Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial

Abstract

BackgroundAccording to the Word Health Organization, patients who can benefit from palliative care should be identified earlier to enable proactive palliative care. Up to now, this is not common practice and has hardly been addressed in scientific literature. Still, palliative care is limited to the terminal phase and restricted to patients with cancer. Therefore, we trained general practitioners (GPs) in identifying palliative patients in an earlier phase of their disease trajectory and in delivering structured proactive palliative care. The aim of our study is to determine if this training, in combination with consulting an expert in palliative care regarding each palliative patient's tailored care plan, can improve different aspects of the quality of the remaining life of patients with severe chronic diseases such as chronic obstructive pulmonary disease, congestive heart failure and cancer.Methods/DesignA two-armed randomized controlled trial was performed. As outcome variables we studied: place of death, number of hospital admissions and number of GP out of hours contacts.DiscussionWe expect that this study will increase the number of identified palliative care patients and improve different aspects of quality of palliative care. This is of importance to improve palliative care for patients with COPD, CHF and cancer and their informal caregivers, and to empower the GP. The study protocol is described and possible strengths and weaknesses and possible consequences have been outlined.Trial RegistrationThe Netherlands National Trial Register: NTR2815

Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study

“…The 2010 SPICT indicators were reviewed and compared with similar tools identified from the literature to achieve consensus about the items for each section and their wording 6 7 11 25. General indicators of deteriorating health identified in several other palliative care assessment tools, or found in disease-specific mortality tools, are in the first section of the SPICT.…”

“…Better identification, holistic assessment and anticipatory care planning for future deterioration, could help to reduce the substantial risk of unplanned hospital admissions and prolonged inpatient stays experienced by all the patients we identified 21 27 28. Primary care teams have previously indicated that they would welcome guidance from hospital specialists about when to put patients on their palliative care registers or open discussions about future care goals 5 25 29. The SPICT indicators offer guidance on which patients are at risk of deteriorating, and describe changes in health status and care needs that can be used as a starting point for these discussions.…”

PROLONG: a cluster controlled trial to examine identification of patients with COPD with poor prognosis and implementation of proactive palliative care

“…This tool is especially useful when exploring the actual en potential problems and needs of the patient [41]. …”

Extent of palliative care need in the acute hospital setting: A survey of two acute hospitals in the UK

“…7 This was evident in a study conducted in an English acute hospital in 2001which aimed to identify the proportion of inpatients with palliative care needs, according to medical and nursing staff. Whilst 23% of the inpatient population were identified as having palliative care needs, there was a lack of concurrence between medical and nursing staff regarding which patients had palliative care needs 8 .Difficulties have also been recognised within primary care, with a lack of any validated tools that predict the optimal timing to initiate palliative care services in general practice, despite a wealth of international research on the prediction of mortality, survival, and prognostication for patients with advanced disease 9,10 . A recent systematic review identified a lack of validated criteria for identifying patients who would benefit from a transition to a palliative care approach, and highlighted that inconsistencies in the identification of patients with palliative care needs may have a negative impact on care delivery.…”