Consultations' demand for a hospital palliative care unit: how to increase appropriateness? Implementing and evaluating a multicomponent educational intervention aimed at increase palliative care complexity perception skill.
Care pathway
Complexity
Hospital
Multidisciplinary discussions
Oncology
Palliative care
Training
Tumour board
Journal
BMC palliative care
ISSN: 1472-684X
Titre abrégé: BMC Palliat Care
Pays: England
ID NLM: 101088685
Informations de publication
Date de publication:
26 May 2022
26 May 2022
Historique:
received:
17
03
2021
accepted:
04
05
2022
entrez:
26
5
2022
pubmed:
27
5
2022
medline:
31
5
2022
Statut:
epublish
Résumé
Planned, multidisciplinary teams' discussions of cases are common in cancer care, but their impact on patients' outcome is not always clear. Palliative care (PC) needs might emerge long before the last weeks of life. Many palliative care patients could be managed from the usual care staff, if appropriately trained; specialist palliative care should be provided to patients with more complex needs. Staff needs adequate training, so that only patients presenting a higher complexity are properly referred to the second level ("specialized") PC services. In the considered hospital setting, "tumour boards" (multidisciplinary discussions) refer often to a low number of patients. Overall complexity of patients' needs is hardly considered. A mixed method pilot study with data triangulation of professionals' interviews and an independently structured evaluation of complexity of referred patients, before and after the intervention, using the PALCOM instrument. We trained four teams of professionals to deliver first-level palliation and to refer patients with complex needs detected in multidisciplinary discussions. A multicomponent, first level PC educational intervention, including information technology's adaptation, a training course, and bedside training was offered from the specialized PC Services, to all the HPs involved in multidisciplinary pancreas, lung, ovarian, and liver tumour boards. While the level of complexity of referred patients did not increase, trainees seemed to develop a better understanding of palliative care and a higher sensitivity to palliative needs. The number of referred patients increased, but patients' complexity did not. Qualitative data showed that professionals seemed to be more aware of the complexity of PC needs. A "meaning shift" was perceived, specifically on the referral process (e.g., "when" and "for what" referring to specialist PC) and on the teams' increased focus on patients' needs. The training, positively received, was adapted to trainees' needs and observations that led also to organizational modifications. Our multicomponent intervention positively impacted the number of referrals but not the patients' complexity (measured with the PALCOM instrument). Hospital staff does not easily recognize that patients may have PC needs significantly earlier than at the end of life.
Sections du résumé
BACKGROUND
BACKGROUND
Planned, multidisciplinary teams' discussions of cases are common in cancer care, but their impact on patients' outcome is not always clear. Palliative care (PC) needs might emerge long before the last weeks of life. Many palliative care patients could be managed from the usual care staff, if appropriately trained; specialist palliative care should be provided to patients with more complex needs. Staff needs adequate training, so that only patients presenting a higher complexity are properly referred to the second level ("specialized") PC services. In the considered hospital setting, "tumour boards" (multidisciplinary discussions) refer often to a low number of patients. Overall complexity of patients' needs is hardly considered.
METHODS
METHODS
A mixed method pilot study with data triangulation of professionals' interviews and an independently structured evaluation of complexity of referred patients, before and after the intervention, using the PALCOM instrument. We trained four teams of professionals to deliver first-level palliation and to refer patients with complex needs detected in multidisciplinary discussions. A multicomponent, first level PC educational intervention, including information technology's adaptation, a training course, and bedside training was offered from the specialized PC Services, to all the HPs involved in multidisciplinary pancreas, lung, ovarian, and liver tumour boards.
RESULTS
RESULTS
While the level of complexity of referred patients did not increase, trainees seemed to develop a better understanding of palliative care and a higher sensitivity to palliative needs. The number of referred patients increased, but patients' complexity did not. Qualitative data showed that professionals seemed to be more aware of the complexity of PC needs. A "meaning shift" was perceived, specifically on the referral process (e.g., "when" and "for what" referring to specialist PC) and on the teams' increased focus on patients' needs. The training, positively received, was adapted to trainees' needs and observations that led also to organizational modifications.
