Project

Entwicklung von Dienstleistungsmodellen der integrierten Onkologie und Palliative Care: Untersuchung von temporalen Aspekten, Involvierung von Onkologen, und Chemotherapie-Gebrauch

Completed · 2010 until 2011

Type
Clinical Studies
Range
Monocentric project at KSSG
Units
Status
Completed
Start Date
2010
End Date
2011
Financing
Self Financed
Study Design
Visual Graphics Analysis, Consensual Prospective datacollection
Brief description/objective

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.