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13-11-2024 | REVIEW

Community Palliative Care: What are the Best Models?

Authors: Claire Stokes, Phillip Good

Published in: Current Treatment Options in Oncology | Issue 12/2024

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Opinion statement

Palliative care seeks to address the physical, psychosocial and spiritual concerns of patients with a life limiting illness and their caregivers. Early referral to palliative care improves symptoms and is the standard of care. This paper evaluates the evidence for different models of community palliative care and looks at the effects of homecare, hospice programs and residential aged care facility (RACF) interventions on symptom management, home death rate and acute health service utilization. It also examines the impact of COVID-19, telehealth, integration and staffing models on the efficacy of community palliative care. Evidence suggests that community palliative care increases the rate of death at home and may improve satisfaction with care, but effect on symptoms and acute health care utilization are less certain. Enrolment in a hospice program may decrease hospitalizations and improve satisfaction. RACF staff training interventions to improve the quality of palliative care provided to residents show mixed results across all indicators. COVID-19 saw a relative increase in the demand for community palliative care, as people opted out of the hospital system. Models of community palliative care that facilitate integration, support primary health providers, and promote technological innovation are worthy of further research.
Literature
2.
go back to reference Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42.CrossRefPubMed Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42.CrossRefPubMed
3.
go back to reference Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721–30.CrossRefPubMed Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721–30.CrossRefPubMed
4.
go back to reference Higginson IJ, Bausewein C, Reilly CC, Gao W, Gysels M, Dzingina M, et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. Lancet Respir Med. 2014;2(12):979–87.CrossRefPubMed Higginson IJ, Bausewein C, Reilly CC, Gao W, Gysels M, Dzingina M, et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. Lancet Respir Med. 2014;2(12):979–87.CrossRefPubMed
5.
go back to reference Vanbutsele G, Pardon K, Van Belle S, Surmont V, De Laat M, Colman R, et al. Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial. Lancet Oncol. 2018;19(3):394–404.CrossRefPubMed Vanbutsele G, Pardon K, Van Belle S, Surmont V, De Laat M, Colman R, et al. Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial. Lancet Oncol. 2018;19(3):394–404.CrossRefPubMed
6.
go back to reference Jordan K, Aapro M, Kaasa S, Ripamonti CI, Scotte F, Strasser A, et al. European Society for Medical Oncology (ESMO) position paper on supportive and palliative care. Ann Oncol. 2018;29(1):36–43.CrossRefPubMed Jordan K, Aapro M, Kaasa S, Ripamonti CI, Scotte F, Strasser A, et al. European Society for Medical Oncology (ESMO) position paper on supportive and palliative care. Ann Oncol. 2018;29(1):36–43.CrossRefPubMed
7.
go back to reference Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Ethan M, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(1):96–112.CrossRefPubMed Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Ethan M, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(1):96–112.CrossRefPubMed
9.
go back to reference Luckett T, Phillips J, Agar M, Virdun C, Green A, Davidson P. Elements of effective palliative care models: a rapid review. BMC Health Serv Res. 2014;14:136–58.CrossRefPubMedPubMedCentral Luckett T, Phillips J, Agar M, Virdun C, Green A, Davidson P. Elements of effective palliative care models: a rapid review. BMC Health Serv Res. 2014;14:136–58.CrossRefPubMedPubMedCentral
11.
go back to reference Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ, Brito M. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev [internet]. Jun 2013 [last accessed 27/03/2024]. 2013;(6):CD007760. https://doi.org/10.1002/14651858.CD007760.pub2. Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ, Brito M. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev [internet]. Jun 2013 [last accessed 27/03/2024]. 2013;(6):CD007760. https://​doi.​org/​10.​1002/​14651858.​CD007760.​pub2.
13.
go back to reference Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, et al. Increased satisfaction with care and lower costs: results of a randomized controlled trial of in-home palliative care. J Am Geriatr Soc. 2007;55(7):993–1000.CrossRefPubMed Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, et al. Increased satisfaction with care and lower costs: results of a randomized controlled trial of in-home palliative care. J Am Geriatr Soc. 2007;55(7):993–1000.CrossRefPubMed
14.
go back to reference Hughes SL, Cummings J, Weaver F, Manheim L, Braun B, Conrad K. A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill. Health Serv Res. 1992;26(6):801–17.PubMedPubMedCentral Hughes SL, Cummings J, Weaver F, Manheim L, Braun B, Conrad K. A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill. Health Serv Res. 1992;26(6):801–17.PubMedPubMedCentral
15.
