Skip to main content
Top
Published in: BMC Palliative Care 1/2013

Open Access 01-12-2013 | Research article

International recommendations for outpatient palliative care and prehospital palliative emergencies – a prospective questionnaire-based investigation

Authors: Christoph HR Wiese, Christoph L Lassen, Utz E Bartels, Mahmoud Taghavi, Saleem Elhabash, Bernhard M Graf, Gerd G Hanekop

Published in: BMC Palliative Care | Issue 1/2013

Login to get access

Abstract

Background

To determine the international recommendations and current practices for the treatment and prevention of palliative emergencies. The primary goal of the study was to gather information from experts on their nationally practised concepts.

Methods

One hundred and fifty self-report surveys were distributed by email to selected leading experts (palliative and emergency medical care) in Europe, North and South America, Africa, Asia, and Australia. An expert in this context was defined as an author of an article that was ranked by three reviewers as relevant to outpatient palliative and emergency medical .

Results

The total response rate was 61% (n = 92 experts). Survey responses were obtained from 35 different countries. The following standards in the treatment of palliative emergencies were recommended: (1) early integration of “Palliative Care Teams” (PCTs) and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, drug boxes, and “Do not attempt resuscitation” orders and (4) emergency medical training (physicians and paramedics).

Conclusions

This study detected structurally and nationally differences in outpatient palliative care regarding the treatment of palliative emergencies. Accordingly, these differences should be discussed and adapted to the respective specifications of individual single countries. A single established outpatient palliative emergency medical care concept may be the basis for an overall out-of-hospital palliative care system.
Literature
1.
go back to reference Wiese CH, Zausig YA, Vormelker J, Orso S, Graf BM, Hanekop GG: Out-patient and in-hospital palliative care in Germany: Comparison with emergency medical care infrastructure. Anaesthesist. 2010, 59: 162-170. 10.1007/s00101-009-1651-8.CrossRefPubMed Wiese CH, Zausig YA, Vormelker J, Orso S, Graf BM, Hanekop GG: Out-patient and in-hospital palliative care in Germany: Comparison with emergency medical care infrastructure. Anaesthesist. 2010, 59: 162-170. 10.1007/s00101-009-1651-8.CrossRefPubMed
2.
go back to reference Currow DC, Ward AM, Plummer JL, Bruera E, Abernethy AP: Comfort in the last 2 weeks of life: relationship to accessing palliative care services. Support Care Cancer. 2008, 16: 1255-1263. 10.1007/s00520-008-0424-2.CrossRefPubMed Currow DC, Ward AM, Plummer JL, Bruera E, Abernethy AP: Comfort in the last 2 weeks of life: relationship to accessing palliative care services. Support Care Cancer. 2008, 16: 1255-1263. 10.1007/s00520-008-0424-2.CrossRefPubMed
3.
go back to reference Haugen DF, Jordhøy MS, Engstrand P, Hessling SE, Garåsen H: Organisation of palliative care in and outside hospital. Tidsskr Nor Laegeforen. 2006, 126: 329-332.PubMed Haugen DF, Jordhøy MS, Engstrand P, Hessling SE, Garåsen H: Organisation of palliative care in and outside hospital. Tidsskr Nor Laegeforen. 2006, 126: 329-332.PubMed
4.
