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WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Albert Tuca, MD, PhDAlbert Tuca, MD, PhD
Palliative Care Hospital Support Team Palliative Care Hospital Support Team ICMHOICMHOHospital Clínic UniversitariHospital Clínic UniversitariBarcelona, SpainBarcelona, Spain
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Definition of Palliative Care Hospital Support Teams
“Multidisciplinary specialist palliative care team which functions in an advisory and supportive capacity within a general hospital. The patients’ care remains the primary responsibility of the physician or surgeon but they are supported and advised by specialist palliative care personnel.”
Recommendation Rec (2003) 24 of the Committee of Ministers to member states on the organisation of palliative care.
Committee of Ministers on 12 November 2003 European Council.
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Main characteristics of a Palliative Care Hospital Support Team
• Specialist multidisciplinary Palliative Care team
• Function: Consultant team
• Setting: General Hospital (acute hospitals)
• Accessibility to any clinical service of hospital
• No own hospital beds
• Intervention based on shared care
• Intensity of Intervention according to specific complexity of every case (intervention levels)
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Professionals (usual structure)
• Doctors: 1-2 / team
• Nurses: 1-2 / team
• Social Worker: 1 or part time
• Psychologist: 1 or part time
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams Objectives of a Palliative Care Hospital Support Team
• Assess the patient from a multidimensional approach
• Physical symptoms• Psychological symptoms• Family and Social needs• Spiritual needs
• To agree the level of shared care with referral service according to clinical complexity
• Establish a therapeutic comprehensive plan
• Patient follow up during episode of hospital admission and control of response to palliative measures (pharmacological and non-pharmacological)
• Establish the liaison with community palliative resources at hospital discharge (case management)
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Clinical complexity Intervention level
Low complexityI: Advice to other professionals (clinical session)
II: Evaluation and proposal but no follow up
Medium complexity III: Shared care with intermittent or periodical interventions (+/-72 hours)
High complexityIV: Shared care with regular interventions (48 hours)
V: Intensive shared care with daily interventions or full responsibility of case
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Usually, Palliative Care Hospital Support Teams are the first specialized palliative unit in a general hospital
The natural development of Palliative Care in a general hospital is to create first a consultant team, after an out-patients clinic, and finally a Palliative Care Unit (Palliative Care Service)
Palliative Care Support Team
Out-patients clinic
Palliative Care Unit
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Strong Points
• Intervention centred in patient’s needs• Flexibility and accessibility (intervention according palliative
complexity)• Effectiveness in clinical outcomes• High capacity of influence in clinical services
Weaknesses
• Small teams• Usually, part-time psychosocial professionals• Brief intervention• No possibility of patients follow up at discharge if the Hospital Support
Team has not an out-patients clinic
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Characteristics of Palliative Care Hospital Support Teams (PCHST) in Spain
• N PCHST in Spain: 96
• 50% were based in University Hospitals
• Mean structure (n/ PCHST) 1.6 doctors / team1.9 nurses / team0.5 social workers / team0.7 psychologists / team
• Mean length of experience: 6.8 years (range: 1-20)
• Global workload (mean): 275 patients / year
• Diagnosis: 90 % advanced cancer
FISESH 2010 Study
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Characteristics of patients attended by PCHST in Spain
• Gender Men 64% Women
36%
• Age (mean) 69 years
• Patients ≤ 65 years 36%
FISESH 2010 Study. N= 364
Age (%)
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Characteristics of patients
• Etiologic treatment during episode of PCHST intervention or last 4 weeks
• 44% Cancer Chemotherapy 30%
• Performance Status (PPS)
• PPS ≤ 40% 72%• PPS 50-60% 15%• PPS ≥ 70% 13%
FISESH 2010 Study. N= 364
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
FISESH 2010 Study. N= 364
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Effectiveness
Comparing the intensity of symptoms (VAS) from the baseline visit with the control at 72 hours after the intervention of PCHST:
Differences statistically significant (p<0.001)for all symptoms except: - Asthenia - Anorexia
FISESH 2010 Study. N= 364
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams Mean stay from admission
to discharge:
13 days (DST: 9.3)
Mean time between admission and first PCHST consultation
6.9 days (DST: 7.8)
Mean time between PCHST consultation and discharge
6.5 days (DST: 7.1)
FISESH 2010 Study. N= 364
Admission Discharge
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Clinical complexity
• Low 85 (23,5%)• Medium 159 (44%)• High 117 (32,4%)
PCHST level of intervention
• Basic advice - Level 1 or 2:74 (20,6%)
• Shared care - Level 3:136 (37,9%)
• Intensive shared care – Level 4 or 5:149
(41,5%)FISESH 2010 Study. N= 364
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams
Hospital discharge
• Exitus 36 %
• Long or medium stay Palliative Care Unit 29 %
• Home discharge 35 %
• PC out-patients clinic 11 %• Home Support Team 14 %
FISESH 2010 Study. N= 364
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
ConclusionsConclusions
PCHST are hospital consultant teams in Palliative Care without own beds for admission
Intervention in any clinical service of a general hospital
Intervention based on shared care
Intensity of shared care is based on specific complexity of every case and needs of referent services (agreement of shared care)
High accessibility, flexibility and clinical effectiveness
Brief intervention and difficulties in the follow up if the team does not have an outpatients clinic
Important role in liaison of palliative resources available in their health area.
WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques
Equip de Suport Hospitalari i Cures Pal·liativesEquip de Suport Hospitalari i Cures Pal·liativesServei Oncologia MèdicaServei Oncologia Mèdica
ICMHOICMHOHospital Clínic Universitari de BarcelonaHospital Clínic Universitari de Barcelona