go back to reference Jordhøy MS, Fayers P, Saltnes T, Ahlner-Elmqvist M, Jannert M, Kaasa S. A palliative-care intervention and death at home: a cluster randomised trial. Lancet. 2000;356(9233):888–93.CrossRefPubMed Jordhøy MS, Fayers P, Saltnes T, Ahlner-Elmqvist M, Jannert M, Kaasa S. A palliative-care intervention and death at home: a cluster randomised trial. Lancet. 2000;356(9233):888–93.CrossRefPubMed
16.
go back to reference Grande GE, Todd CJ, Barclay SIG, Farquhar MC. A randomized controlled trial of a hospital at home service for the terminally ill. Palliat Med. 2000;14(5):375–85.CrossRefPubMed Grande GE, Todd CJ, Barclay SIG, Farquhar MC. A randomized controlled trial of a hospital at home service for the terminally ill. Palliat Med. 2000;14(5):375–85.CrossRefPubMed
17.
go back to reference Kane R, Bernstein L, Wales J, Leibowitz A, Kaplan S. A randomised controlled trial of hospice care. Lancet. 1984;323(8382):890–4.CrossRef Kane R, Bernstein L, Wales J, Leibowitz A, Kaplan S. A randomised controlled trial of hospice care. Lancet. 1984;323(8382):890–4.CrossRef
18.
go back to reference Obermeyer Z, Clarke AC, Makar M, Schuur JD, Cutler DM. Emergency care use and the Medicare Hospice Benefit for individuals with cancer with a poor prognosis. J Am Geriatr Soc. 2016;64(2):323–9.CrossRefPubMedPubMedCentral Obermeyer Z, Clarke AC, Makar M, Schuur JD, Cutler DM. Emergency care use and the Medicare Hospice Benefit for individuals with cancer with a poor prognosis. J Am Geriatr Soc. 2016;64(2):323–9.CrossRefPubMedPubMedCentral
19.
go back to reference Obermeyer Z, Makar M, Abujaber S, Dominici F, Block S, Cutler DM. Association between the Medicare Hospice Benefit and health care utilization and costs for patients with poor-prognosis cancer. J Am Med Assoc. 2014;312(18):1888–96.CrossRef Obermeyer Z, Makar M, Abujaber S, Dominici F, Block S, Cutler DM. Association between the Medicare Hospice Benefit and health care utilization and costs for patients with poor-prognosis cancer. J Am Med Assoc. 2014;312(18):1888–96.CrossRef
20.
go back to reference Gomes B, Higginson IJ. Where people die (1974–2030): past trends, future projections and implications for care. Palliat Med. 2008;22(1):33–41.CrossRefPubMed Gomes B, Higginson IJ. Where people die (1974–2030): past trends, future projections and implications for care. Palliat Med. 2008;22(1):33–41.CrossRefPubMed
21.
go back to reference Lamppu PJ, Pitkala KH. Staff training interventions to improve end-of-life care of nursing home residents: a systematic review. J Am Med Dir Assoc. 2021;22(2):268–78.CrossRefPubMed Lamppu PJ, Pitkala KH. Staff training interventions to improve end-of-life care of nursing home residents: a systematic review. J Am Med Dir Assoc. 2021;22(2):268–78.CrossRefPubMed
22.
go back to reference Arendts G, Deans P, O’Brien K, Etherton-Beer C, Howard K, Lewin G, et al. A clinical trial of nurse practitioner care in residential aged care facilities. Arch Gerontol Geriatr. 2018;77:129–32.CrossRefPubMed Arendts G, Deans P, O’Brien K, Etherton-Beer C, Howard K, Lewin G, et al. A clinical trial of nurse practitioner care in residential aged care facilities. Arch Gerontol Geriatr. 2018;77:129–32.CrossRefPubMed
23.
go back to reference Connolly MJ, Boyd M, Broad JB, Kerse N, Lumley T, Whitehead N, et al. The aged residential care healthcare utilization study (ARCHUS): A multidisciplinary cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities. J Am Med Dir Assoc. 2015;16(1):49–55.CrossRefPubMed Connolly MJ, Boyd M, Broad JB, Kerse N, Lumley T, Whitehead N, et al. The aged residential care healthcare utilization study (ARCHUS): A multidisciplinary cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities. J Am Med Dir Assoc. 2015;16(1):49–55.CrossRefPubMed
24.