go back to reference Wiese CH, Vossen-Wellmann A, Morgenthal HC, Popov AF, Graf BM, Hanekop GG: Emergency calls and need for emergency care in patients looked after by a palliative care team: Retrospective interview study with bereaved relatives. BMC Palliat Care. 2008, 7: 11-10.1186/1472-684X-7-11.CrossRefPubMedPubMedCentral Wiese CH, Vossen-Wellmann A, Morgenthal HC, Popov AF, Graf BM, Hanekop GG: Emergency calls and need for emergency care in patients looked after by a palliative care team: Retrospective interview study with bereaved relatives. BMC Palliat Care. 2008, 7: 11-10.1186/1472-684X-7-11.CrossRefPubMedPubMedCentral
5.
go back to reference Heyland DK, Dodek P, Rocker G, Groll D, Gafni A, Pichora D, Shortt S, Tranmer J, Lazar N, Kutsogiannis J, Lam M, Canadian End of Life Network (CARENET): What matters most in end-of-life care: perceptions of seriously ill patients and their family members. CMAJ. 2006, 174: 627-633.CrossRefPubMedPubMedCentral Heyland DK, Dodek P, Rocker G, Groll D, Gafni A, Pichora D, Shortt S, Tranmer J, Lazar N, Kutsogiannis J, Lam M, Canadian End of Life Network (CARENET): What matters most in end-of-life care: perceptions of seriously ill patients and their family members. CMAJ. 2006, 174: 627-633.CrossRefPubMedPubMedCentral
6.
go back to reference Dy SM, Shugarman LR, Lorenz KA, Mularski RA, Lynn J: A systematic review of satisfaction with care at the end of life. J Am Geriatr Soc. 2008, 56: 124-129. 10.1111/j.1532-5415.2007.01507.x.CrossRefPubMed Dy SM, Shugarman LR, Lorenz KA, Mularski RA, Lynn J: A systematic review of satisfaction with care at the end of life. J Am Geriatr Soc. 2008, 56: 124-129. 10.1111/j.1532-5415.2007.01507.x.CrossRefPubMed
7.
go back to reference Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA, et al: Evidence for improving palliative care at the End of life: a systematic review. Ann Intern Med. 2008, 148: 147-159.CrossRefPubMed Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA, et al: Evidence for improving palliative care at the End of life: a systematic review. Ann Intern Med. 2008, 148: 147-159.CrossRefPubMed
8.
go back to reference Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Sheild R, Mor V: Family perspectives on end-of-life care at the last place of care. JAMA. 2004, 291: 88-93. 10.1001/jama.291.1.88.CrossRefPubMed Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Sheild R, Mor V: Family perspectives on end-of-life care at the last place of care. JAMA. 2004, 291: 88-93. 10.1001/jama.291.1.88.CrossRefPubMed
9.
go back to reference Brumley RD, Euguidanos S, Cherin DA: Effectiveness of a home-based palliative care program for end-of-life. J Palliat Med. 2003, 6: 715-724. 10.1089/109662103322515220.CrossRefPubMed Brumley RD, Euguidanos S, Cherin DA: Effectiveness of a home-based palliative care program for end-of-life. J Palliat Med. 2003, 6: 715-724. 10.1089/109662103322515220.CrossRefPubMed
10.
go back to reference Hughes SL, Cummings J, Weaver F, Manhein L, Braun B, Conrad K: A randomized trial of the cost effectiveness of VA hospital-based home care for terminally ill. Health Serv Res. 1992, 26: 801-817.PubMedPubMedCentral Hughes SL, Cummings J, Weaver F, Manhein L, Braun B, Conrad K: A randomized trial of the cost effectiveness of VA hospital-based home care for terminally ill. Health Serv Res. 1992, 26: 801-817.PubMedPubMedCentral
11.
go back to reference Wallston KA, Burger C, Smith RA, Baugher RJ: Comparing the quality of death for hospice and non-hospice cancer patients. Med Care. 1988, 26: 177-182. 10.1097/00005650-198802000-00008.CrossRefPubMed Wallston KA, Burger C, Smith RA, Baugher RJ: Comparing the quality of death for hospice and non-hospice cancer patients. Med Care. 1988, 26: 177-182. 10.1097/00005650-198802000-00008.CrossRefPubMed
