Integration and activity of hospital-based palliative care consultation teams: the INSIGHT multicentric cohort study

Vinant, Pascale; Joffin, Ingrid; Serresse, Laure; Grabar, Sophie; Jaulmes, Hélène; Daoud, Malika; Abitbol, G.; Fouassier, Pascale; Triol, Isabelle; Rostaing, S.; Brette, M. D.; Colombet, Isabelle

doi:10.1186/s12904-017-0209-9

Cited by 36 publications

(31 citation statements)

References 26 publications

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“…However, our results on the location of death (44.7% of patients died in hospital, emergency room or intensive care units, or rehabilitation unit) are to be interpreted in the French healthcare system in which home care is underdeveloped, as shown by the national mortality data (18.9% of cancer death occurring at home) [31]. This proportion is even lower in our population, as it has been described in similar population from university hospitals [6].…”

Section: Discussionsupporting

confidence: 44%

“…The access to palliative care in oncology, for patients with advanced cancers, hinges on hospital-based palliative care consultation teams (PCT). Despite being recommended early in the course of advanced cancer [1][2][3] palliative care is often proposed late and after the stop of antitumoral treatments [4][5][6] with low impact on patient's quality of life [7]. The reasons for this delay are now well known [4,[8][9][10]., Patients and family-related barriers for early referral often include negative image of palliative care and unwillingness to end anti-cancer treatments.…”

Section: Introductionmentioning

confidence: 99%

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First referral to an integrated onco-palliative care program: a retrospective analysis of its timing

et al. 2020

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Background: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient's profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. Methods: The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). Results: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16-0.72], ranging between 0.53 [0.20-0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07-0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. Conclusions: The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.

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Section: Discussionsupporting

confidence: 44%

Section: Introductionmentioning

confidence: 99%

First referral to an integrated onco-palliative care program: a retrospective analysis of its timing

et al. 2020

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“…The role of palliative care consultation teams is to provide on-demand services within the hospital [12]. In this qualitative study, the characteristics of the PCCS programme were examined in a structured manner.…”

Section: Discussionmentioning

confidence: 99%

“…transferring patients form inpatient care to homecare). A recent multicentre cohort study in France showed that there is still late referral to palliative care and that the "on request" model which originally characterized these services is gradually being exchanged for the integrated palliative care model [12]. Several studies suggest that even after one visit with the palliative care team in inpatient setting, there are improvements in physical and psychological symptoms, quality of life, as well as patient satisfaction with care [13][14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Implementation of palliative care consult Service in Hungary – integration barriers and facilitators

Zemplényi

Csikós

Csanádi³

et al. 2020

BMC Palliat Care

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Background: The Palliative Care Consult Service (PCCS) programme was among the first initiations in Hungary to provide palliative care for patients admitted to hospital. The PCCS team provides palliative care for mainly cancer patients and their family members and manages the patient pathway after being discharged from the hospital. The service started in 2014 with 300-400 patient visits per year. The aim of this study is to give a comprehensive overview of the PCCS programme guided by a conceptual framework designed by SELFIE ("Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE"), a Horizon2020 funded EU project and to identify the facilitators and barriers to its wider implementation. Methods: PCCS has been selected by the SELFIE consortium for in-depth evaluation as one of the Hungarian integrated care models for persons with multi-morbidity. The qualitative analysis of the PCCS programme was based on available documents of the care provider and interviews with different stakeholders related to the programme. Results: The integrated, multidisciplinary and patient-centred approach was well-received among the patients, family members and clinical departments, as verified by the increasing number of requests for consultations. As a result of the patient pathway management across providers (e.g. from inpatient care to homecare) a higher level of coordination could be achieved in the continuity of care for seriously-ill patients. The regulatory framework has only partially been established, policies to integrate care across organizations and sectors and adequate financial mechanism to support the enhancement and sustainability of the PCCS are still missing. Conclusions: The service integration of palliative care could be implemented successfully in an academic hospital in Hungary. However, the continuation and enhancement of the programme will require further evidence on the performance of the integrated model of palliative care and a more systematic approach particularly regarding the evaluation, financing and implementation process.

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“…The access to palliative care in oncology, for patients with advanced cancers, hinges on hospitalbased palliative care consultation teams (PCT). Despite being recommended early in the course of advanced cancer (1), (2), (3) palliative care is often proposed late and after the stop of antitumoral treatments (4), (5), (6) with low impact on patient's quality of life (7) . The reasons for this delay are now well known (4), (8), (9), (10) .…”

Section: Introductionmentioning

confidence: 99%

First referral to an Integrated Onco-Palliative Care program: a retrospective analysis of its timing

Barth

Colombet

Montheil³

et al. 2020

Preprint

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Background: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. Patients and Methods: The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). Results: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level >35g/l. The median [1st-3rd quartile] IP was 0.39 [0.16-0.72], ranging between 0.53 [0.20-0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07-0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units.Conclusions: The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.

show abstract

Integration and activity of hospital-based palliative care consultation teams: the INSIGHT multicentric cohort study

Cited by 36 publications

References 26 publications

First referral to an integrated onco-palliative care program: a retrospective analysis of its timing

First referral to an integrated onco-palliative care program: a retrospective analysis of its timing

Implementation of palliative care consult Service in Hungary – integration barriers and facilitators

First referral to an Integrated Onco-Palliative Care program: a retrospective analysis of its timing

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