Establishment of a Palliative Care Consultation Service (PCCS) in an Acute Hospital Setting

Abstract

<jats:p>Background and study aims: Acute health service requires focused palliative care (PC). This study was performed to provide guidance for the establishment of a palliative care consultation service (PCCS). Patients and methods: This study was conceived as a retrospective single-center study for observing, analyzing and evaluating the initial setup of a PCCS from 1 May 2015 to 31 May 2018. Patients from Muenster University Hospital with advanced life-limiting diseases, identified to require PC, were included. Results: PCCS was requested from various departments, for between 20 and 80 patients per month, corresponding to a total of 2359 for the study period. Requests were highest in internal medicine (27.3%), gynecology (18.1%) and radiotherapy (17.6%). Time to referral was significantly shorter in departments with special PCCS ward rounds (6 ± 9 vs. 12 ± 22 days, p &lt; 0.001). The most frequently reported symptoms were fatigue, pain and loss of appetite. Pain was frequently localized in the stomach (20.4%), back (17.1%), or in the head and neck area (14.9%). After the first PCCS consultation, 254 patients (90%) reported sufficient pain relief after 48 h. An introduction/modification of painkiller medication, which was recommended for 142 inpatients, was implemented in 57.0% of cases by the respective departments. Overall, the direct realization of PCCS recommendations reached only 50% on average. Conclusions: Besides an analysis of the ability to address the symptoms of the referred patients by the PCCS, this study highlights the importance of the interaction between PCCS and other departments. It further elucidates the role and possibilities of this service both in regular ward rounds and individual staff contacts.</jats:p>

Trend analysis of palliative care consultation service for terminally ill non-cancer patients in Taiwan: a 9-year observational study

“…Multiple palliative care services have been initiated in recent years, including inpatient care in palliative care unit [ 15 ], palliative home care service [ 16 ] and palliative care consultation service (PCCS) [ 17 ]. A previous study has shown that PCCS during hospitalization for cancer patients can improve patients’ and families’ awareness of disease diagnosis and prognosis, and also increase consent to DNR [ 18 ].…”

Virtual reality reduces pain in palliative care–A feasibility trial

“…Albeit pain was the main problem for all patients when VR intervention was performed, initial contact with specialized PC resulted due to pain (57.5%, n = 23), organization of outpatient care (35%, n = 14), and complexity of care in ICU/isolation (7.5%, n = 3). Patients were treated by the PCCS according to their actual needs and under the consideration of our treatment algorithm [15]. Variations among the participants regarding their need for supportive care are also apparent in days of PCCS cocare, which ranged between 1 and 245 days (29 ± 41.18).…”

“…The proportion of PC patients suffering from pain is quantified to be 64% according to another survey [14]. Looking at inpatients who were treated by the Palliative Care Consultation Service (PCCS) at Muenster University Hospital between May 1, 2015 and May 31, 2016, 56.7% (278 of 490) were affected by pain (measured with visual analog scale, mean 5.1, SD 2.7, median 5.0) [15]. Observational research confirms that many patients suffering from cancer experience moderate or severe pain yet do not receive appropriate treatment [13,16].…”

Palliative and End-of-Life Care: More Work is Required

“…A wide spectrum of patient populations was included, ranging from cancer patients to noncancer patients and older adults with moderate–severe physical impairment and cognitive frailty. Engel and colleagues [ 4 ] reported the establishment of a palliative care consultation service in an acute hospital in Germany. This palliative care consultation team supports physicians and nurses by providing medication recommendations for their patients.…”