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Published in: Supportive Care in Cancer 10/2015

Open Access 01-10-2015 | Original Article

Involvement of supportive care professionals in patient care in the last month of life

Authors: Arianne Brinkman-Stoppelenburg, Bregje D. Onwuteaka-Philipsen, Agnes van der Heide

Published in: Supportive Care in Cancer | Issue 10/2015

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Abstract

Background

In the last month of life, many patients suffer from multiple symptoms and problems. Professional supportive care involvement may help to alleviate patients’ suffering and provide them with an optimal last phase of life.

Purpose

We investigated how often palliative care consultants, pain specialists, psychological experts and spiritual caregivers are involved in caring for patients in the last month of life, and which factors are associated with their involvement.

Methods

Questionnaires were mailed to physicians who had attended the death of a patient from a stratified sample of 8496 deaths that had occurred in 2010 in the Netherlands. The response rate was 74 % (n = 6263).

Results

A palliative care team or consultant had been involved in the last month of life in 12 % of all patients for whom death was expected; this percentage was 3 % for pain specialists, 6 % for psychologists or psychiatrists and 13 % for spiritual caregivers. Involvement of palliative care or pain specialists was most common in younger patients, in patients with cancer and in patients who died at home. Involvement of psychological or spiritual caregivers was most common in older patients, in females, in patients with dementia and in patients who died in a nursing home. Involvement of supportive caregivers was also associated with the use of morphine and end-of-life decisions.

