The impact of early palliative care on the quality of care during the last days of life: what does the evidence say?

Zambrano, Sofía C.; Fliedner, Monica; Eychmüller, Steffen

doi:10.1097/spc.0000000000000240

Cited by 15 publications

(11 citation statements)

References 46 publications

(33 reference statements)

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“…In our study, we found that patients who received palliative care and their FCs have more needs than those who did not receive palliative care. Although, it can be expected that those who received palliative care are more ill (tended to be inpatients and lower KPS) and therefore have more needs, as early palliative care has been proven to improve the QOL of the patients with advanced cancer [ 52 – 56 ], we postulate that this may also imply that patients with advanced cancer were referred by their oncologists to palliative care physicians late in their cancer trajectory. This late referral may have resulted in patients who are more ill and therefore, have more needs and require more care.…”

Section: Discussionmentioning

confidence: 99%

Supporting the patients with advanced cancer and their family caregivers: what are their palliative care needs?

Chua

Pang²,

Yee

et al. 2020

BMC Cancer

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Background: The impact and consequences of cancer on the patients and their family caregivers (FCs) are closely intertwined. Caregivers' burdens can be increased due to the patients' unmet needs and unresolved problems. Additionally, the caregivers' unmet needs may adversely affect their own well-being and the patients' health outcomes. This study aims to determine the palliative care needs and the factors associated with these needs in patients with advanced solid cancer and their FCs. Methods: In a cross-sectional survey, 599 patients with advanced solid tumours and 599 FCs were recruited from the largest ambulatory cancer centre and the inpatient ward of the largest hospital in Singapore. Determinants of patients' and FCs' needs were assessed by the Comprehensive Needs Assessment Tool (CNAT) and CNAT-C respectively. Clinical characteristics of patients were obtained from medical records. Results: The FCs (median age 51 years) were younger than the patients (median age 62 years), and were mostly female (62.6%) whereas the gender distribution of patients was quite balanced (49.2% male and 50.8% female). Both patients and FCs had "information" and "practical support" in their top three domains of palliative care needs. The second highest domain of needs was "psychological problems" (16.4 ± 21.5) in patients and "health-care staff" (23.4 ± 26.5) in FCs. The item that had the highest need score in "information" domain for both patients and FCs was "financial support for patients, either from government and/ or private organizations". Under clinical setting, the inpatients (19.2 ± 16.4) and their FCs (26.0 ± 19.0) tend to have higher needs than the outpatients (10.5 ± 12.1) and their FCs (14.7 ± 14.3). In terms of palliative care, higher total CNAT score was observed in both patients (16.6 ± 12.9 versus 13.3 ± 15.2) and their FCs (25.1 ± 18.6 versus 17.7 ± 16.7) who received palliative care. In terms of patients' KPS scores, patients with lower KPS scores tend to have higher needs. Conclusion: Overall, the findings confirm that patients with advanced cancer and their FCs have many palliative care needs irrespective of their clinical settings. Initiatives and interventions for the development of a comprehensive support system for both patients with advanced cancer and their FCs are warranted and can be derived from these findings.

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Section: Discussionmentioning

confidence: 99%

Supporting the patients with advanced cancer and their family caregivers: what are their palliative care needs?

Chua

Pang²,

Yee

et al. 2020

BMC Cancer

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“…Multiple organizations 1–4 emphasize that palliative care interventions should be initiated early in the disease trajectory and support advance care planning (ACP) 5 for patients with serious, life-limiting illnesses alongside disease modifying treatment. 3,6 Early palliative care, including ACP, involves complex interventions 7 in which professionals discuss symptom management, support end-of-life decision-making and coordinate care.…”

Section: Introductionmentioning

confidence: 99%

“…Multiple organizations [1][2][3][4] emphasize that palliative care interventions should be initiated early in the disease trajectory and support advance care planning (ACP) 5 for patients with serious, life-limiting illnesses alongside disease modifying treatment. 3,6 Early palliative care, including ACP, involves complex interventions 7 in which professionals discuss symptom management, support end-of-life decision-making and coordinate care. Intervention trials 6,[8][9][10][11][12][13][14][15][16][17][18][19] confirm that patients with advanced cancer who receive early palliative care experience improved quality of life, 6,[19][20][21] symptoms, 6,19 and mood, 6 are more likely to document end-of-life care decisions, 19 and be knowledgeable about palliative and hospice care.…”

