Effects of Early Integrated Palliative Care on Caregivers of Patients with Lung and Gastrointestinal Cancer: A Randomized Clinical Trial

El‐Jawahri, Areej; Greer, Joseph A.; Pirl, William F.; Park, Elyse R.; Jackson, Vicki A.; Back, Anthony L.; Kamdar, Mihir; Jacobsen, Juliet; Chittenden, Eva; Rinaldi, Simone; Gallagher, Emily R.; Eusebio, Justin; Fishman, Sarah; VanDusen, Harry; Li, Zhigang; Muzikansky, Alona; Temel, Jennifer S.

doi:10.1634/theoncologist.2017-0227

Cited by 151 publications

(184 citation statements)

References 34 publications

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“…In this section, we focus on more recent publications, because older studies have been summarized in previous reviews . Table highlights the key elements of study design and outcomes . A majority of these clinical trials concluded that concurrent palliative care improves quality of life, symptoms, and patient‐clinician communication compared with oncologic care alone .…”

Section: Evidence To Support Early Palliative Carementioning

confidence: 99%

“…A majority of these clinical trials concluded that concurrent palliative care improves quality of life, symptoms, and patient‐clinician communication compared with oncologic care alone . Some studies also demonstrated that palliative care enhances mood, patient satisfaction, quality of end‐of‐life care, survival, and caregiver outcomes (Table ) . Of note, none of the studies favored oncologic care alone for the primary outcome.…”

Section: Evidence To Support Early Palliative Carementioning

confidence: 99%

“…Furthermore, palliative care has not yet been accredited in some countries, which may contribute further to inconsistencies in its delivery. As shown in Table , it appears that studies involving interdisciplinary palliative care teams were more likely to have a positive outcome than those involving nurse‐led palliative care (4 of 5 trials vs 2 of 6 trials for the primary outcome) . However, to date, no single study has directly compared interdisciplinary teams with single‐practitioner–led models, and further research is needed.…”

Section: Evidence To Support Early Palliative Carementioning

confidence: 99%

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Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Hui

Hannon

Zimmermann

et al. 2018

CA A Cancer J Clinicians

293

272

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Over the past decade, a large body of evidence has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer. The question is no longer whether palliative care should be offered, but what is the optimal model of delivery, when is the ideal time to refer, who is in greatest need of a referral, and how much palliative care should oncologists themselves be providing. These questions are particularly relevant given the scarcity of palliative care resources internationally. In this state-of-science review directed at the practicing cancer clinician, we will first discuss the contemporary literature examining the impact of specialist palliative care on various health outcomes. We will then provide conceptual models to support team-based, timely and targeted palliative care. Team-based palliative care allows the interdisciplinary members to address comprehensively the multi-dimensional care needs of patients and their caregivers. Timely palliative care, at its best, is preventative care to minimize crises at the end-of-life. Targeted palliative care involves identifying patients most likely to benefit from specialist palliative care interventions, akin to the concept of targeted cancer therapies. Finally, we will summarize the strengths and weaknesses of innovative care models, such as outpatient clinics, embedded clinics, nurse-led palliative care, primary palliative care provided by oncology teams, and automatic referral. Moving forward, more research is needed to determine how different health systems can best personalize palliative care to provide the right level of intervention, for the right patient, in the right setting, at the right time.

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Section: Evidence To Support Early Palliative Carementioning

confidence: 99%

Section: Evidence To Support Early Palliative Carementioning

confidence: 99%

Section: Evidence To Support Early Palliative Carementioning

confidence: 99%

See 1 more Smart Citation

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Hui

Hannon

Zimmermann

et al. 2018

CA A Cancer J Clinicians

293

272

View full text Add to dashboard Cite

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“…The routine integration of PC referral into the outpatient transplantation assessment process has been shown to significantly improve the symptoms of patients with ESLD, impacting positively on depression, pruritus, appetite, anxiety, and fatigue . In surgical and oncology settings, early incorporation of PC has been demonstrated to increase family goals of care consensus and advance directive planning, but this has not yet been shown for patients with ESLD . This is likely related to a difference in the perceived prognosis of the underlying condition.…”

Section: Quality Of Life and Palliative Managementmentioning

confidence: 99%

Palliative care in end‐stage liver disease: Time to do better?

et al. 2018

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Optimal involvement of palliative care (PC) services in the management of patients with decompensated cirrhosis and end-stage liver disease (ESLD) is limited. This may result from both ignorance and the failure to recognize the spectrum and unpredictability of the underlying liver condition. Palliative care is a branch of medicine that focuses on quality of life (QoL) by optimizing symptom management and providing psychosocial, spiritual, and practical support for both patients and their caregivers. Historically, palliative care has been underutilized for patients with decompensated liver disease. This review provides an evidence-based analysis of the benefits of the integration of palliative care into the management of patients with ESLD. Liver Transplantation 24 961-968 2018 AASLD.

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“…The first randomized controlled trials (RCTs) published in high‐impact journals provided evidence that concurrent palliative care could have positive effects on quality of life, depression, symptom burden, satisfaction with care, and survival among individuals who were living with metastatic solid tumors. The evidence base continued to expand beyond these seminal studies and demonstrated positive effects on illness communication, adaptive coping, prognostic awareness, treatment decision making, end‐of‐life care, caregiver outcomes, and cost‐effectiveness . As the science matured, palliative care researchers were able to identify mediators and moderators of the beneficial effects of palliative care …”

Section: Strategy 1: Stimulating the Science In Specific Gap Areasmentioning

confidence: 99%

Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation

Lyons

Padgett

Marshall

et al. 2018

CA A Cancer J Clinicians

Self Cite

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Despite research explicating the benefits of cancer rehabilitation interventions to optimize physical, social, emotional, and vocational functioning, many reports document low rates of referral to and uptake of rehabilitation in oncology. Cancer rehabilitation clinicians, researchers, and policy makers could learn from the multidisciplinary specialty of palliative care, which has benefited from a growth strategy and has garnered national recognition as an important and necessary aspect of oncology care. The purpose of this article is to explore the actions that have increased the uptake and integration of palliative care to yield insights and multimodal strategies for the development and growth of cancer rehabilitation. After examining the history of palliative care and its growth, the authors highlight 5 key strategies that may benefit the field of cancer rehabilitation: 1) stimulating the science in specific gap areas; 2) creating clinical practice guidelines; 3) building clinical capacity; 4) ascertaining and responding to public opinion; and 5) advocating for public policy change. Coordinated and simultaneous advances on these 5 strategies may catalyze the growth, utilization, and effectiveness of patient screening, timely referrals, and delivery of appropriate cancer rehabilitation care that reduces disability and improves quality of life for cancer survivors who need these services.

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Effects of Early Integrated Palliative Care on Caregivers of Patients with Lung and Gastrointestinal Cancer: A Randomized Clinical Trial

Cited by 151 publications

References 34 publications

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Palliative care in end‐stage liver disease: Time to do better?

Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation

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