Conclusion

Supportive care professionals are involved in end-of-life care in about a quarter of all non-suddenly dying patients. Their involvement is related to the setting where patients die, to the patient’s characteristics and to complex ethical decision-making.
Literature
1.
go back to reference Arthur J, Bruera E (2013) Supportive and palliative care: a poorly understood science for the perioperative clinician. Best Pract Res Clin Anaesthesiol 27(4):563–573CrossRefPubMed Arthur J, Bruera E (2013) Supportive and palliative care: a poorly understood science for the perioperative clinician. Best Pract Res Clin Anaesthesiol 27(4):563–573CrossRefPubMed
2.
go back to reference Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A (2007) Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manag 34(1):94–104CrossRef Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A (2007) Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manag 34(1):94–104CrossRef
3.
go back to reference Barbera L, Seow H, Howell D, Sutradhar R, Earle C, Liu Y et al (2010) Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer 116(24):5767–5776CrossRefPubMed Barbera L, Seow H, Howell D, Sutradhar R, Earle C, Liu Y et al (2010) Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer 116(24):5767–5776CrossRefPubMed
4.
go back to reference Lloyd-Williams M, Dennis M, Taylor F (2004) A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 18(6):558–563CrossRefPubMed Lloyd-Williams M, Dennis M, Taylor F (2004) A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 18(6):558–563CrossRefPubMed
5.
go back to reference Walsh D, Rybicki L (2006) Symptom clustering in advanced cancer. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 14(8):831–836 Walsh D, Rybicki L (2006) Symptom clustering in advanced cancer. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 14(8):831–836
6.
go back to reference Janssen DJ, Spruit MA, Uszko-Lencer NH, Schols JM, Wouters EF (2011) Symptoms, comorbidities, and health care in advanced chronic obstructive pulmonary disease or chronic heart failure. J Palliat Med 14(6):735–743CrossRefPubMed Janssen DJ, Spruit MA, Uszko-Lencer NH, Schols JM, Wouters EF (2011) Symptoms, comorbidities, and health care in advanced chronic obstructive pulmonary disease or chronic heart failure. J Palliat Med 14(6):735–743CrossRefPubMed
7.
go back to reference Hendriks SA, Smalbrugge M, Hertogh CM, van der Steen JT (2013) Dying with dementia: symptoms, treatment, and quality of life in the last week of life. J Pain Symptom Manag 47(4):710–720 Hendriks SA, Smalbrugge M, Hertogh CM, van der Steen JT (2013) Dying with dementia: symptoms, treatment, and quality of life in the last week of life. J Pain Symptom Manag 47(4):710–720
8.
go back to reference Van der Steen JT (2010) Dying with dementia: what we know after more than a decade of research. J Alzheimers Dis: JAD 22(1):37–55PubMed Van der Steen JT (2010) Dying with dementia: what we know after more than a decade of research. J Alzheimers Dis: JAD 22(1):37–55PubMed
9.
10.
go back to reference World Health Organization (2002) National cancer control programmes: policies and managerial guidelines. World Health Organization, Geneva World Health Organization (2002) National cancer control programmes: policies and managerial guidelines. World Health Organization, Geneva
11.
go back to reference Radbruch LPS (2009) White Paper on standards and norms for hospice and palliative care in Europe: part 1. Eur J Palliat Care 16(6):278–289 Radbruch LPS (2009) White Paper on standards and norms for hospice and palliative care in Europe: part 1. Eur J Palliat Care 16(6):278–289
12.
go back to reference Bruera E, Hui D (2010) Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care. J Clin Oncol Off J Am Soc Clin Oncol 28(25):4013–4017CrossRef Bruera E, Hui D (2010) Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care. J Clin Oncol Off J Am Soc Clin Oncol 28(25):4013–4017CrossRef
13.
go back to reference Higginson IJ, Evans CJ (2010) What is the evidence that palliative care teams improve outcomes for cancer patients and their families? Cancer J (Sudbury) 16(5):423–435CrossRef Higginson IJ, Evans CJ (2010) What is the evidence that palliative care teams improve outcomes for cancer patients and their families? Cancer J (Sudbury) 16(5):423–435CrossRef
14.
go back to reference Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742CrossRefPubMed Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742CrossRefPubMed
15.
go back to reference Bakitas M, Lyons KD, Hegel MT, Balan S, Barnett KN, Brokaw FC et al (2009) The project ENABLE II randomized controlled trial to improve palliative care for rural patients with advanced cancer: baseline findings, methodological challenges, and solutions. Palliat Support Care 7(1):75–86PubMedCentralCrossRefPubMed Bakitas M, Lyons KD, Hegel MT, Balan S, Barnett KN, Brokaw FC et al (2009) The project ENABLE II randomized controlled trial to improve palliative care for rural patients with advanced cancer: baseline findings, methodological challenges, and solutions. Palliat Support Care 7(1):75–86PubMedCentralCrossRefPubMed
