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Early integration of palliative care in hospitals: A systematic review on methods, barriers, and outcome

Published online by Cambridge University Press:  13 March 2014

Karen Marie Dalgaard ,
Heidi Bergenholtz ,
Marianne Espenhain Nielsen  and
Helle Timm
Karen Marie Dalgaard*
Affiliation:
The Danish Knowledge Centre for Palliative Care, University of Southern Denmark, Copenhagen, Denmark
Heidi Bergenholtz
Affiliation:
The Regional Research Unit, Region Zealand, Roskilde, Koege and Holbaek Hospitals, Denmark
Marianne Espenhain Nielsen
Affiliation:
The Danish Knowledge Centre for Palliative Care, University of Southern Denmark, Copenhagen, Denmark
Helle Timm
Affiliation:
The Danish Knowledge Centre for Palliative Care, University of Southern Denmark, Copenhagen, Denmark
*
Address correspondence and reprints requests to: Karen Marie Dalgaard, Researcher, The Danish Knowledge Centre of Palliative Care, University of Southern Denmark, Strandboulevarden 47B, 1, 2100 Copenhagen, Denmark. E-mail: [email protected]
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Abstract

Objective:

According to the World Health Organization (WHO), palliative care (PC) should be available to everyone suffering from life-threatening diseases and should be started early on in the illness trajectory. However, PC is often initiated much later and is restricted to cancer patients. There is a need for more knowledge about how early PC can be implemented in clinical practice. The purpose of our study was to document the best evidence on methods for early identification (EI) of palliative trajectories in cancer, chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD) populations, and to identify preconditions for early integration of general PC in hospitals and outcomes for patients and relatives.

Method:

A comprehensive systematic review of methods, preconditions, and outcomes was conducted via an electronic literature search of publications between 2002 and September 2012. A final sample of 44 papers was reviewed in detail.

Results:

Our study identified disease-specific and general methods for EI of patients who might benefit from PC. Prognostication of end-stage disease based on (holistic) clinical judgment, prognostic factors, and/or care needs are the most frequently recommended methods. A number of interacting disease-, staff-, user-, and organization-specific barriers need to be overcome in order to implement early integration of PC in clinical practice. Early integration of PC may lead to better symptom management, prolonged survival, and better quality of life.

Significance of Results:

No methods can be recommended for routine clinical practice without further validation. There is an urgent need to develop and evaluate methods based on the holistic assessment of symptoms or needs. The barriers to early integration of PC are most extensive with regard to CHF and COPD. Professional training and education are recommended to facilitate early implementation of PC. The evidence about outcome is sparse and mostly relates to cancer populations receiving specialized PC.

Keywords

Early palliative careCancerCOPDCHFHospitals
Type
Review Article
Information
Palliative & Supportive Care , Volume 12 , Issue 6 , December 2014 , pp. 495 - 513
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