12.
go back to reference Kane RL, Bernstein L, Wales J, Leibowitz A, Kaplan S: A randomized controlled trial of hospice care. Lancet. 1984, 323: 890-894. 10.1016/S0140-6736(84)91349-7.CrossRef Kane RL, Bernstein L, Wales J, Leibowitz A, Kaplan S: A randomized controlled trial of hospice care. Lancet. 1984, 323: 890-894. 10.1016/S0140-6736(84)91349-7.CrossRef
13.
go back to reference Tsai SC, Liu LN, Tang ST, Chen JC, Chen ML: Cancer pain as the presenting problem in emergency departments: incidence and related factors. Support Care Cancer. 2009, Apr 7. [Epub ahead of print] Tsai SC, Liu LN, Tang ST, Chen JC, Chen ML: Cancer pain as the presenting problem in emergency departments: incidence and related factors. Support Care Cancer. 2009, Apr 7. [Epub ahead of print]
14.
go back to reference Smith AK, Fisher J, Schonberg MA, Pallin DJ, Block SD, Forrow L, Phillips RS, McCarthy EP: Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department. Ann Emerg Med. 2009, 54: 86-93. 10.1016/j.annemergmed.2008.08.022.CrossRefPubMed Smith AK, Fisher J, Schonberg MA, Pallin DJ, Block SD, Forrow L, Phillips RS, McCarthy EP: Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department. Ann Emerg Med. 2009, 54: 86-93. 10.1016/j.annemergmed.2008.08.022.CrossRefPubMed
15.
go back to reference Wiese CH, Bartels UE, Marczynska K, Ruppert D, Graf BM, Hanekop GG: Quality of out-of-hospital palliative emergency care depends on the expertise of the emergency medical team–a prospective multi-centre analysis. Support Care Cancer. 2009, 17: 1499-1506. 10.1007/s00520-009-0616-4.CrossRefPubMedPubMedCentral Wiese CH, Bartels UE, Marczynska K, Ruppert D, Graf BM, Hanekop GG: Quality of out-of-hospital palliative emergency care depends on the expertise of the emergency medical team–a prospective multi-centre analysis. Support Care Cancer. 2009, 17: 1499-1506. 10.1007/s00520-009-0616-4.CrossRefPubMedPubMedCentral
16.
go back to reference Barbera L, Paszat L, Chartier C: Indicators of poor quality end-of-life care in Ontario. J Palliat Care. 2006, 22: 12-17.PubMed Barbera L, Paszat L, Chartier C: Indicators of poor quality end-of-life care in Ontario. J Palliat Care. 2006, 22: 12-17.PubMed
17.
go back to reference Hanson LC, Earp JA, Garrett J, Menon M, Danis M: Community physicians who provide terminal care. Arch Intern Med. 1999, 159: 1133-1138. 10.1001/archinte.159.10.1133.CrossRefPubMed Hanson LC, Earp JA, Garrett J, Menon M, Danis M: Community physicians who provide terminal care. Arch Intern Med. 1999, 159: 1133-1138. 10.1001/archinte.159.10.1133.CrossRefPubMed
18.
go back to reference Wiese CH, Vagts DA, Kampa U, Pfeiffer G, Grom IU, Gerth MA, Graf BM, Zausig YA: Expertengruppe Palliativ- und Notfallmedizin Akademie für Palliativmedizin und Hospizarbeit Dresden. Palliative care and end-of-life patients in emergency situations Recommendations on optimization of out-patient care. Anaesthesist. 2011, 60: 161-171. 10.1007/s00101-010-1831-6.CrossRefPubMed Wiese CH, Vagts DA, Kampa U, Pfeiffer G, Grom IU, Gerth MA, Graf BM, Zausig YA: Expertengruppe Palliativ- und Notfallmedizin Akademie für Palliativmedizin und Hospizarbeit Dresden. Palliative care and end-of-life patients in emergency situations Recommendations on optimization of out-patient care. Anaesthesist. 2011, 60: 161-171. 10.1007/s00101-010-1831-6.CrossRefPubMed
19.