16.
go back to reference Casarett D, Pickard A, Bailey FA, Ritchie C, Furman C, Rosenfeld K et al (2008) Do palliative consultations improve patient outcomes? J Am Geriatr Soc 56(4):593–599CrossRefPubMed Casarett D, Pickard A, Bailey FA, Ritchie C, Furman C, Rosenfeld K et al (2008) Do palliative consultations improve patient outcomes? J Am Geriatr Soc 56(4):593–599CrossRefPubMed
17.
go back to reference Hanks GW, Robbins M, Sharp D, Forbes K, Done K, Peters TJ et al (2002) The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team. Br J Cancer 87(7):733–739PubMedCentralCrossRefPubMed Hanks GW, Robbins M, Sharp D, Forbes K, Done K, Peters TJ et al (2002) The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team. Br J Cancer 87(7):733–739PubMedCentralCrossRefPubMed
18.
go back to reference Manfredi PL, Morrison RS, Morris J, Goldhirsch SL, Carter JM, Meier DE (2000) Palliative care consultations: how do they impact the care of hospitalized patients? J Pain Symptom Manag 20(3):166–173CrossRef Manfredi PL, Morrison RS, Morris J, Goldhirsch SL, Carter JM, Meier DE (2000) Palliative care consultations: how do they impact the care of hospitalized patients? J Pain Symptom Manag 20(3):166–173CrossRef
19.
go back to reference Christakis NA, Iwashyna TJ (2003) The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses. Soc Sci Med 57(3):465–475CrossRefPubMed Christakis NA, Iwashyna TJ (2003) The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses. Soc Sci Med 57(3):465–475CrossRefPubMed
20.
go back to reference Murtagh FE, Bausewein C, Verne J, Groeneveld EI, Kaloki YE, Higginson IJ (2014) How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliat Med 28(1):49–58CrossRefPubMed Murtagh FE, Bausewein C, Verne J, Groeneveld EI, Kaloki YE, Higginson IJ (2014) How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliat Med 28(1):49–58CrossRefPubMed
21.
go back to reference Kuin A, Courtens AM, Deliens L, Vernooij-Dassen MJ, van Zuylen L, van der Linden B et al (2004) Palliative care consultation in The Netherlands: a nationwide evaluation study. J Pain Symptom Manag 27(1):53–60CrossRef Kuin A, Courtens AM, Deliens L, Vernooij-Dassen MJ, van Zuylen L, van der Linden B et al (2004) Palliative care consultation in The Netherlands: a nationwide evaluation study. J Pain Symptom Manag 27(1):53–60CrossRef
22.
go back to reference Abarshi E, Echteld MA, Van den Block L, Donker G, Bossuyt N, Meeussen K et al (2011) Use of palliative care services and general practitioner visits at the end of life in The Netherlands and Belgium. J Pain Symptom Manag 41(2):436–448CrossRef Abarshi E, Echteld MA, Van den Block L, Donker G, Bossuyt N, Meeussen K et al (2011) Use of palliative care services and general practitioner visits at the end of life in The Netherlands and Belgium. J Pain Symptom Manag 41(2):436–448CrossRef
24.
go back to reference Grandjean I, Galesloot C (2013) Consultatie Palliatieve Zorg. Jaarverslag 2012. Integraal Kankercentrum Nederland (IKNL). Report No Grandjean I, Galesloot C (2013) Consultatie Palliatieve Zorg. Jaarverslag 2012. Integraal Kankercentrum Nederland (IKNL). Report No
25.
go back to reference Galesloot C, Brinkman-Stoppelenburg A, Klinkenberg M, Van der Heide A, Baar FPM (2013) Enquete stand van zaken palliatieve zorg in Nederlandse Ziekenhuizen. Verslag van een inventarisatie bij ziekenhuizen in Nederland door Stichting Leerhuizen Palliatieve Zorg, IKNL en het Erasmus MC. Stichting Leerhuizen Palliatieve Zorg, IKNL, Erasmus MC Galesloot C, Brinkman-Stoppelenburg A, Klinkenberg M, Van der Heide A, Baar FPM (2013) Enquete stand van zaken palliatieve zorg in Nederlandse Ziekenhuizen. Verslag van een inventarisatie bij ziekenhuizen in Nederland door Stichting Leerhuizen Palliatieve Zorg, IKNL en het Erasmus MC. Stichting Leerhuizen Palliatieve Zorg, IKNL, Erasmus MC
26.
go back to reference Onwuteaka-Philipsen BD, Brinkman-Stoppelenburg A, Penning C, de Jong-Krul GJ, van Delden JJ, van der Heide A (2012) Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet 380(9845):908–915CrossRefPubMed Onwuteaka-Philipsen BD, Brinkman-Stoppelenburg A, Penning C, de Jong-Krul GJ, van Delden JJ, van der Heide A (2012) Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet 380(9845):908–915CrossRefPubMed
27.
go back to reference Australia PC (2005) A guide to palliative care service development. A population based approach Australia PC (2005) A guide to palliative care service development. A population based approach
28.
go back to reference Schols JM, Crebolder HF, van Weel C (2004) Nursing home and nursing home physician: the Dutch experience. J Am Med Dir Assoc 5(3):207–212CrossRefPubMed Schols JM, Crebolder HF, van Weel C (2004) Nursing home and nursing home physician: the Dutch experience. J Am Med Dir Assoc 5(3):207–212CrossRefPubMed
29.
