17 research outputs found
Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial
BACKGROUND According to the Word Health Organization, patients who can benefit from palliative care should be identified earlier to enable proactive palliative care. Up to now, this is not common practice and has hardly been addressed in scientific literature. Still, palliative care is limited to the terminal phase and restricted to patients with cancer. Therefore, we trained general practitioners (GPs) in identifying palliative patients in an earlier phase of their disease trajectory and in delivering structured proactive palliative care. The aim of our study is to determine if this training, in combination with consulting an expert in palliative care regarding each palliative patient's tailored care plan, can improve different aspects of the quality of the remaining life of patients with severe chronic diseases such as chronic obstructive pulmonary disease, congestive heart failure and cancer. METHODS/DESIGN A two-armed randomized controlled trial was performed. As outcome variables we studied: place of death, number of hospital admissions and number of GP out of hours contacts. DISCUSSION We expect that this study will increase the number of identified palliative care patients and improve different aspects of quality of palliative care. This is of importance to improve palliative care for patients with COPD, CHF and cancer and their informal caregivers, and to empower the GP. The study protocol is described and possible strengths and weaknesses and possible consequences have been outlined. TRIAL REGISTRATION The Netherlands National Trial Register: NTR2815
Timely identification of palliative patients and anticipatory care planning by GPs: practical application of tools and a training programme
Contains fulltext :
171812.pdf (publisher's version ) (Open Access)BACKGROUND: Palliative care is mainly restricted to terminal care. General practitioners (GPs) are not trained to early identify palliative patients with cancer, COPD or heart failure. With the help of the RADboud indicators for PAlliative Care needs (RADPAC), we trained GPs to identify patients' needs and to make a proactive care plan. They were also able to join two role-plays where they discussed the patient's future, and consulted a palliative care consultant to fine-tune the care plan. We evaluated the programme with the GPs and consultants and noted its impact on their daily practice. METHODS: Two years after they had participated in the programme, we held semi-structured interviews with the GPs and a focus group interview with the consultants and performed a thematic content analysis. RESULTS: Six consultants and nine GPs participated in the programme. Most GPs and consultants mentioned positive changes in the thinking or acting of GPs regarding early palliative care. A number continued to use the tool to identify patients; most of the others noted they had internalised the indicators. Although half of them still considered discussing end-of-life aspects difficult, particularly in patients with organ failure, the others were more easily able to discuss the future with their palliative patients. CONCLUSION: Although most GPs and consultants were positive about the training programme and applying it in daily practice, we conclude that in future programmes, more attention needs to paid to timely identification of palliative patients with COPD or CHF and how to discuss the future with them
Timely identification of palliative patients and anticipatory care planning by GPs: Practical application of tools and a training programme
Background:
Palliative care is mainly restricted to terminal care. General practitioners (GPs) are not trained to early identify palliative patients with cancer, COPD or heart failure. With the help of the RADboud indicators for PAlliative Care needs (RADPAC), we trained GPs to identify patients’
needs and to make a proactive care plan. They were also able to join two role-plays where they discussed the patient’s future, and consulted a palliative care consultant to fine-tune the care plan. We evaluated the programme with the GPs and consultants and noted its impact on their
daily practice.
Methods:
Two years after they had participated in the programme, we held semi-structured interviews with the GPs and a focus group interview with the consultants and performed a thematic content analysis.
Results:
Six consultants and nine GPs participated in the programme. Most GPs and consultants mentioned
positive changes in the thinking or acting of GPs regarding early palliative care. A number continued to use the
tool to identify patients; most of the others noted they had internalised the indicators. Although half of them still
considered discussing end-of-life aspects difficult, part
icularly in patients with organ failure, the others were more
easily able to discuss the future with their palliative patients.
Conclusion:
Although most GPs and consultants were positive about the training programme and applying it in daily practice, we conclude that in future programmes, more attention needs to paid to timely identification of
palliative patients with COPD or CHF and how to discuss the future with them
Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial
Contains fulltext :
96843.pdf (publisher's version ) (Open Access)BACKGROUND: According to the Word Health Organization, patients who can benefit from palliative care should be identified earlier to enable proactive palliative care. Up to now, this is not common practice and has hardly been addressed in scientific literature. Still, palliative care is limited to the terminal phase and restricted to patients with cancer. Therefore, we trained general practitioners (GPs) in identifying palliative patients in an earlier phase of their disease trajectory and in delivering structured proactive palliative care. The aim of our study is to determine if this training, in combination with consulting an expert in palliative care regarding each palliative patient's tailored care plan, can improve different aspects of the quality of the remaining life of patients with severe chronic diseases such as chronic obstructive pulmonary disease, congestive heart failure and cancer. METHODS/DESIGN: A two-armed randomized controlled trial was performed. As outcome variables we studied: place of death, number of hospital admissions and number of GP out of hours contacts. DISCUSSION: We expect that this study will increase the number of identified palliative care patients and improve different aspects of quality of palliative care. This is of importance to improve palliative care for patients with COPD, CHF and cancer and their informal caregivers, and to empower the GP. The study protocol is described and possible strengths and weaknesses and possible consequences have been outlined. TRIAL REGISTRATION: The Netherlands National Trial Register: NTR2815
Timely identification of palliative patients and anticipatory care planning by GPs: practical application of tools and a training programme
Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial
Spiritualiteit in palliatieve thuiszorg: handvatten voor de dagelijkse praktijk
status: publishe
Training general practitioners contributes to the identification of palliative patients and to multidimensional care provision: secondary outcomes of an RCT
Introduction To support general practitioners
(GPs) in providing early palliative care to patients
with cancer, chronic obstructive pulmonary
disease or heart failure, the RADboud university
medical centre indicators for PAlliative Care
needs tool (RADPAC) and a training programme
were developed to identify such patients and to
facilitate anticipatory palliative care planning. We
studied whether GPs, after 1 year of training,
identified more palliative patients, and provided
multidimensional and multidisciplinary care more
often than untrained GPs.
