was the reason for consultation with the PCT in 67% of cases. This is possibly a result of the now improved pain management in general palliative care.…”

Section: Symptoms and Psychosocial Needsmentioning

confidence: 98%

Anxiety, depression and psychosocial needs are the most frequent concerns reported by patients: preliminary results of a comparative explorative analysis of two hospital-based palliative care teams in Germany and Japan

et al. 2020

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In the partnership between the medical departments of Würzburg University, Germany, and Nagasaki University, Japan, palliative care is a relevant topic. The aim of the study was to perform a comparative analysis of the hospital-based palliative care teams in Würzburg (PCT-W) and Nagasaki (PCT-N). Survey of staff composition and retrospective analysis of PCT patient charts in both PCTs were conducted. Patients self-assessed their symptoms in PCT-W and in Radiation Oncology Würzburg (RO-W). The (negative) quality indicator ‘percentage of deceased hospitalised patients with PCT contact for less than 3 days before death’ (Earle in Int J Qual Health Care 17(6):505–509, 2005) was analysed. Both PCTs follow a multidisciplinary team approach. PCT-N saw 410 cancer patients versus 853 patients for PCT-W (22.8% non-cancer patients). The Eastern Cooperative Oncology Group Performance Status at first contact with PCT-N was 3 or 4 in 39.3% of patients versus 79.0% for PCT-W. PCT-N was engaged in co-management longer than PCT-W (mean 20.7 days, range 1–102 versus mean 4.9 days, range 1–48). The most frequent patient-reported psychological symptom was anxiety (family anxiety: 98.3% PCT-W and 88.7% RO-W, anxiety 97.9% PCT-W and 85.9% RO-W), followed by depression (98.2% PCT-W and 80.3% RO-W). In 14 of the 148 deceased patients, PCT-N contact was initiated less than 3 days before death (9.4%) versus 121 of the 729 deceased PCT-W patients (16.6%). Psychological needs are highly relevant in both Germany and Japan, with more than 85% anxiety and depression in patients in the Japanese IPOS validation study (Sakurai in Jpn J Clin Oncol 49(3):257–262, 2019). This should be taken into account when implementing PCTs.

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“…Therefore, it is important that all health care personnel have basic skills in PC to care for these patients. Previously, unmet PC needs among patients dying in hospital were identified [ 25 , 27 – 29 ]. It is also known that team members in settings other than specialised PC may not prioritise, do not recognise, or are uninterested in PC competencies [ 25 , 30 ] and have deeply rooted beliefs in their self-sufficiency [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Cultures that collide: an ethnographic study of the introduction of a palliative care consultation team on acute wards

et al. 2021

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Background Acute care and palliative care (PC) are described as different incompatible organisational care cultures. Few studies have observed the actual meeting between these two cultures. In this paper we report part of ethnographic results from an intervention study where a palliative care consultation team (PCCT) used an integrative bedside education approach, trying to embed PC principles and interventions into daily practice in acute wards. Purpose To study the meeting and interaction of two different care cultures, palliative care and curative acute wards, when a PCCT introduces consulting services to acute wards regarding end-of-life palliative care, focusing on the differences between the cultures. Methods An ethnographic study design was used, including observations, interviews and diary entries. A PCCT visited acute care wards during 1 year. The analysis was inspired by Spradleys ethnography. Results Three themes were found: 1) Anticipations meets reality; 2) Valuation of time and prioritising; and 3) The content and creation of palliative care. Conclusion There are many differences in values, and the way PC are provided in the acute care wards compared to what a PCCT expects. The didactic challenges are many and the PC require effort.

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Discrepancies between Reasons of Palliative Care Team Consultation and Palliative Care Team Activities

Cited by 8 publications

References 27 publications

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Anxiety, depression and psychosocial needs are the most frequent concerns reported by patients: preliminary results of a comparative explorative analysis of two hospital-based palliative care teams in Germany and Japan

Cultures that collide: an ethnographic study of the introduction of a palliative care consultation team on acute wards

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