Section: Introductionmentioning

confidence: 99%

An early palliative care intervention can be confronting but reassuring: A qualitative study on the experiences of patients with advanced cancer

et al. 2019

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Background: Intervention trials confirm that patients with advanced cancer receiving early palliative care experience a better quality of life and show improved knowledge about and use of palliative care services. To involve patients in future health-care decisions, health professionals should understand patients’ perspectives. However, little is known about how patients’ experience such interventions. Aim: To explore advanced cancer patients’ experiences with a structured early palliative care intervention, its acceptability and impact on the patients’ life including influencing factors. Design: Qualitative content analysis of in-depth, semi-structured interviews. Setting/participants: Patients with various advanced cancer diagnoses were enrolled in a multicenter randomized controlled trial (NCT01983956), which investigated the impact of “Symptoms, End-of-life decisions, Network, Support,” a structured early palliative care intervention, on distress. Of these, 20 patients who underwent the intervention participated in this study. Results: Participants received the intervention well and gained a better understanding of their personal situation. Patients reported that the intervention can feel “confronting” but with the right timing it can be confirming and facilitate family conversations. Patients’ personal background and the intervention timing within their personal disease trajectory influenced their emotional and cognitive experiences; it also impacted their understanding of palliative care and triggered actions toward future care planning. Conclusion: Early palliative care interventions like “Symptoms, End-of-life decisions, Network, Support” may provoke emotions and feel “confrontational” often because this is the first time when issues about one’s end of life are openly discussed; yet, advanced cancer patients found it beneficial and felt it should be incorporated into routine care.

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“…Neste contexto, cartilhas educativas para cuidadores de pacientes oncológicos em cuidados paliativos visando desenvolver comportamentos positivos e aumentar a adesão ao reconhecimento dos sinais e sintomas, além da necessidade de um maior envolvimento do profissional, enfermeiro, com a educação em saúde e os pacientes oncológicos em cuidados paliativos. O Enfermeiro precisa compreender as práticas relacionadas à oncologia -cuidados paliativos -de maneira integral 16,17 . Deve-se estar disponível para um diálogo e sadio relacionamento com as questões de sobrecarga do cuidador, qualidade de vida do paciente oncológico, cuidados paliativos, morte e as dimensões éticas, sociais e culturais.…”

Section: Discussionunclassified

Cuidados Paliativos: Cartilha educativa para cuidadores de pacientes oncológicos

et al. 2019

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Introdução: O câncer e seu tratamento são impactantes tanto para a família, quanto para o cuidador de paciente oncológico em cuidados paliativos. Como consequência, podem ocorrem várias alterações biopsicossociais e sintomas como ansiedade, fadiga, estresse, exaustão, isolamento social, instabilidade emocional. Esses problemas podem estar associados à mudança da rotina de vida do cuidador em relação ao cuidado oferecido ao paciente. O cuidador, na maioria das vezes, apresenta uma insegurança oriunda aos cuidados proporcionados ao paciente oncológico. Identifica-se que a maioria das vezes as orientações são fornecidas aos cuidadores de forma oral, mas não são fornecidas na forma impressa e nem disponibilizadas em mídias. Desta forma, há a possibilidade da redução da compreensão das informações fornecidas, podendo diminuir a efetividade do cuidado hospitalar, domiciliar e o entendimento sobre os cuidados paliativos. Métodos: Estudo metodológico, desenvolvido em duas etapas: levantamento bibliográfico e a elaboração da cartilha educativa para cuidadores de pacientes oncológicos em cuidados paliativos. Estudo descritivo sobre a elaboração de uma cartilha educativa em cuidados paliativos. Resultados: O uso do material educativo elaborado visa uma assistência mais humanizada prestada pelo cuidador ao paciente em cuidados paliativos, assim como um conhecimento preciso da magnitude do problema. Conclusão: A cartilha educativa foi elaborada como instrumento capaz de favorecer os cuidadores de pacientes oncológicos em cuidados paliativos sobre os principais sintomas, cuidados e informações que visam amenizar os momentos finais da vida desses pacientes.

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The impact of early palliative care on the quality of care during the last days of life: what does the evidence say?

Cited by 15 publications

References 46 publications

Supporting the patients with advanced cancer and their family caregivers: what are their palliative care needs?

Supporting the patients with advanced cancer and their family caregivers: what are their palliative care needs?

An early palliative care intervention can be confronting but reassuring: A qualitative study on the experiences of patients with advanced cancer

Cuidados Paliativos: Cartilha educativa para cuidadores de pacientes oncológicos

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