CONCLUSIONS
CONCLUSIONS
Our multicomponent intervention positively impacted the number of referrals but not the patients' complexity (measured with the PALCOM instrument). Hospital staff does not easily recognize that patients may have PC needs significantly earlier than at the end of life.
Identifiants
pubmed: 35619110
doi: 10.1186/s12904-022-00968-7
pii: 10.1186/s12904-022-00968-7
pmc: PMC9133822
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
90Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2022. The Author(s).
Références
Tumori. 2020 Feb;106(1):25-32
pubmed: 31456509
BMC Palliat Care. 2019 Oct 26;18(1):88
pubmed: 31655585
J Palliat Med. 2019 Nov;22(11):1318-1323
pubmed: 31347940
BMC Palliat Care. 2020 Apr 13;19(1):47
pubmed: 32284064
Implement Sci. 2014 Jan 17;9:14
pubmed: 24438584
BMJ. 2007 Mar 3;334(7591):455-9
pubmed: 17332585
Palliat Med. 2020 May;34(5):605-618
pubmed: 32020829
Lancet. 2014 May 17;383(9930):1721-30
pubmed: 24559581
Support Care Cancer. 2018 Jan;26(1):241-249
pubmed: 28780728
BMC Palliat Care. 2021 Jan 15;20(1):18
pubmed: 33451311
BMC Palliat Care. 2016 Jul 08;15:56
pubmed: 27391378
Support Care Cancer. 2020 Jan;28(1):295-301
pubmed: 31044305
Palliat Med. 2010 Mar;24(2):198-9
pubmed: 19926648
J Palliat Med. 2019 May;22(5):508-516
pubmed: 30632886
Oncologist. 2015 Jan;20(1):77-83
pubmed: 25480826
BMC Med Res Methodol. 2013 Sep 18;13:117
pubmed: 24047204
Ann Palliat Med. 2015 Jul;4(3):89-98
pubmed: 26231806
Med Care. 2013 Aug;51(8):e51-7
pubmed: 23860333
BMC Health Serv Res. 2019 Aug 16;19(1):577
pubmed: 31419973
Lancet Oncol. 2018 Nov;19(11):e588-e653
pubmed: 30344075
Palliat Med. 2020 Oct;34(9):1220-1227
pubmed: 32736486
J Clin Oncol. 2017 Jan;35(1):96-112
pubmed: 28034065
Palliat Med. 2020 Jan;34(1):114-125
pubmed: 31849272
JAMA Surg. 2020 Feb 1;155(2):138-146
pubmed: 31895424
J Clin Oncol. 2020 Mar 20;38(9):926-936
pubmed: 32023152
Oncologist. 2016 Sep;21(9):1149-55
pubmed: 27412394
N Engl J Med. 2013 Mar 28;368(13):1173-5
pubmed: 23465068
Ann Palliat Med. 2020 Sep;9(5):2800-2808
pubmed: 32787372
Palliat Med. 2014 Jun;28(6):474-479
pubmed: 24637342
BMJ. 2000 Sep 16;321(7262):694-6
pubmed: 10987780
Oncologist. 2017 Dec;22(12):1528-1534
pubmed: 28894017
BMC Med Educ. 2020 Oct 15;20(1):363
pubmed: 33059642
BMC Health Serv Res. 2019 Feb 14;19(1):120
pubmed: 30764822
Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259
pubmed: 22696318
Cochrane Database Syst Rev. 2010 Jan 20;(1):CD008006
pubmed: 20091660
Nat Rev Clin Oncol. 2016 Mar;13(3):159-71
pubmed: 26598947
J Contin Educ Health Prof. 2009 Winter;29(1):1-15
pubmed: 19288562