Xavier Gómez-Batiste, Marisa Martínez-Muñoz and Carles Blay, WHO Collaborating Centre for Palliative Care Public Health Programmes, Catalan Institute of Oncology, Spain, explain the background to their research study that has been selected as Editor’s Choice in the April issue of Palliative Medicine. (1)
Palliative care must become a key element (‘the centre‘) of chronic care programmes – cancer, geriatric or other specific diseases – by offering high quality patient-centred models of care. In Catalonia (Spain), a formal programme of palliative care innovation has been set up at the Department of Health. (2) Our WHO Collaborating Centre (3) is strongly committed to this and the EAPC Task Force on Palliative Care in Primary Care in the Community is our way to progress it.
There are major challenges to improve needs assessment including: a) a focus on care for patients with terminal cancer, b) lack of knowledge of the patients’ clinical characteristics and c) the difficulty of identifying the so-called ‘transitions in care needs’ in patients suffering from chronic diseases other than cancer. It is especially difficult to identify patients in need of palliative care and those with limited life prognosis in the community. But as a result of new research, we can now use several effective tools. Additionally, the concept of a palliative approach increases the early provision of care to all patients in any setting. It focuses on quality of life, and offers an integrated flexible pattern of care.
Following these innovations, we measured for the first time the prevalence of people in need of palliative care in the general population (1.5%) and in different age groups and settings. In Catalonia this was: 18 patients per general practitioner, 37% in acute hospitals, 54% in nursing homes, and 70% in socio-health centres. Patients were mainly elderly with multi-morbidity; advanced frailty, dementia and organ failure; and live at home or in nursing homes. We are currently analysing the results of mortality at two years in this identified cohort, to test the predictive value of the NECPAL CCOMS-ICO© tool.
These figures outline the major challenge for palliative care policy in the future. The model of care must include advance care planning, case management, and shared and integrated care based on geriatrics and chronic care models. (4) Additionally, new challenges arise for palliative care specialist services, eg being able to look after patients with advanced chronic disease and establish systems of shared care in primary care services and nursing homes. Such services should be empowered to respond to these challenges through training, networking with other services, having a district-based perspective, and promoting comprehensive and integrated pathways.
We’d be delighted to share our experience with you and you’re welcome to email us (or leave a reply in the comment box below).
Download a free copy of the longer article…
This blog post relates to a longer article, ‘Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: A cross-sectional study’ by Gómez-Batiste X et al. Pall Med 2014; 28 (4): 302-311. EAPC members and registered users of the EAPC website can download a free copy of this article and other ‘Editor’s choice’ papers from the EAPC website. (Just follow the instructions in the top right-hand corner of the page to register or login, and scroll down to download the article). Click here to view other EAPC-originated papers on the EAPC website.
1. Gómez-Batiste X, Martinez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X, Espaulella J, Espinosa J, Constante C, Mitchell GK. Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: a cross-sectional study. Pall Med 2014; 28(4):302-311. doi:10.1177/0269216313518266.
2. Gómez-Batiste X, Martínez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X, Espaulella J, Espinosa J, Figuerola M, and Constante C. Identifying chronic patients in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia. BMJ Support Palliat Care 2013; 3: 300-308 doi: 10.1136/bmjspcare-2012-000211.
3. Ela S, Espinosa J, Martínez-Muñoz M, Lasmarías C, Beas E, Mateo D, Novellas A, Gómez-Batiste X. The WHO Collaborating Centre for Public Health Palliative Care Programs: an innovative approach of Palliative Care Development. JPM, 2014; 17 (4). doi: 10.1089/jpm.2013.0203.
4. Gómez-Batiste X, Martínez-Muñoz M, Blay C, Espinosa J, Contel JC, and Ledesma A. Identifying needs and improving palliative care of chronically ill patients: a community-oriented, population-based, public-health approach. CurrOp in Support Palliat Care 2012, 6:371–378.
Nos veremos al 8vo Congreso Mundial de Recerca del EAPC, en Lleida, España, del 5 al 7 de junio 2014. Si puede seguirnos en Twitter @EAPCOnlus – el hashtag oficial del congreso es #eapc2014.
See you at the 8th EAPC World Research Congress in Lleida, Spain. 5-7 June 2014. Follow us on Twitter @EAPCOnlus – our official congress hashtag is #eapc2014.