go back to reference Yuen KJ, Behrndt MM, Jacklyn C, Mitchell GK: Palliative care at home: general practitioners working with palliative care teams. MJA. 2003, 179: S38-S40.PubMed Yuen KJ, Behrndt MM, Jacklyn C, Mitchell GK: Palliative care at home: general practitioners working with palliative care teams. MJA. 2003, 179: S38-S40.PubMed
20.
go back to reference Kritek PA, Slutsky AS, Hudson LD: Care of an unresponsiveness patient with a poor prognosis – polling results. N Engl J Med. 2009, 360: e15-e16. 10.1056/NEJMclde0900810.CrossRefPubMed Kritek PA, Slutsky AS, Hudson LD: Care of an unresponsiveness patient with a poor prognosis – polling results. N Engl J Med. 2009, 360: e15-e16. 10.1056/NEJMclde0900810.CrossRefPubMed
21.
go back to reference Slutsky AS, Hudson LD: Care of an unresponsive patient with a poor prognosis. N Engl J Med. 2009, 360: 527-531. 10.1056/NEJMclde0808330.CrossRefPubMed Slutsky AS, Hudson LD: Care of an unresponsive patient with a poor prognosis. N Engl J Med. 2009, 360: 527-531. 10.1056/NEJMclde0808330.CrossRefPubMed
22.
go back to reference Quest TE, Emanuel LL, Gisondi M, Engel K, Osgood K: Impact of the education in palliative and end-of-life care project on emergency medicine education and practice. J Emerg Nurs. 2010, 39: 334-335. Quest TE, Emanuel LL, Gisondi M, Engel K, Osgood K: Impact of the education in palliative and end-of-life care project on emergency medicine education and practice. J Emerg Nurs. 2010, 39: 334-335.
23.
go back to reference Schrijvers D, van Fraeyenhove F: Emergencies in Palliative Care. Cancer J. 2010, 16: 514-520. 10.1097/PPO.0b013e3181f28a8d.CrossRefPubMed Schrijvers D, van Fraeyenhove F: Emergencies in Palliative Care. Cancer J. 2010, 16: 514-520. 10.1097/PPO.0b013e3181f28a8d.CrossRefPubMed
24.
go back to reference Quest TE, Marco CA, Derse AR: Hospice and palliative medicine: new subspecialty, new opportunities. Ann Emerg Med. 2009, 54: 94-102. 10.1016/j.annemergmed.2008.11.019.CrossRefPubMed Quest TE, Marco CA, Derse AR: Hospice and palliative medicine: new subspecialty, new opportunities. Ann Emerg Med. 2009, 54: 94-102. 10.1016/j.annemergmed.2008.11.019.CrossRefPubMed
25.
go back to reference Ciais JF, Pradier C, Ciais C, Berthier F, Vallageas M, Raucoules-Aime M: Impact of a hospice home visit team on unwanted hospitalization of terminally-ill patients at home in acute medical emergencies. Presse Med. 2007, 36: 404-409. 10.1016/j.lpm.2006.12.010.CrossRefPubMed Ciais JF, Pradier C, Ciais C, Berthier F, Vallageas M, Raucoules-Aime M: Impact of a hospice home visit team on unwanted hospitalization of terminally-ill patients at home in acute medical emergencies. Presse Med. 2007, 36: 404-409. 10.1016/j.lpm.2006.12.010.CrossRefPubMed
26.
go back to reference Ciais JF, Ciais C, Pradier C, Marchand P, Lenoble C, Raucoules-Aime M: Emergencies in patients undergoing palliative care at home. A qualitative study of telephone calls to Center 15. Presse Med. 2002, 31: 970-972.PubMed Ciais JF, Ciais C, Pradier C, Marchand P, Lenoble C, Raucoules-Aime M: Emergencies in patients undergoing palliative care at home. A qualitative study of telephone calls to Center 15. Presse Med. 2002, 31: 970-972.PubMed
27.
go back to reference Laufenberg-Feldmann R, Kappis B, Weber M, Werner C: Save life--allow death. Collation of emergency missions for terminally ill patients. Schmerz. 2011, 25: 69-76. 10.1007/s00482-010-1000-5.CrossRefPubMed Laufenberg-Feldmann R, Kappis B, Weber M, Werner C: Save life--allow death. Collation of emergency missions for terminally ill patients. Schmerz. 2011, 25: 69-76. 10.1007/s00482-010-1000-5.CrossRefPubMed
28.