Methods We performed a survey 1 year after GPs
in the intervention group of an RCT were trained.
With the help of a questionnaire, all 134 GPs were
asked how many palliative patients they had
identified, and whether anticipatory care was
provided. We studied number of identified
palliative patients, expected lifetime, contact
frequency, whether multidimensional care was
provided and which other disciplines were involved.
Results Trained GPs identified more palliative
patients than did untrained GPs (median 3 vs 2; p
0.046) and more often provided multidimensional
palliative care (p 0.024). In both groups, most
identified patients had cancer.
Conclusions RADPAC sensitises GPs in the
identification of palliative patients. Trained GPs
more often provided multidimensional palliative
care. Further adaptation and evaluation of the tools
and training are necessary to improve early
palliative care for patients with organ failure.
Trial registration number NTR2815; post resultsThe study was financially supported by a grant from
the Netherlands Organisation for Health Research and
Development—ZonMw Foundation. Grant number
1150.0002
Early identification of palliative care patients in general practice: Development of RADboud indicators for PAlliative Care Needs (RADPAC)
Background: According to the World Health Organization (WHO) definition, palliative care should be initiated in an early phase and not be restricted to terminal care. In the literature, no validated tools predicting the optimal timing for initiating palliative care have been determined. Aim: The aim of this study was to systematically develop a tool for GPs with which they can identify patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer respectively, who could benefit from proactive palliative care. Design: A three-step procedure, including a literature review, focus group interviews with input from the multidisciplinary field of palliative healthcare professionals, and a modified Rand Delphi process with GPs. Method: The three-step procedure was used to develop sets of indicators for the early identification of CHF, COPD, and cancer patients who could benefit from palliative care. Results: Three comprehensive sets of indicators were developed to support GPs in identifying patients with CHF, COPD, and cancer in need of palliative care. For CHF, seven indicators were found: for example, frequent hospital admissions. For COPD, six indicators were found: such as, Karnofsky score ≤50%. For cancer, eight indicators were found: for example, worse prognosis of the primary tumour. Conclusion: The RADboud indicators for PAlliative Care Needs (RADPAC) is the first tool developed from a combination of scientific evidence and practice experience that can help GPs in the identification of patients with CHF, COPD, or cancer, in need of palliative care. Applying the RADPAC facilitates the start of proactive palliative care and aims to improve the quality of palliative care in general practice
Training general practitioners in early identification and anticipatory palliative care planning: A randomized controlled trial Clinical presentation, diagnosis, and management
Background: Most patients with advanced cancer, debilitating COPD or chronic heart failure (CHF) live at home. General practitioners (GPs) asked for guidance in how to recognize patients in need of palliative care in a timely way and to structure anticipatory care. For that reason, we developed a training for GPs in identifying patients in need of palliative care and in structuring anticipatory palliative care planning and studied its effect on out-of-hours contacts, contacts with their own GP, hospitalizations and place of death. Methods: We performed a cluster randomised controlled trial. GPs in the intervention group were trained in identifying patients in need of palliative care and anticipatory care planning. Next, for each identified patient, they were offered a coaching session with a specialist in palliative care to fine-tune a structured care plan. The GPs in the control group did not receive training or coaching, and were asked to provide care as usual. After one year, characteristics of patients deceased of cancer, COPD or CHF in both study groups were compared with mixed effects models for out-of-hours contacts (primary outcome), contacts with their own GP, place of death and hospitalizations in the last months of their life (secondary outcomes). As a post-hoc analysis, of identified patients (of the intervention GPs) these figures were compared to all other deceased patients, who had not been identified as in need of palliative care. Results: We did not find any differences between the intervention and control group. Yet, only half of the trained GPs (28) identified patients (52), which was only 24 % of the deceased patients. Those identified patients had significantly more contacts with their own GP (B 4.5218; p <0.0006), were less often hospitalized (OR 0.485; p 0.0437) more often died at home (OR 2.126; p 0.0572) and less often died in the hospital (OR 0.380; p 0.0449). Conclusions: Although we did not find differences between the intervention and control group, we found in a post-hoc analysis that those patients that had been identified as in need of palliative care had more contacts with their GP, less hospitalizations, and more often died at home. We recommend future controlled studies that try to further increase identification of patients eligible for anticipatory palliative care. The Netherlands National Trial Register: NTR2815 date 07-04-2010