3.2 Palliative Care Delivery Models

Question 1

What do current population characteristics tell us about future palliative needs? List 3 predictions.

What does this tell us about future palliative care delivery models? List 3 aspects.

Answer 1

1. LIFE EXPECTANCY is expected to increase, especially in oldest-old (>60 to >80 year old) groups by year 2050
2. ANNUAL NUMBER OF DEATHS are increasing in many countries (because longer survival + baby boom in 1950’s)
3. NON-COMMUNICABLE DEATHS are majority (>80%) of deaths. –> growing co-morbidity

Future models will need to address:

1. increased demand for palliative care services (i.e. more hospital beds, community services, ++ health care costs)
2. Embrace increased multi-morbidity (pall care cannot be based in single “silo” disease model or be experts of single problem/illness
3. Palliative care prognostic models will need to change with increased multi-morbidity (= increased uncertainty)

Question 2

List 3 components of specialist palliative care

Answer 2

(1) directly provide care for the more complex patients and families

(2) provide education and support to generalists

(3) undertake or collaborate in research to improve the care for patients and families in the future

Question 3

List a barrier to specialist palliative care research.

What kind of delivery model could address this issue.

Answer 3

Lack of necessary expertise for pilot studies to lead to larger trials

*this is why many Cochrane/systematic reviews are inconclusive and why many palliative care medicines lack patents for use**

A delivery model that supports centres of excellence as hubs of expertise that could drive forward large collaborations

Question 4

1. List 3 ways in which palliative care delivery models need to change to meet the needs of future populations.
2. Name 1 new model that may address these gaps

Answer 4

1. better integration with existing services
2. earlier involvement of palliative care specialists
3. providing care for patients with longer trajectories of illness (in both cancer and non-cancer conditions)

“Short-term integrated palliative care”- see patients for a limited time, to set things in order, and then discharge them to the care of existing services. Will be triggered by patient needs not prognosis

Question 5

List 4 benefits found by RCTs looking at the integration of oncology and palliative care.

Answer 5

1. Improved survival and symptom control
2. less anxiety and depression
3. reduced use of futile chemotherapy at the end of life
4. improved family satisfaction and quality of life
5. improved use of healthcare resources
6. Promotes patient-centered care

Question 6

List 3 barriers to the integration of this palliative care

Answer 6

1. misconception that palliative care is end of life care only
2. stigmatization of death and dying
3. insufficient infrastructure and funding

Question 7

What is the evidence for effectiveness of:

1) Specialist PCU’s and hospices
2) Hospital Palliative care consultation teams
3) Palliative home care teams

Answer 7

1) PCU/hospices:
- benefit in symptom management,
- higher satisfaction with quality of care per patient and family

2) Hospital consultation teams:
-Small positive effect for:
symptoms, QOL, time in hospital, total length of time in palliative care, or professional changes, such as prescribing practices

3) Home care teams:
- very good evidence for odds of patients dying at home
- small benefit to symptoms

Question 8

Systematic assessment and use of patient-reported outcomes in clinical care can result in better symptom control, improved patient physical and mental health, better detection of hidden problems, and better use of healthcare resources.

List 3 such scales used in palliative care

Answer 8

1. Edmonton Symptom Assessment System (ESAS)
2. Palliative Care Outcome Scale
3. Support Team Assessment Scale