Feb 6 2013
By Sarah Guy, medwireNews Reporter
Palliative care provided early in the ambulatory care setting varies with the trajectory of patients' disease and is complementary to medical management, show study results.
Furthermore, an analysis of the conversations held between healthcare providers and palliative care patients indicates that discussions about end-of-life and hospice care do not occur until late in the disease process.
"This key finding may allay patient and oncologist concerns that early [palliative care] may ask patients and families to discuss and make decisions... before they are ready to address such challenging topics," say Jennifer Temel (Massachusetts General Hospital Cancer Center, Boston, USA) and co-workers.
The team analyzed clinical documentation from a randomized controlled trial of early palliative care integrated with standard oncologic care (intervention) versus oncologic care alone, in patients with metastatic non-small-cell lung cancer.
Twenty patients from four survival groups (<3 months, 3-6 months, 6-12 months, 12-24 months) were identified for analysis from the intervention group. Study participants were aged a mean of 68 years, and their early palliative care visits covered relationship and rapport building, establishing illness understanding, and discussing the effects of cancer treatments.
Regardless of patients' disease trajectories, all visits showed evidence of discussions about symptom management, coping, patients' knowledge of their illness status, and the involvement of family members. This complemented clinical management at clinical "turning points," with the patients' notes suggesting that the palliative care consultations supported them in coping with worsening disease, whereas the oncology consultations focused on treatment and managing side effects.
Temel and colleagues note that only late-stage palliative care consultations covered end-of-life planning, in particular, discussions about resuscitation preference and hospice care.
"Our analysis sheds light on the clinical components of early integrated [palliative care] in the ambulatory setting, which may serve as a clinically useful foundation for developing these services to enhance the care of patients with advanced cancers," write Temel et al in JAMA Internal Medicine.
"More important, we observed that the specific content of the early [palliative care] visits varied according to timing along the disease trajectory and clinical events, rather than following a generally prescribed checklist.
"This novel finding may serve to guide clinicians in providing early [palliative care] tailored to specific individual needs, depending on their phase of illness," concludes the team.
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