Evidence for the benefits of specialist palliative care is already compelling – it’s time to move on to research on comparing different ways of care delivery

WE’RE DELIGHTED TO PRESENT THIS MONTH’S ‘EDITOR’S CHOICE’ FROM PALLIATIVE MEDICINE, THE OFFICIAL RESEARCH JOURNAL OF THE EAPC    

Each month, Professor Catherine Walshe, Editor-in-Chief of ‘Palliative Medicine’, chooses an article that readers may find particularly interesting or useful and invites the authors to draw out the key points on the EAPC blog. Focusing on research that is novel, a robust review, from a specific country or just slightly left of field, the ‘Editor’s Choice’ post aims to share experience and stimulate ideas. We hope you’ll read the longer article in ‘Palliative Medicine’.

Professor Yin-Bun Cheung (left) and Assistant Professor Grace Yang

Grace Yang, palliative medicine physician in National Cancer Centre Singapore, and Yin-Bun Cheung, epidemiologist and biostatistician in Duke-NUS Medical School in Singapore, explain the background to their longer article, selected as ‘Editor’s Choice’ in the September 2021 issue of ‘Palliative Medicine’. And EAPC members can download a PDF of the full-text article from EAPC website.


Not whether, but how?

People with advanced cancer have high rates of hospitalisation, with the chief reason for admission being disease progression or uncontrolled symptoms such as pain. Specialist palliative care consultation for cancer patients in the acute inpatient hospital setting is associated with better patient outcomes. In Singapore General Hospital, like many hospitals worldwide, the Supportive and Palliative Care team from the National Cancer Centre Singapore runs a consult service where referrals were made to a separate specialist palliative care team. Is there a better way for us to be more integrated with the oncologists?

The question is not ‘Should we integrate specialist palliative care with oncology?’ The evidence for the benefits of palliative care is already compelling. The question is HOW this integration should be implemented to optimise health outcomes. Our study compared two ways of delivering specialist palliative care – the consult model versus the co-rounding model. Both provided the same content of specialist palliative care but differed with regard to integration with oncologists.

What study design should be used?

In our institution, oncologists had been asking us to co-round with them for many years. We had also piloted the co-rounding model – there was preliminary evidence of shorter hospital length of stay and the qualitative study found better communication between oncologists and specialist palliative care physicians.1,2 A randomized controlled trial would not be acceptable because no one wanted to be in the control group. We decided on using a stepped-wedge cluster-randomized design – this is an efficient and pragmatic design that allows for all clusters to receive the intervention but starting at different times.

Does it matter how palliative care is delivered?

We found that compared to the consult model, the co-rounding model was associated with a marginally shorter hospital length of stay among all admissions (0.70 days, p=0.065). A shorter hospital length of stay for the co-rounding model was observed in patients with stage 3-4 cancer (0.85 days, p=0.038) and in patients who received specialist palliative care (2.62 days, p=0.010). There was no difference in the proportion of patients who were readmitted within 30 days of discharge.

The mechanisms by which a shorter hospital length of stay can be achieved are not entirely clear. It could be that the co-rounding model fostered more effective collaboration between oncology and specialist palliative care clinicians, thereby improving both the timeliness and the quality of specialist palliative care. Further research is warranted to explore the active components of the co-rounding model and the impact of contextual features on its implementation and effect on patient outcomes.

What next? 

As part of a multi-faceted evaluation, we will be reporting on the patients’ experience of care in the consult model versus the co-rounding model. We also plan to assess end-of-life outcomes such as acute healthcare utilisation in the last 30 days of life and chemotherapy in the last 14 days of life. Look out for these forthcoming papers!

References

  1. Yang GM, Kanesvaran R, Neo SH, Yee ACP, Block SD and Cheung YB. Pilot Study of a Palliative Care and Medical Oncology Co-Rounding Model for Advanced Cancer Inpatients in a Tertiary Hospital in Singapore. J Palliat Med. 2018; 21: 95-8.
  2. Yang GM, Yoon S, Tan YY and Liaw K. Experience and Views of Oncology and Palliative Care Professionals on a Corounding Model of Care for Inpatients with Advanced Cancer. Am J Hosp Palliat Care. 2018; 35: 1433-8.

VIEW THE FULL ARTICLE IN ‘PALLIATIVE MEDICINE’
This post relates to the longer article, ‘Comparing the effect of a consult model versus an integrated palliative care and medical oncology co-rounding model on health care utilization in an acute hospital – an open-label stepped-wedge cluster-randomized trial’ by Grace M Yang,  Siqin Zhou, Zhizhen Xu, Stella SL Goh, Xia Zhu, Dawn QQ Chong, Daniel SW Tan, Ravindran Kanesvaran, Alethea CP Yee, Patricia SH Neo, Yin-Bun Cheung, published in Palliative Medicine 2021 Volume 35 issue:8, page(s): 1578-1589. First published 15 September 2021. https://doi.org/10.1177/02692163211022957

Links    

EAPC MEMBERS – DOWNLOAD THIS, AND ALL OTHER ‘EDITOR’S CHOICE’ ARTICLES, FREE OF CHARGE
If you are currently an Individual or Associate EAPC Member you have full access to the Members Area of the EAPC website, and the chance to download a free PDF of all ‘Editor’s choice’ articles, as well as many other membership benefits. Just click here,  enter your email address and membership password and choose from the list of journal articles under 2021.

Join, or renew your membership, here. Members of our national associations can join the EAPC for free at https://www.eapcnet.eu/join-as-an-associate-member/

 


EXPLORE NEW DIMENSIONS at #EAPC2021. The EAPC 17th World Congress Online offers interactive online sessions from 6 to 8 October 2021, an entire day dedicated to Paediatric Palliative Care and a selection of pre-congress sessions on 5 October.

  • Register for the congress here. (Up to 25% discount for EAPC members)
  • View the live scientific programme here.
  • Enter the Science Slam here.
  • Enjoy lots of on-demand content from 27 September until 31 January 2022.
  • Get a sneak peek of congress presentations on the EAPC blog.
  • Follow latest congress news @EAPCvzw #EAPC2021and via the EAPC blog.
This entry was posted in EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice, RESEARCH, Uncategorized. Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.