Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care

Abstract

BackgroundCase managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse.ObjectivesTo compare cancer patients with and without additional support from a case manager on: 1) the patients’ general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes.MethodsThis article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013.ResultsThe GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care.ConclusionsInvolvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is ‘only’ advisory and he or she does not provide hands-on care or prescribe medication.

What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient’s Expectations and Needs when Being Admitted to a Palliative Care Unit

“…Furthermore, social workers are very important members of palliative care teams. Social workers may help the patients and their families to resolve difficulties and maintain an active social life [ 49 , 50 ].…”

Integration of oncology and palliative care: a Lancet Oncology Commission

“…As well, the case manager may offer palliative care advice to other healthcare providers, including the GP and the home care nurse. 472…”

Is home care an issue for primary health care? Expert views from Poland and Estonia

“…personal hygiene, assistance with meals), rehabilitation care and supportive care [3]. nevertheless, a majority of hc clients need health services as well, thus, the family doctor (Fd) is usually involved in provision of care [4][5][6] or is expected to be a coordinator of the care [7]. however, as argued in a recent who report [1], health workers are often unprepared to deal with the needs of these patients, and thus, many patients with several health and social needs may suffer from gaps in the coordination of their care.…”

“…This situation is explained by the ways in which services are organized and delivered, some being administered by the health system and others by the social care system. it seems that, as in some other countries [4][5][6][7], the Fds in Poland and in Estonia are mostly involved in the care of the patients with a need of hc. Thus, they may have a key role in this process, primarily in provision the appropriate information about other services that might be necessary for the patients and their families.…”