When Does Palliative Care Begin? A Needs Assessment of Cancer Patients with Recurrent Disease

Abstract

This cross-sectional study compared the prevalence and intensity of needs expressed by cancer patients at the time of first recurrence (n=75) with those of patients at the time of disease progression (n=75). On a 72-item Likert-type scale participants rated from “none” to “very much” the severity of physical symptoms; emotional, psychological, and social problems; and difficulties with activities of daily living. The progressive disease group reported more problems than the first recurrence group in 11 of 24 (47%, p<0.05) symptom-related questions. The progressive disease group also expressed greater needs in 19% of the function-related questions. There were no differences in reported psychological problems, responses to recurrence, or greatest concern between the two groups. These results support the need for palliative care throughout the entire course of illness.

A concept analysis of palliative care in the United States

“…The second was the emerging technologies, and improved pharmaceuticals, which resulted in people living longer, therefore altering illness trajectories. These changed conditions gave birth to a generation of dissenters who questioned the sufficiency of then existing models of health care delivery for those with non‐malignant, progressively terminal illnesses (Magno 1990, Dush 1993, Dudgeon et al. 1995).…”

Unmet psychosocial needs of Pennsylvanians with cancer: 1986–2005

“…The findings of these studies were used to develop a series of psychosocial and educational programs to address the unmet psychosocial needs of cancer patients 3–8. Subsequent needs assessments have focused on the general unmet needs of cancer patients and their families,9–11 site‒specific unmet needs,12–16 unmet needs related to cancer stage,17–20 relationship‒specific issues,21, 22 ethnicity‒based issues,12, 23, 24 and unmet needs related to socioeconomic status25 and geographic factors 26…”

Bereavement care for the non-bereaved

“…In palliative care the longer part of dying actually occurs outside episodes of direct service provision and professional care (Dudgeon et al, 1995). After disclosure of a limited life expectancy (prognosis), many people with a life-threatening illness are able to continue for some considerable time to engage in their usual occupations -in work or play.…”