AGREE Collaboration, The (2003). AGREE instrumentet: Kursusmanual [The AGREE instrument: Course manual]. Available at http://www.kliniskeretningslinjer.dk/images/file/AGREE-Manual.pdf.Google Scholar
Albert, N.M. (2008). Referral for palliative care in advanced heart failure. Progress in Palliative Care, 16, 220–228.CrossRefGoogle Scholar
Allen, L.A., Yager, J.E., Jonsson, Funk, M., et al. (2008). Discordance between patient-predicted and model-predicted life expectancy among ambulatory patients with heart failure. The Journal of the American Medical Association, 299, 2533–2542.Google Scholar
Barclay, S., Momen, N., Case-Upton, S., et al. (2011). End-of-life care conversations with heart failure patients: A systematic literature review and narrative synthesis. British Journal of General Practice, 61, e49–e62.CrossRefGoogle ScholarPubMed
Boyd, K. & Murray, S.A. (2010). Recognising and managing key transitions in end of life care. BMJ, 341, c4863.CrossRefGoogle ScholarPubMed
Boyd, K.J., Worth, A., Kendall, M., et al. (2009). Making sure services are delivered for people with advanced heart failure: A longitudinal qualitative study of patients, family carers, and health professionals. Palliative Medicine, 23, 767–776.Google Scholar
Clark, D. & Seymour, J. (1999). Reflections on palliative care. Buckingham: Open University Press.Google Scholar
Critical Appraisal Skills Programme (CASP) (2010). Available at http://www.casp-uk.net/ retrieved 31.08.12.Google Scholar
Dalgaard, K.M. (2010). Projekt Lindrende Indsats: Hæmatologisk Afdeling, Aalborg Sygehus: Evalueringsrapport [Project Palliative Care: Evaluation report]. Aalborg: Department of Haematology, Aalborg University Hospital.Google Scholar
Dalgaard, K.M., Thorsell, G. & Delmar, C. (2010). Identifying transitions in terminal illness trajectories: A critical factor in hospital-based palliative care. International Journal of Palliative Nursing, 16, 87–92.CrossRefGoogle ScholarPubMed
Department of Health (2008). End-of-life care strategy: Promoting high-quality care for all adults at the end of life. London: Department of Health.Google Scholar
Ezekowitz, J.A., Thai, V., Hodnefield, T.S., et al. (2011). The correlation of standard heart failure assessment and palliative care questionnaires in a multidisciplinary heart failure clinic. Journal of Pain and Symptom Management, 42, 379–387.Google Scholar
Fischer, S.M., Gozansky, W.S., Sauaia, A., et al. (2006). A practical tool to identify patients who may benefit from a palliative approach: The CARING criteria. Journal of Pain and Symptom Management, 31, 285–292.Google Scholar
Gaertner, J., Wolf, J., Scheicht, D., et al. (2010 a). Implementing WHO recommendations for palliative care into routine lung cancer therapy: A feasibility study. Journal of Palliative Medicine, 13, 727–732.Google Scholar
Gaertner, J., Wolf, J., Ostgathe, C., et al. (2010 b). Specifying WHO recommendations: Moving toward disease-specific guidelines. Journal of Palliative Medicine, 13, 1273–1276.Google Scholar
Gaertner, J., Wuerstlein, R., Klein, U., et al. (2011 a). Integrating palliative medicine into comprehensive breast cancer therapy: A pilot project. Breast Care, 6, 215–220.CrossRefGoogle ScholarPubMed
Gaertner, J., Wolf, J., Hallek, M., et al. (2011 b). Standardizing integration of palliative care into comprehensive cancer therapy: A disease-specific approach. Supportive Care in Cancer, 19, 1037–1043.CrossRefGoogle ScholarPubMed
Gaertner, J., Wolf, J., Frechen, S., et al. (2012). Recommending early integration of palliative care: Does it work? Supportive Care in Cancer, 20, 507–513.Google Scholar
Glare, P. & Sinclair, C.T. (2008). Palliative medicine review: Prognostication. Journal of Palliative Medicine, 11, 84–103.Google Scholar
Grant, L., Murray, S.A. & Sheikh, A. (2010). Spiritual dimensions of dying in pluralist societies. BMJ, 341, c4859.Google Scholar
Green, E., Gardiner, C., Gott, M., et al. (2010). Communication surrounding transitions to palliative care in heart failure: A review and discussion of the literature. Progress in Palliative Care, 18, 281–290.Google Scholar
Gripp, S., Moeller, S., Bölke, E., et al. (2007). Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. Journal of Clinical Oncology, 25, 3313–3320.Google Scholar
Highet, G., Crawford, D., Murray, S., et al. (2012). Identifying patients with advanced conditions for supportive and palliative care using a clinical indicators tool: SPICT™. Available at http://www.spict.org.uk/ retrieved 28.09.12.Google Scholar
Iley, K. (2012). Improving palliative care for patients with COPD. Nursing Standard, 26, 40–46.Google Scholar
Jaarsma, T., Beattie, J.M., Ryder, M., et al. (2009). Palliative care in heart failure: A position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 11, 433–443.Google Scholar
James, T., Offer, M., Wilson, M., et al. (2010). Increasing palliative consults for heart failure inpatients using the Seattle Heart Failure Model. Journal of Hospice & Palliative Nursing, 12, 273–281.Google Scholar
Knauft, E., Nielsen, E.L., Engelberg, R.A., et al. (2005). Barriers and facilitators to end-of-life care communication for patients with COPD. Chest, 127, 2188–2196.Google Scholar
Levy, W.C., Mozaffarian, D., Linker, D.T. et al. (2006). The Seattle Heart Failure Model: Prediction of survival in heart failure. Circulation, 113, 1424–1433.Google Scholar
Lunney, J.R., Lynn, J., Foley, D.J., et al. (2003). Patterns of functional decline at the end of life. The Journal of the American Medical Association, 289, 2387–2392.Google Scholar
Lynn, J. (2005). Living long in fragile health: The new demographics shape end of life care. Hastings Center Report, 35(6) (Suppl.), S14–S18.CrossRefGoogle Scholar