go back to reference Temkin-Greener H, Mukamel DB, Ladd H, Ladwig S, Caprio TV, Norton SA, et al. Impact of nursing home palliative care teams on end-of-life outcomes: A randomized controlled trial. Med Care. 2018;56(1):11–8.CrossRefPubMed Temkin-Greener H, Mukamel DB, Ladd H, Ladwig S, Caprio TV, Norton SA, et al. Impact of nursing home palliative care teams on end-of-life outcomes: A randomized controlled trial. Med Care. 2018;56(1):11–8.CrossRefPubMed
25.
go back to reference Kovach CR, Wilson SA, Noonan PE. The effects of hospice interventions on behaviors, discomfort, and physical complications of end stage dementia nursing home residents. Am J Alzheimer’s Dis. 1996;11(4):7–15.CrossRef Kovach CR, Wilson SA, Noonan PE. The effects of hospice interventions on behaviors, discomfort, and physical complications of end stage dementia nursing home residents. Am J Alzheimer’s Dis. 1996;11(4):7–15.CrossRef
26.
go back to reference Van den Block L, Honinx E, Pivodic L, Miranda R, Onwuteaka-Philipsen BD, van Hout H, et al. Evaluation of a palliative care program for nursing homes in 7 countries: The PACE cluster-randomized clinical trial. JAMA Intern Med. 2020;180(2):233–42.CrossRefPubMed Van den Block L, Honinx E, Pivodic L, Miranda R, Onwuteaka-Philipsen BD, van Hout H, et al. Evaluation of a palliative care program for nursing homes in 7 countries: The PACE cluster-randomized clinical trial. JAMA Intern Med. 2020;180(2):233–42.CrossRefPubMed
27.
go back to reference Agar M, Luckett T, Luscombe G, Phillips J, Beattie E, Pond D, et al. Effects of facilitated family case conferencing for advanced dementia: a cluster randomised clinical trial. PloS One. 2017;12(8):e0181020-e0181020. Article e0181020 [last accessed 15/3/24]. Agar M, Luckett T, Luscombe G, Phillips J, Beattie E, Pond D, et al. Effects of facilitated family case conferencing for advanced dementia: a cluster randomised clinical trial. PloS One. 2017;12(8):e0181020-e0181020. Article e0181020 [last accessed 15/3/24].
28.
go back to reference Hanson LC, Zimmerman S, Song M-K, Lin F-C, Rosemond C, Carey TS, et al. Effect of the goals of care intervention for advanced dementia: A randomized clinical trial. JAMA Intern Med. 2017;177(1):24–31.CrossRefPubMedPubMedCentral Hanson LC, Zimmerman S, Song M-K, Lin F-C, Rosemond C, Carey TS, et al. Effect of the goals of care intervention for advanced dementia: A randomized clinical trial. JAMA Intern Med. 2017;177(1):24–31.CrossRefPubMedPubMedCentral
29.
go back to reference Kane RL, Huckfeldt P, Tappen R, Engstrom G, Rojido C, Newman D, et al. Effects of an intervention to reduce hospitalizations from nursing homes. A randomized implementation trial of the INTERACT program. JAMA Intern Med. 2017;177(9):1257–64.CrossRefPubMedPubMedCentral Kane RL, Huckfeldt P, Tappen R, Engstrom G, Rojido C, Newman D, et al. Effects of an intervention to reduce hospitalizations from nursing homes. A randomized implementation trial of the INTERACT program. JAMA Intern Med. 2017;177(9):1257–64.CrossRefPubMedPubMedCentral
32.
go back to reference Oluyase AO, Hocaoglu M, Cripps RL, Maddocks M, Walshe C, Fraser LK, et al. The challenges of caring for people dying from COVID-19: a multinational observational study (CovPall). J Pain Symptom Manage. 2021;62(3):460–70.CrossRefPubMedPubMedCentral Oluyase AO, Hocaoglu M, Cripps RL, Maddocks M, Walshe C, Fraser LK, et al. The challenges of caring for people dying from COVID-19: a multinational observational study (CovPall). J Pain Symptom Manage. 2021;62(3):460–70.CrossRefPubMedPubMedCentral
33.
go back to reference Sleeman KE, Cripps RL, Murtagh FEM, Oluyase AO, Hocaoglu MB, Maddocks M, et al. Change in activity of palliative care services during the Covid-19 pandemic: a multinational survey (CovPall). J Palliat Med. 2022;25(3):465–71.CrossRefPubMedPubMedCentral Sleeman KE, Cripps RL, Murtagh FEM, Oluyase AO, Hocaoglu MB, Maddocks M, et al. Change in activity of palliative care services during the Covid-19 pandemic: a multinational survey (CovPall). J Palliat Med. 2022;25(3):465–71.CrossRefPubMedPubMedCentral
34.
