Jeroen Hasselaar (Radboud University, Nijmegen, the Netherlands) and Agnes Csikos (University of Pécs Medical School, Hungary are members of the Integrated Palliative Care InSup-C Consortium Management Team. The project has been investigating the best way to deliver care to people who have advanced cancer, heart failure or lung disease as they come towards the end of their lives.
The integration of palliative care is an emerging topic, which was included in the programme of the 9th World Research Congress of the European Association for Palliative Care (EAPC) in Dublin via several sessions and abstracts. We highlight three examples here.
Stein Kaasa (Norway) approached the topic from the viewpoint of increased costs and complexity of treatments. These complexities increase transfers of patients and information exchange between professional caregivers. Integrated care pathways are mentioned as a possible solution for this. Such pathways need to include all possible steps that palliative patients undergo, from hospital diagnostics to community home care. For each different stage, care plans are needed, the evaluation of which can partly take place via patient-reported outcome measures (PROMs).
Tit Albreht (Slovenia) focused on the strategic transfer of hospital care towards community care because patients increasingly want to be cared for at home as much as possible. For palliative care delivery at home, availability of a professional team and patient trust in home care delivery are needed. Investment in education and training of multidisciplinary teams are therefore needed, together with the availability of social care.
Jeroen Hasselaar (the Netherlands) reported some preliminary results from the InSup-C international study on integrated palliative care. More than 150 patients and 90 family carers were included from palliative care initiatives in five European countries (the UK, the Netherlands, Germany, Belgium and Hungary). Patients and family carers particularly valued the personal/patient-centred approach deployed in palliative care compared to general healthcare, although the presence of several professional caregivers can also be challenging in terms of information exchange/sharing.
What different things are we talking about?
Integration can be defined as the act or process of uniting different things. So, in palliative care, the first question is: What different things are we talking about? From the above-mentioned examples, it appears that due to increased complexity of treatment, palliative care becomes fragmented across several care settings, such as hospital care and home care. This demands more advanced ways of information exchange/sharing and the competencies of other professional caregivers.
What brings unity?
The second question is: What brings unity? Pathways were mentioned as a structure that binds professionals together and gives clear clinical parameters to act upon, tailored to the setting where the patient is residing. This comes with a need for investments in multidisciplinary teams and competencies. Finally, however, it seems that the unifying element for patients and carers, which positively distinguishes palliative care, is the personal approach where patients are considered as ‘whole human beings’ instead of being identified merely by their disease.
The organisational integration of palliative care starts therefore with the acknowledgement that palliative patients are approached from an integrated perspective, namely as whole human beings.
To find out more . . .
- Download all the abstracts for the 9th EAPC World Research Congress from the June edition of Palliative Medicine.
- Integrated Palliative Care: Are we ready for change? Symposium 30 September 2016, Museum of Natural Sciences, Brussels, Belgium. Find out more and register here.
- Read more contributions from members of InSup-C on the EAPC Blog.