go back to reference Mengual RP, Feldman MJ, Jones GR: Implemantation of a novel prehospital advance directive protocol in southeastern Ontario. Can J Emerg Med. 2007, 9: 250-259. Mengual RP, Feldman MJ, Jones GR: Implemantation of a novel prehospital advance directive protocol in southeastern Ontario. Can J Emerg Med. 2007, 9: 250-259.
29.
go back to reference Rausch PG, Ramzy AI: Development of a palliative care protocol for emergency medical services. Ann Emerg Med. 1991, 20: 1383-1386. 10.1016/S0196-0644(05)81088-1.CrossRefPubMed Rausch PG, Ramzy AI: Development of a palliative care protocol for emergency medical services. Ann Emerg Med. 1991, 20: 1383-1386. 10.1016/S0196-0644(05)81088-1.CrossRefPubMed
30.
go back to reference Teno JM, Gruneis A, Schwartz Z, Nanda A, Wetle T: Association between advance directives and quality of end-of-life care. J Am Geriatr Soc. 2007, 55: 189-194. 10.1111/j.1532-5415.2007.01045.x.CrossRefPubMed Teno JM, Gruneis A, Schwartz Z, Nanda A, Wetle T: Association between advance directives and quality of end-of-life care. J Am Geriatr Soc. 2007, 55: 189-194. 10.1111/j.1532-5415.2007.01045.x.CrossRefPubMed
31.
go back to reference LeGrand SB, Tropiano P, Marx JD, Davis MP, Walsh D: Dying at home: emergency medications for terminal symptoms. Am J Hosp Palliat Care. 2001, 18: 421-423. 10.1177/104990910101800614.CrossRefPubMed LeGrand SB, Tropiano P, Marx JD, Davis MP, Walsh D: Dying at home: emergency medications for terminal symptoms. Am J Hosp Palliat Care. 2001, 18: 421-423. 10.1177/104990910101800614.CrossRefPubMed
32.
go back to reference Savory EA, Marco CA: End-of-life issues in the acute and critically ill patient. Scan J Trauma Resusc Emerg Med. 2010, 17: 21.CrossRef Savory EA, Marco CA: End-of-life issues in the acute and critically ill patient. Scan J Trauma Resusc Emerg Med. 2010, 17: 21.CrossRef
33.
go back to reference Vainio A, Auvonen A: Prevalence of symptoms among patients with advanced cancer: an international cooperative study. J Pain Symptom Manage. 1996, 12: 3-10. 10.1016/0885-3924(96)00042-5.CrossRefPubMed Vainio A, Auvonen A: Prevalence of symptoms among patients with advanced cancer: an international cooperative study. J Pain Symptom Manage. 1996, 12: 3-10. 10.1016/0885-3924(96)00042-5.CrossRefPubMed
34.
go back to reference Smith AM: Emergencies in palliative care. Ann Acad Med Singapore. 1994, 23: 186-190.PubMed Smith AM: Emergencies in palliative care. Ann Acad Med Singapore. 1994, 23: 186-190.PubMed
35.
go back to reference Timmermann A, Russo SG, Hollmann MW: Paramedic versus emergency physician emergency medical service: role of the anaesthesiologist and the European versus the Anglo-American concept. Curr Opin Anaesthesiol. 2008, 21: 222-227. 10.1097/ACO.0b013e3282f5f4f7.CrossRefPubMed Timmermann A, Russo SG, Hollmann MW: Paramedic versus emergency physician emergency medical service: role of the anaesthesiologist and the European versus the Anglo-American concept. Curr Opin Anaesthesiol. 2008, 21: 222-227. 10.1097/ACO.0b013e3282f5f4f7.CrossRefPubMed
Metadata
Title
International recommendations for outpatient palliative care and prehospital palliative emergencies – a prospective questionnaire-based investigation
Authors
Christoph HR Wiese
Christoph L Lassen
Utz E Bartels
Mahmoud Taghavi
Saleem Elhabash
Bernhard M Graf
Gerd G Hanekop
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2013
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/1472-684X-12-10

Other articles of this Issue 1/2013

BMC Palliative Care 1/2013 Go to the issue