Risultati per: Linee guida pratiche sulle cure palliative

Presidente Perrone: ‘Difendere l’universalismo delle cure’

Sono 224mila i casi diagnosticati, ma si stimano circa 600mila

Sono 224mila i casi diagnosticati, ma si stimano circa 600mila

A relatively low-intensity intervention of nurse and social worker phone calls improved quality of life and health status.

Objectives
To compare the discussions from two panels on the concept of palliative care quality for patients with advanced cancer, exploring the priorities reflected in each group’s perspectives.

Design
We convened two RAND-UCLA appropriateness panel discussions on palliative care quality in advanced cancer. Discussions were audio-recorded and transcribed verbatim. Panel transcripts were analysed thematically using a matrix approach to examine perceptions and experiences of quality.

Setting
Discussions were framed within the context of advanced cancer care and palliative care.

Participants
The patient–caregiver panel had 9 patients with current or a history of cancer and caregivers, and the practitioner panel had 10 expert practitioners representing fields of oncology, primary care, social work, palliative care, nursing, pain management and ethics.

Results
Our analysis identified three thematic categories for understanding quality common across both groups and nine subthemes within those categories. At the highest level, quality was conceived as: (1) the patient and caregiver experience of care, (2) technical competence and (3) the structure of health system. Among the subthemes, four were present in only one of the two group’s discussions: ‘purpose and action’ was specific to the patient–caregiver panel, whereas ‘adhering to best medical practice’, ‘mitigating unintended consequences and side effects’, and ‘health system resources and costs’ were specific to the practitioner panel.

Conclusions
While both panels aligned on the three key domains of quality, the particular dimensions through which they perceived quality varied in relation to their experience and role as a professional provider of care versus recipient of healthcare services. These differences suggest the importance of adopting a collaborative approach to quality measurement and improvement so that the values of all interested parties are represented in improvement efforts.

Il report di Gimbe sulla mobilità sanitaria

At first glance, the 2 palliative care trials in this issue of JAMA may seem a study in contrasts. One was an outpatient intervention, the other inpatient. One included 306 participants, the other 24 065. One was an efficacy study, the other a pragmatic effectiveness study. One of the interventions added resources to expand access to palliative care, the other tried to expand access to palliative care with no additional resources. In one study the primary outcome was quality of life (QOL), in the other length of stay (LOS). In one study the primary outcome was positive, in the other it was negative.

This cluster randomized trial examines whether the effect of ordering palliative care consultation by default for seriously ill hospitalized patients without requiring greater palliative care staffing increased consultations and improved outcomes.

This randomized clinical trial compares differences in quality of life among 306 adults at high risk of death who have COPD, heart failure, or interstitial lung disease and who received nurse and social worker palliative telecare vs usual care.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

L’oncologo del Pascale intervistato da BeeMagazine. Lo dimostrano i dati sulla sopravvivenza con nivolumab

Objectives
Tailored models of home-based palliative care aimed to support death at home, should also ensure optimal symptom control. This study aimed to explore symptom occurrence and distress over time in Palliative Extended And Care at Home (PEACH) model of care recipients.

Design
This was a prospective cohort study.

Setting and participants
Participants were consecutive recipients of the PEACH rapid response nurse-led model of care in metropolitan Sydney (December 2013–January 2017) who were in the last weeks of life with a terminal or deteriorating phase of illness and had a preference to be cared or die at home.

Outcome measures
Deidentified data including sociodemographic and clinical characteristics, and symptom distress scores (Symptom Assessment Score) were collected at each clinical visit. Descriptive statistics and forward selection logistic regression analysis were used to explore influence of symptom distress levels on mode of separation ((1) died at home while still receiving a PEACH package, (2) admitted to a hospital or an inpatient palliative care unit or (3) discharged from the package (alive and no longer requiring PEACH)) across four symptom distress level categories.

Results
1754 consecutive clients received a PEACH package (mean age 70 years, 55% male). 75.7% (n=1327) had a home death, 13.5% (n=237) were admitted and 10.8% (n=190) were still alive and residing at home when the package ceased. Mean symptom distress scores improved from baseline to final scores in the three groups (p