Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Palliative Care
Published in: BMC Palliative Care 1/2018

Open Access 01-12-2018 | Study protocol

Strengthening primary health care teams with palliative care leaders: protocol for a cluster randomized clinical trial

Authors: Joan Llobera, Noemí Sansó, Amador Ruiz, Merce Llagostera, Estefania Serratusell, Carlos Serrano, María Luisa Martín Roselló, Enric Benito, Eusebio J. Castaño, Alfonso Leiva

Published in: BMC Palliative Care | Issue 1/2018

Login to get access

Abstract

Background

The objective of the Balearic Islands Palliative Care (PC) Program is to improve the quality of PC through a shared model consisting of primary health care professionals, home-based PC teams, and PC units in hospitals. According to the World Health Organization (WHO), patients with advanced cancer and other terminal diseases benefit from early identification and proactive PC. We will evaluate the effectiveness of an intervention in which a PC leader is established in the primary health care center, and assess the effect of this intervention on the early identification of patients in need of PC, the efficient use of health care services, and direct health care costs.

Methods

Design: A two-arm cluster randomized clinical trial of 30 Primary Health Care Centers (PHCC) in Mallorca (Spain), in which each center was randomized to an intervention arm or a usual care arm. We expect that the number of patients identified as suitable for PC (including non-oncological PC) is at least 5% greater in the intervention arm.
Sample size: A total of 4640 deceased patients. Outcomes will be assessed by a blinded external review of the electronic records.
Interventions: General practitioners (GPs) and nurse leaders in PC for each PHCC will be appointed. These leaders will help promote PC training of colleagues, improve symptom management and psychological support of patients, and evaluate the complexity of individual cases so that these cases receive assistance from PC home-based teams.
Measurements: Early identification (>90 days before death), evaluation of case complexity, level of case complexity (with referral to a home-based PC team), use and cost of hospital and primary care services, and quality of life during the last month of life (≥2 emergency room visits, ≥2 hospital admissions, ≥14 days of hospitalization).

Discusion

PC leaders in primary care teams will improve the early identification of patients eligible for PC. This initiative could improve the quality of end-of-life care and utilization of hospital resources.

