Ana Isabel Luque Blanco
Institut Català d’Oncologia, Barcelona
Early and Proactive Multidimensional Needs’ Assessment in in-patient cancer patients at a Comprehensive Cancer Center
According to the World Health Organization, Palliative Care can be conceptualised as a multidimensional and multiprofessional assessment and intervention, focused in the prevention and treatment of patients and their families facing the issues related with life-threatening illness, with the aim of improving quality of life. Previous evidence supporting a benefit of palliative care has improved lately but still has methodological limitations. In the imPaCT study there were highly significant improvements in symptoms, HRQoL, mood and ‘emotional bother’ (1). In another study consultation by a palliative medicine team led to improved patient outcomes in dyspnoea, anxiety, and spiritual well-being, but failed to improve pain or depression (2). Measuring the impact of an interdisciplinary palliative care service (IPCS), patients reported greater satisfaction with their care experience and providers’ communication, had fewer ICU admissions on readmission, and lower total health care costs following hospital discharge (3). Early integration of palliative care with standard oncologic care in patients with metastatic non–small-cell lung cancer resulted in survival that was prolonged by approximately two months and clinically meaningful improvements in quality of life and mood (4). There is an effect of Inpatient Palliative Care on Quality of Life two weeks after hematopoietic stem cell transplantation (5). The American Society of Clinical Oncology Practice Guideline Update recommends that inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course and concurrent with active treatment.
As a part of care improvement of cancer patients admitted at the ICO Girona ward, we started in March 2017 to pilot an early and proactive multidimensional screening strategy regardless of the referral of the primary team. The main aim of this strategy is getting to know the multidimensional patient and family needs (physical symptoms, complex nursing, nutrition, emotional, and social).
So the goal of this project is to assess the acceptance of early and proactive assessment of multidimensional needs in cancer patients recently admmited to an haemato-oncology ward in the catalan oncological institute.
The study will be developed in two parts. The first part includes a qualitative analysis based on focus groups and semi-structured interviews and the second part is a quantitative analysis of the Oncoscreening data. Focus groups provide explanations and contribute to the design of the investigation process. Trained nurses will administer Oncoscreening. Patients will be asked to appraise the intervention in terms of appropriateness and usefulness. Ward integration in terms of symptom control, emotional benefit for the patients and the caregivers, benefit on the health-care provided by the ward team, and interference with the ward organisation.
It is expected that the implementation of early and proactive palliative care multidimensional assessment in a onco-heamatology ward will allow patients and their families to get advantage of timely detection of needs and health-care specific assessment, intervention and follow-up. Early intervention in these patients could also imply a benefit in quality of life, mood and even survival as demonstrated in previous studies and also patients’ families could benefit. The integration of Oncoscreening into the daily practice in the oncology room could also help the professionals who attend the patients, seeking care directed to the needs of patients and family. We completed the pilot phase in March 2018. Currently we are recruiting patients for the quantitative phase of the study. Later we will begin the qualitative phase to evaluate the integration into the hospitalization room. If the study objective is achieved, we will design new specific studies for different types of pathology interventions, patients and families, psychological groups for patients and families and develop guidelines for early intervention in oncology. We intend to present the initial results of the study at the next National Congress of Palliative Care and write an article for an oncology journal after the analysis of the data.
1. Hanks GW, Robbins M, Sharp D, Forbes K, Done K, Peters TJ, et al. The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team. Br J Cancer [Internet]. 2002 Sep 23 [cited 2017 Oct 17];87(7):733–9.
2. Rabow MW, Dibble SL, Pantilat SZ, McPhee SJ. The Comprehensive Care Team. Arch Intern Med [Internet]. 2004 Jan 12 [cited 2017 Oct 17];164(1):83.
3. Gade G, Venohr I, Conner D, McGrady K, Beane J, Richardson RH, et al. Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med [Internet]. 2008 Mar [cited 2017 Oct 17];11(2):180–90.
4. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med [Internet]. 2010 Aug 19 [cited 2017 Oct 17];363(8):733–42.
5. El-Jawahri A, LeBlanc T, VanDusen H, Traeger L, Greer JA, Pirl WF, et al. Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial. JAMA [Internet]. 2016 Nov 22 [cited 2017 Oct 17];316(20):2094–103.