Entwicklung von Dienstleistungsmodellen der integrierten Onkologie und Palliative Care: Untersuchung von temporalen Aspekten, Involvierung von Onkologen, und Chemotherapie-Gebrauch
Abgeschlossen · 2010 bis 2011
Strasser Florian, Silzle Tobias, Nestor Karen, Köberle Dieter, Omlin Aurelius, Blum David, Linder Susanne, Früh Martin
Introduction: Integrated models of oncological palliative care are demanded (Ferris JCO 2009) and currently develop in various settings. Patient-data centered descriptions of concrete service patterns (SePa) may serve this process. We aim to explore SePa in out- and inpatient settings, various patient trajectories and temporal changes, the role of oncologists and patterns of chemotherapy use until close to death. Methods: Patients seen the first time in the outpatient clinic of oncological palliative medicine were included. All visits until death were recorded, specified for specialised palliative care or oncology, in- or outpatients, and ER. Service Patterns were defined and re-evaluated by two independent palliativ medicine consultants followed by a testing phase within a multiprofessional group (physician/nurse) in order to verify the reliability of patterns (previously communicated: oncology only=W, palliative only=Z, shared=X, simultaneous care=Y). Patients with incurable, stage IV cancer disease, and patients with cancer disease II-II receiving chemotherapy with palliative intention were identified. The data were collected by chart review retrospectively. Demographics in terms of age, gender, reason for referral, tumordiagnosis, 10-Item quality of life questionnaire (ESAS), Anxiety and Depression Scale (HADS-D) and CRP levels were identified. Lead oncologists (50% of all visits/patient involved) were coded. Use of chemotherapy: timepoint of last new line and of last application before death was assessed. Results: 521 patients from the years 2006-2009 were analysed. From more than 400 patients having incurable disease patients from the first 6 months of 2007 (n=72, survival 234 days) and 2009 (n=64, 197d) did not differ for main patterns (2007: W=16; X: 13; Y=11; Z=32 / 2009: W=14; X: 11; Y=7; Z=30; survival was 321, 207, 456, and 81 days; and 233, 176, 276, and 53 days, respectively). Temporal analysis (3 months intervall): of X/Y patters 7 were at the beginning W, and 6 Z for 2007, and 2009 4 and 2, respectively. Number of joint visits (same day) were 65 and 81, respectively. Only in a minority of patients a main oncologist was identifiable. 55 patients (40%) had chemotherapy, applications less than 14 days before death are rare. Conclusions: This preliminary data suggest no major change in service patterns, but a constant 1/3 shared/simulatneous care and 1/2 specialised palliative care closer to death, with increasing joint visits.