Publikation
Patient-perceived Needs, Gaps in Service Delivery, and Quality Indicators in Seven Dimensions of Palliative Interventions (PCIs) in Cancer Care
Präsentation/Vortrag - 18.05.2017
Magayakalbermatten N, Achimas P., Domeisen Benedetti Franzisca, Rahnea G., Poroch V., Mosoiu D., Groza M., Grigorescu A., Curca R., Schmidt Mary Helen, Strasser Florian
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Background: Integration of PCIs in routine oncology care
remains challenging, specifically in resource-restricted
settings with variable training of health care professionals
(HCPs). Patients (pts) who get adequate PCIs may have more
favorable quality indicators for Palliative Care (PC).
Aims: To explore if high level of unmet needs for PCIs are
associated with symptom burden and/or aggressive end-oflife
care.
Methods: Prospective 6 month study in Romania and
Switzerland of adult incurable cancer pts with defined PC
needs (IPOS, ECOG 1–3). Needs for 7 “Key PCIs” perceived by
pts and their recalled delivery by hcp (if lacking: gap) were
collected monthly by a nurse-led assessment. Quality
indicators: toxicity resulting from inappropriate anticancer
treatment, pt-reported burden (IPOS), repeated ER
admissions, aggressive end-of-life care (CPR, ICU admission,
new chemotherapy started < = 1 month or given < =14 days
before death, ICU as place of death), and the Quality of Death
and Dying score. Pearson’s chi-squared tests for relationship between gap level and burden and aggressive end-of-life care,
respectively, at Follow-Up 1. Longitudinal analyses on the
dataset are ongoing.
Results: Of 308 pts 24% had a high level of gaps (≥3 gaps) in
delivery of PCIs. A significant relationship (Χ2= 7.452, p=.006)
between high depression burden and high level of gaps in
service delivery was seen; all other symptom categories
showed non-significant relationships. The occurrence of
aggressive end-of-life care was low (e.g. last month ICU=5,
CPR=19; death ICU=3). 35% of the 102 respondents to the
QODD questionnaire had a score of ≤60, indicating a poor
quality of death, longitudinal analysis of related unmet needs
for PCI are ongoing.
Conclusion: This prospective longitudinal study assessing
patients’ unmet needs for predefined PCIs suggests that they
are related with patients depression consistent with RCTs of
early PC. Further analysis may identify most vulnerable pts
groups.