go back to reference Wentlandt K, Cook R, Morgan M, Nowell A, Kaya E, Zimmermann C. Palliative care in Toronto during the COVID-19 pandemic. J Pain Symptom Manage. 2021;62(3):615–8.CrossRefPubMedPubMedCentral Wentlandt K, Cook R, Morgan M, Nowell A, Kaya E, Zimmermann C. Palliative care in Toronto during the COVID-19 pandemic. J Pain Symptom Manage. 2021;62(3):615–8.CrossRefPubMedPubMedCentral
35.
go back to reference Mercadante S, Adile C, Ferrera P, Giuliana F, Terruso L, Piccione T. Palliative care in the time of COVID-19. J Pain Symptom Manage. 2020;60(2):79–89.CrossRef Mercadante S, Adile C, Ferrera P, Giuliana F, Terruso L, Piccione T. Palliative care in the time of COVID-19. J Pain Symptom Manage. 2020;60(2):79–89.CrossRef
36.
go back to reference Disalvo D, Agar M, Caplan G, Murtagh FEM, Luckett T, Heneka N, et al. Virtual models of care for people with palliative care needs living in their own home: a systematic meta-review and narrative synthesis. Palliat Med. 2021;35(8):1385–406.CrossRefPubMed Disalvo D, Agar M, Caplan G, Murtagh FEM, Luckett T, Heneka N, et al. Virtual models of care for people with palliative care needs living in their own home: a systematic meta-review and narrative synthesis. Palliat Med. 2021;35(8):1385–406.CrossRefPubMed
37.
go back to reference Rainsford S, Hall Dykgraaf S, Phillips C. Effectiveness of telehealth palliative care Needs Rounds in rural residential aged care during the COVID-19 pandemic: A hybrid effectiveness-implementation study. Aust J Rural Health. 2022;30(1):108–14.CrossRefPubMed Rainsford S, Hall Dykgraaf S, Phillips C. Effectiveness of telehealth palliative care Needs Rounds in rural residential aged care during the COVID-19 pandemic: A hybrid effectiveness-implementation study. Aust J Rural Health. 2022;30(1):108–14.CrossRefPubMed
38.
go back to reference Osuji TA, Macias M, McMullen C, Haupt E, Mittman B, Mularski RA, et al. Clinician perspectives on implementing video visits in home-based palliative care. Palliat Med Rep. 2020;1(1):221–6.CrossRefPubMedPubMedCentral Osuji TA, Macias M, McMullen C, Haupt E, Mittman B, Mularski RA, et al. Clinician perspectives on implementing video visits in home-based palliative care. Palliat Med Rep. 2020;1(1):221–6.CrossRefPubMedPubMedCentral
39.
go back to reference Shih KK, Arechiga AB, Chen X, Urbauer DL, Rozman De Moraes A, Rodriguez AJ, et al. Telehealth preferences among patients with advanced cancer in the post COVID-19 vaccination era. J Pain Symptom Manage. 2024;67(6):525–34.CrossRefPubMed Shih KK, Arechiga AB, Chen X, Urbauer DL, Rozman De Moraes A, Rodriguez AJ, et al. Telehealth preferences among patients with advanced cancer in the post COVID-19 vaccination era. J Pain Symptom Manage. 2024;67(6):525–34.CrossRefPubMed
41.
go back to reference Abernethy AP, Currow DC, Shelby-James T, Rowett D, May F, Samsa GP, et al. Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the “palliative care trial” [ISRCTN 81117481]. J Pain Symptom Mangage. 2013;45(3):488–505.CrossRef Abernethy AP, Currow DC, Shelby-James T, Rowett D, May F, Samsa GP, et al. Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the “palliative care trial” [ISRCTN 81117481]. J Pain Symptom Mangage. 2013;45(3):488–505.CrossRef
Metadata
Title
Community Palliative Care: What are the Best Models?
Authors
Claire Stokes
Phillip Good
Publication date
13-11-2024
Publisher
Springer US
Published in
Current Treatment Options in Oncology / Issue 12/2024
Print ISSN: 1527-2729
Electronic ISSN: 1534-6277
DOI
https://doi.org/10.1007/s11864-024-01278-1

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