Main, J., Whittle, C., Treml, J., et al. (2006). The development of an integrated care pathway for all patients with advanced life-limiting illness: The Supportive Care Pathway. Journal of Nursing Management, 14, 521–528.Google Scholar
Maltoni, M., Caraceni, A., Brunelli, C., et al. (2005). Prognostic factors in advanced cancer patients: Evidence-based clinical recommendations. A study by the Steering Committee of the European Association for Palliative Care. Journal of Clinical Oncology, 23, 6240–6248.Google Scholar
Mazanec, P., Daly, B.J., Pitorak, E.F., et al. (2009). A new model of palliative care for oncology patients with advanced disease. Journal of Hospice & Palliative Nursing, 11, 324–331.Google Scholar
Momen, N., Hadfield, P., Kuhn, I., et al. (2012). Discussing an uncertain future: End-of-life care conversations in chronic obstructive pulmonary disease: A systematic literature review and narrative synthesis. Thorax, 67, 777–780.Google Scholar
Murray, S.A., Kendall, M., Boyd, K., et al. (2005). Illness trajectories and palliative care. BMJ, 330, 1007–1011.Google Scholar
Murtagh, F.E.M., Preston, M. & Higginson, I. (2004). Patterns of dying: Palliative care for non-malignant disease. Clinical Medicine, 4, 39–44.Google Scholar
National Comprehensive Cancer Network. (2011). NCCN clinical practice guidelines in oncology (NCCN Guidelines™): Palliative care, version 2.2011. Available at www.nccn.org retrieved 27.09.12.Google Scholar
Pinnock, H., Kendall, M., Murray, S.A., et al. (2011). Living and dying with severe chronic obstructive pulmonary disease: Multi-perspective longitudinal qualitative study. BMJ, 342, d142.Google Scholar
Polit, D.F. & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.Google Scholar
Radbruch, L. & Payne, S. (2009). White paper on standards and norms for hospice and palliative care in Europe, part 1: Recommendations from the European Association for Palliative Care. European Journal of Palliative Care, 16, 278–289.Google Scholar
Rector, T.S., Ringwala, S.N., Ringwala, S.N., et al. (2006). Validation of a risk score for dying within one year of an admission for heart failure. Journal of Cardiac Heart Failure, 12, 276–280.Google Scholar
Seamark, D.A., Seamark, C.J. & Halpin, D.M.G. (2007). Palliative care in chronic obstructive pulmonary disease: A review for clinicians. Journal of the Royal Society of Medicine, 100, 225–233.CrossRefGoogle ScholarPubMed
Selman, L., Harding, R., Beynon, T., et al. (2007). Improving end-of-life care for patients with chronic heart failure: “Let's hope it'll get better, when I know in my heart of hearts it won't.” Heart, 93, 963–967.Google Scholar
Seymour, J. (2012). Looking back, looking forward: The evolution of palliative and end-of-life care in England. Mortality, 17, 1–17.Google Scholar
Spathis, A. & Booth, S. (2008). End-of-life care in chronic obstructive pulmonary disease: In search of a good death. International Journal of Chronic Obstructive Pulmonary Disease, 3, 11–29.Google Scholar
Sundhedsstyrelsen [Danish Health and Medicines Authority] (2004). Vejledning i udarbejdelse af referenceprogrammer [Guidelines for the preparation of reference programmes]. Copenhagen: Danish Health and Medicines Authority.Google Scholar
Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology (2008). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. European Heart Journal, 29, 2388–2442.CrossRefGoogle Scholar
Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European Heart Journal, 33, 1787–1847.Google Scholar
Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine 363, 733–742.Google Scholar
Temel, J., Greer, J.A., Admane, S., et al. (2011). Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: Results of a randomized study of early palliative care. Journal of Clinical Oncology, 17, 2319–2326.Google Scholar
Thomas, K.T. (2010). The GSF Prognostic Indicator Guidance. End of Life Care, 4(1), 62–64.Google Scholar
Thomas, K.T. (2011). The GSF Prognostic Indicator Guidance, 4th ed. (September 2011) Vol. 4, No. 1: The Gold Standards Framework. London: Royal College of General Practitioners.Google Scholar
Thoonsen, B., Groot, M., Engels, Y., et al. (2011). Early identification of and proactive palliative care for patients in general practice: Incentive and methods of a randomized controlled trial. BMC Family Practice, 12, 123.Google Scholar
Trajkovic-Vidakovic, M., de Graeff, A., Voest, E.E., et al. (2012). Symptoms tell it all: A systematic review of the value of symptom assessment to predict survival in advanced cancer patients. Critical Reviews in Oncology/Hematology, 84, 130–148.CrossRefGoogle ScholarPubMed
Trueman, J. & Trueman, I. (2011). COPD: Criteria to assist in the identification of the palliative phase. British Journal of Nursing, 20, 635–639.Google Scholar
Weissman, D.E. & Meier, D.E. (2011). Identifying patients in need of a palliative care assessment in the hospital setting: A consensus report from the Center to Advance Palliative Care. Journal of Palliative Medicine, 14, 17–23.CrossRefGoogle ScholarPubMed
World Health Organization (WHO) (1990). Cancer pain relief and palliative care: Report of a WHO Expert Committee. Geneva: World Health Organization.Google Scholar
World Health Organization (WHO) (2002). WHO definition of palliative care. Available from http://www.who.int/cancer/palliative/definition/en/.Google Scholar
Wright, A.A., Zhang, B., Ray, A., et al. (2008). Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. The Journal of the American Medical Association, 300, 1665–1673.CrossRefGoogle ScholarPubMed
Zambroski, C.H. (2006). Managing beyond an uncertain illness trajectory: Palliative care in advanced heart failure. International Journal of Palliative Nursing, 12, 566–573.CrossRefGoogle ScholarPubMed