Trial registration

ISRCTN Registry identifier: ISRCTN92479122. Retrospectively registered on 28 February 2017.
Literature
1.
Hall S, Petkova H, Tsouros AD, et al. Palliative care for older people: better practices. Copenhagen: World Health Organization Regional Office for Europe; 2011.
2.
Centeno C, Clark D, Lynch T, Racafort J, Praill D, De Lima L, et al. Facts and indicators on palliative care development in 52 countries of the WHO European region: results of an EAPC task force. Palliat Med. 2007;21:463–71.CrossRefPubMed
3.
4.
Doblado R, Herrera E, Librada S, Muñoz I, Rodriguez Z. Directorio de Recursos de Cuidados Paliativos en España. Monogr SECPAL. 2016;8
5.
Expert Committee. Cancer pain relief and palliative care. Geneva: World Health Organization; 1990. Technical Report Series. p. 804.
6.
World Health Organization. The solid facts: Palliative Care. Copenhagen: WHO Regional Office for Europe; 2004.
7.
Gómez-Batiste X, Martínez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X, et al. Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia. BMJ Support Palliat Care. 2013;3:300–8.CrossRefPubMed
8.
McNamara B, Rosenwax LK, Holman CDJ. A method for defining and estimating the palliative care population. J Pain Symptom Manag. 2006;32:5–12.CrossRef
9.
Rosenwax LK, McNamara B, Blackmore AM, Holman CDJ. Estimating the size of a potential palliative care population. Palliat Med. 2005;19:556–62.CrossRefPubMed
10.
Murtagh FEM, Bausewein C, Verne J, Groeneveld EI, Kaloki YE, Higginson IJ. How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliat Med. 2014;28:49–58.CrossRefPubMed
11.
12.
Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at the end of life. JAMA. 2003;289:2387–92.CrossRefPubMed
13.
Stjernswärd J, Teoh N. Current status of the global cancer control program of the World Health Organization. J Pain Symptom Manag. 1993;8:340–7.CrossRef
14.
National cancer control programmes. Policies and managerial guidelines. 2nd ed. Geneva: World Health Organization; 2002.
15.
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;363:733–42.CrossRefPubMed
16.
Bakitas M, Lyons KD, Hegel MT, Balan S, Barnett KN, Brokaw FC, et al. 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. 2009;7:75–86.CrossRefPubMedPubMedCentral
17.
McNamara B, Rosenwax LK, Holman CDJ. A Method for Defining and Estimating the Palliative Care Population. J. Pain Symptom Manage. 2006;32(1):5–12.
18.
Smith S, Brick A, O’Hara S, Normand C. Evidence on the cost and cost-effectiveness of palliative care: a literature review. Palliat Med. 2014;28:130–50.CrossRefPubMed
19.
Murtagh FEM. What matters time? The importance of time for those with advanced progressive disease and their families. Palliat Med. 2015;29:3–4.CrossRefPubMed
20.
Lamont EB, Christakis NA. Complexities in prognostication in advanced cancer “ to help them live their lives the way they want to”. JAMA. 2003;290(1):98–104.CrossRefPubMed
21.
Llobera J, Esteva M, Rifaá J, Benito E, Terrasa J, Rojas C, et al. Terminal cancer: duration and prediction of survival time. Eur J Cancer. 2000;36(16):2036–43.CrossRefPubMed
22.
Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med. 2013;368:1173–5.CrossRefPubMed
23.
24.
Rosenwax L, Spilsbury K, McNamara BA, Semmens JB. A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on? BMC Palliat Care. 2016;15:46.CrossRefPubMedPubMedCentral
25.
Benítez MA, Castañeda P, Gimeno V, Gómez M, Duque A, Pascual L, et al. [consensus document of the Spanish Society of Palliative Care (SECPAL) and the Spanish Society of Family and Community Medicine (semFYC). Domiciliary care for the patient with cancer in terminal phase]. Aten. Primaria/soc. Española Med Fam y Comunitaria. 2001;27:123–6.
26.
27.
28.
Sansó Martínez N, Riera EJC, Bugeda EA, Morro SS, Cánaves JL, Oliver B. Programa de Cuidados Paliativos de las Islas Baleares palliative care program of the Balearic Islands. Med Balear. 2013;28:49–55.
29.
30.
31.
32.
Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the supportive and palliative care indicators tool (SPICT): a mixed-methods study. BMJ Support Palliat Care. 2014;4:285–90.CrossRefPubMed
33.
Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol. 2004;22:315–21.CrossRefPubMed
34.
Gulliford MC, Adams G, Ukoumunne OC, Latinovic R, Chinn S, Campbell MJ. Intraclass correlation coefficient and outcome prevalence are associated in clustered binary data. J Clin Epidemiol. 2005;58:246–51.CrossRefPubMed
35.
Gómez-Batiste X, Tuca A, Corrales E, Porta-Sales J, Amor M, Espinosa J, et al. Resource consumption and costs of palliative Care Services in Spain: a multicenter prospective study. J Pain Symptom Manag. 2006 Jun;31(6):522–32.CrossRef
36.
Gómez-Batiste X, Porta-Sales J, Pascual A, Nabal M, Espinosa J, Paz S, et al. Catalonia WHO palliative care demonstration project at 15 years. J Pain Symptom Manag. 2007;33:584–90.CrossRef
37.
Henson LA, Gomes B, Koffman J, Daveson BA, Higginson IJ, Gao W, et al. Factors associated with aggressive end of life cancer care. Support Care Cancer. 2016;24:1079–89.CrossRefPubMed
38.
Leemans K, Deliens L, Van den Block L, Vander Stichele R, Francke AL, Cohen J. Systematic Quality Monitoring For Specialized Palliative Care Services: Development of a Minimal Set of Quality Indicators for Palliative Care Study (QPAC). Am. J. Hosp. Palliat. Care. 2016. [Epub ahead of print].
39.
Tang ST, Wu S-C, Hung Y-N, Chen J-S, Huang E-W, Liu T-W. Determinants of aggressive end-of-life care for Taiwanese cancer decedents, 2001 to 2006. J Clin Oncol. 2009;27:4613–8.CrossRefPubMed
40.
Earle CC, Neville BA, Landrum MB, Souza JM, Weeks JC, Block SD, et al. Evaluating claims-based indicators of the intensity of end-of-life cancer care. Int J Qual Health Care. 2005;17:505–9.CrossRefPubMed
41.
Wright AA, Keating NL, Ayanian JZ, Chrischilles EA, Kahn KL, Ritchie CS, et al. Family perspectives on aggressive cancer care near the end of life. JAMA. 2016;315(3):284–92.CrossRefPubMedPubMedCentral
42.
Delaney BC, Peterson KA, Speedie S, Taweel A, Arvanitis TN, FDR H. Envisioning a learning health care system: the electronic primary care research network, a case study. Ann Fam Med Am Acad Fam Physicians. 2012;10:54–9.CrossRef
43.
Leysen B, Van den Eynden B, Gielen B, Bastiaens H, Wens J. Implementation of a care pathway for primary palliative care in 5 research clusters in Belgium: quasi-experimental study protocol and innovations in data collection (pro-SPINOZA). BMC Palliat Care. 2015;14:46.CrossRefPubMedPubMedCentral
44.
Schneider N, Mitchell GK, Murray SA. Palliative care in urgent need of recognition and development in general practice: the example of Germany. BMC Fam Pract. 2010;11:66.CrossRefPubMedPubMedCentral
45.
Bainbridge D, Brazil K, Krueger P, Ploeg J, Taniguchi A, Darnay J. Evaluating program integration and the rise in collaboration: case study of a palliative care network. J Palliat Care. 2011;27:270–8.PubMed
46.
Murray SA, Boyd K, Sheikh A. Developing primary palliative care: primary palliative care services must be better funded by both day and night. BMJ. 2005;330:671.CrossRefPubMedPubMedCentral
Metadata
Title
Strengthening primary health care teams with palliative care leaders: protocol for a cluster randomized clinical trial
Authors
Joan Llobera
Noemí Sansó
Amador Ruiz
Merce Llagostera
Estefania Serratusell
Carlos Serrano
María Luisa Martín Roselló
Enric Benito
Eusebio J. Castaño
Alfonso Leiva
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2018
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-017-0217-9

Other articles of this Issue 1/2018

BMC Palliative Care 1/2018 Go to the issue

Research article

Anticipatory grief of spousal and adult children caregivers of people with dementia

Research article

What does ‘complex’ mean in palliative care? Triangulating qualitative findings from 3 settings

Research article

Differences in do-not-resuscitate orders, hospice care utilization, and late referral to hospice care between cancer and non-cancer decedents in a tertiary Hospital in Taiwan between 2010 and 2015: a hospital-based observational study

Research article

Adding a second surprise question triggers general practitioners to increase the thoroughness of palliative care planning: results of a pilot RCT with case vignettes

Research article

The ‘lived experience’ of palliative care patients in one acute hospital setting – a qualitative study

Research article

Negative pain management index scores do not necessarily indicate inadequate pain management: a cross-sectional study