National and Kapodistrian University, Athens
Melitus Needs – The assessment of palliative care problems and needs of outpatient patients with advanced diabetes mellitus
There is a paucity of evidence to guide palliative care of patients with advance diabetes mellitus. Diabetes mellitus is associated with increased morbidity and mortality. The disease and its complications, such us cardiovascular and renal disease are leading to the premature death of patients. A palliative care approach could be provided by primary care and specialized health care professionals for symptom relief, advance care planning and assistance for patients with diabetes mellitus, during various time periods before death. Diabetes health care professionals can play a major role in early management of patients’ unmet needs, focusing on quality of life and preparing them for end of life care.
The purpose of this project is the assessment of palliative care problems and needs of outpatient patients with advanced diabetes mellitus.
The convenience study sample will consist of 200 ambulatory diabetes mellitus patients. The setting will be an outpatient diabetes mellitus clinic of a University Internal Diseases Clinic situated at a General Public Hospital at Athens. Study inclusion criteria: adult patients able to fluently communicate in Greek language, who consent to participate to the study. Demographic and clinical data will be obtained from the patients’ file. Patients will complete a Greek translated version of the Problems and Needs in Palliative Care Questionnaire–short version (PNPC-sv). The PNPC is a 33 items self-report checklist of the problems patients experience in palliative care, and their needs for care (professional attention), divided into 8 categories: Activities of daily living, Autonomy, Physical symptoms, Social, Psychological and Spiritual issues, Financial problems and Need for information. The patient first select the degree to which he actually experiences a problem (Yes/Somewhat/No), and second, his need for professional support (Yes, more/As much as until now/No). Based on the quantitative statistics results, a number of patients’ focus groups will be held in order to confirm the quantitative results, to reveal potential additional problems and needs and clarity the professional attendance they need to manage their problems. Two independent researchers will perform the content analysis of the taped material. Study permission will obtained by the Hospital.
The results of this project could identify the multidimensional problems and needs that diabetes mellitus patients experience, and to specify the range of health care professionals who could manage these problems and needs throughout the advance disease trajectory. These results will also enable the early identification and provision of timely and appropriate care, based on patients unmet needs. This project represents an opportunity for patients’ needs assessment and sensitization of diabetes health care professionals regarding patients’ palliative care needs. This could be the first step for them, to recognize the need for appropriate palliative care education. Initiating a new philosophy that would provoke changes in every day clinical practice is a great challenge.