go back to reference Rhee JJ, Zwar N, Vagholkar S, Dennis S, Broadbent AM, Mitchell G (2008) Attitudes and barriers to involvement in palliative care by Australian urban general practitioners. J Palliat Med 11(7):980–985CrossRefPubMed Rhee JJ, Zwar N, Vagholkar S, Dennis S, Broadbent AM, Mitchell G (2008) Attitudes and barriers to involvement in palliative care by Australian urban general practitioners. J Palliat Med 11(7):980–985CrossRefPubMed
30.
go back to reference Gardiner C, Cobb M, Gott M, Ingleton C (2011) Barriers to providing palliative care for older people in acute hospitals. Age Ageing 40(2):233–238CrossRefPubMed Gardiner C, Cobb M, Gott M, Ingleton C (2011) Barriers to providing palliative care for older people in acute hospitals. Age Ageing 40(2):233–238CrossRefPubMed
31.
go back to reference Beernaert K, Deliens L, De Vleminck A, Devroey D, Pardon K, Van den Block L et al (2014) Early identification of palliative care needs by family physicians: a qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients. Palliat Med 28(6):480–490CrossRefPubMed Beernaert K, Deliens L, De Vleminck A, Devroey D, Pardon K, Van den Block L et al (2014) Early identification of palliative care needs by family physicians: a qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients. Palliat Med 28(6):480–490CrossRefPubMed
32.
go back to reference Miyashita M, Sanjo M, Morita T, Hirai K, Kizawa Y, Shima Y et al (2007) Barriers to providing palliative care and priorities for future actions to advance palliative care in Japan: a nationwide expert opinion survey. J Palliat Med 10(2):390–399CrossRefPubMed Miyashita M, Sanjo M, Morita T, Hirai K, Kizawa Y, Shima Y et al (2007) Barriers to providing palliative care and priorities for future actions to advance palliative care in Japan: a nationwide expert opinion survey. J Palliat Med 10(2):390–399CrossRefPubMed
33.
go back to reference Feeg VD, Elebiary H (2005) Exploratory study on end-of-life issues: barriers to palliative care and advance directives. Am J Hosp Palliat Care 22(2):119–124CrossRefPubMed Feeg VD, Elebiary H (2005) Exploratory study on end-of-life issues: barriers to palliative care and advance directives. Am J Hosp Palliat Care 22(2):119–124CrossRefPubMed
34.
go back to reference Lopez-Acevedo M, Lowery WJ, Lowery AW, Lee PS, Havrilesky LJ (2013) Palliative and hospice care in gynecologic cancer: a review. Gynecol Oncol 131(1):215–221CrossRefPubMed Lopez-Acevedo M, Lowery WJ, Lowery AW, Lee PS, Havrilesky LJ (2013) Palliative and hospice care in gynecologic cancer: a review. Gynecol Oncol 131(1):215–221CrossRefPubMed
35.
go back to reference Higginson IJ, Koffman J (2005) Public health and palliative care. Clin Geriatr Med 21(1):45–55, viiiCrossRefPubMed Higginson IJ, Koffman J (2005) Public health and palliative care. Clin Geriatr Med 21(1):45–55, viiiCrossRefPubMed
36.
go back to reference Currow DC, Abernethy AP, Fazekas BS (2004) Specialist palliative care needs of whole populations: a feasibility study using a novel approach. Palliat Med 18(3):239–247CrossRefPubMed Currow DC, Abernethy AP, Fazekas BS (2004) Specialist palliative care needs of whole populations: a feasibility study using a novel approach. Palliat Med 18(3):239–247CrossRefPubMed
37.
go back to reference Beernaert K, Cohen J, Deliens L, Devroey D, Vanthomme K, Pardon K et al (2013) Referral to palliative care in COPD and other chronic diseases: a population-based study. Respir Med 107(11):1731–1739CrossRefPubMed Beernaert K, Cohen J, Deliens L, Devroey D, Vanthomme K, Pardon K et al (2013) Referral to palliative care in COPD and other chronic diseases: a population-based study. Respir Med 107(11):1731–1739CrossRefPubMed
38.
go back to reference Ministry of Health, Welfare and Sport (2013) Kamerbrief Investeren in Palliatieve Zorg (175699-113710-DLZ). The Hague Ministry of Health, Welfare and Sport (2013) Kamerbrief Investeren in Palliatieve Zorg (175699-113710-DLZ). The Hague
39.
go back to reference Quill TE, Abernethy AP (2013) Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med 368(13):1173–1175CrossRefPubMed Quill TE, Abernethy AP (2013) Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med 368(13):1173–1175CrossRefPubMed
40.
go back to reference The Royal Dutch Medical Association (KNMG) (2009) Guideline for palliative sedation. Utrecht, The Netherlands The Royal Dutch Medical Association (KNMG) (2009) Guideline for palliative sedation. Utrecht, The Netherlands
41.
go back to reference Onwuteaka-Philipsen BD, Rurup ML, Pasman HR, van der Heide A (2010) The last phase of life: who requests and who receives euthanasia or physician-assisted suicide? Med Care 48(7):596–603CrossRefPubMed Onwuteaka-Philipsen BD, Rurup ML, Pasman HR, van der Heide A (2010) The last phase of life: who requests and who receives euthanasia or physician-assisted suicide? Med Care 48(7):596–603CrossRefPubMed
Metadata
Title
Involvement of supportive care professionals in patient care in the last month of life
Authors
Arianne Brinkman-Stoppelenburg
Bregje D. Onwuteaka-Philipsen
Agnes van der Heide
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 10/2015
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-2655-3

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