We hope you enjoyed the EAPC 12th World Research Congress! All congress content is available online for delegates until 30th September 2022. There were many highlights from #EAPC2022 but we particularly enjoyed the award presentations, which included Palliative Medicine’s Paper of the Year award. The winners were Lise Nottelmann and colleagues for their paper about integrated palliative rehabilitation.
I recently shared a conversation with nurse Grethe, who has been a key contributor in the development of the Palliative Rehabilitation offer at Vejle Hospital, Denmark, and still works as a facilitating nurse in the group program. We were talking about the fact that our publication ‘Early, integrated palliative rehabilitation improves quality of life of patients with newly diagnosed advanced cancer: The Pal-Rehab randomized controlled trial’ has been selected as Palliative Medicine’s ‘Paper of the Year’.
In the article we presented how a time limited and integrated palliative rehabilitation offer improved quality of life and emotional functioning for patients with newly diagnosed advanced cancer (1). Palliative rehabilitation has been suggested as “a paradigm which integrates rehabilitation, enablement, self-management and self-care into the holistic model of palliative care” (2).
The elements of the intervention which we tested were two consultations at a palliative outpatient clinic over a twelve-week period. Depending on individual needs identified during the initial assessments and follow up, patients were encouraged to participate in our twelve-week patient and caregiver education and discussion sessions combined with individually tailored physical exercise in groups. Supplementary individual consultations with physicians, nurses, physiotherapists, psychologists, occupational therapist, dietician, or social worker were also offered, if needed.
The program has since been fully implemented in the clinical setting of the palliative team in Vejle. I asked Grethe what she identifies as the greatest strengths and barriers of palliative rehabilitation in groups:
‘It’s remarkable’, she said, ‘how the patients often hesitate at first but once enrolled, they don’t want to let go again’.
‘Why do you think that is?’, I asked.
‘Firstly, I see how they benefit from meeting others in the same situation’, Grethe replied, ‘They form quite strong bonds and enjoy the fact that they don’t have to explain or excuse themselves. Secondly, it really makes a difference when they feel their bodies getting stronger. It opens up new possibilities for the remainder of their lives that they didn’t foresee.’
‘But why the hesitation?’, I asked.
Grethe herself didn’t hesitate long before answering, ‘The problem is still the word palliative. It has this cloud of death hanging over it that patients don’t identify with until we explain it. But also, the patients are often quite humble. They think that others must be more deserving and more in need of our services’.
Grethe’s thoughts and experiences align with the findings of the study where we saw that about 25% of study participants didn’t express a need for help before meeting the palliative rehabilitation team. But of this group about two thirds ended up joining the group programme or getting more than the two mandatory consultations. Almost all participants (93%) would strongly recommend the offer to others in the same situation regardless of their own initial perception of need (3). When I presented the results of the study to the Hospital’s Patient and Caregiver council, which had been acting as an advisory board throughout the process, they highlighted this as the most important finding of the study.
The selection as Palliative Medicine’s ‘Paper of the Year’ may hopefully generate additional attention to our model. On behalf of the author group and the clinical team, I therefore wish to thank Palliative Medicine for this great honour and recognition.
Catherine Walshe, Editor of Palliative Medicine, commented on the reason for choosing this paper:
“The judges felt this was a well conducted study on an important area. We particularly liked the way that the challenges of conducting a difficult study had been managed, with meaningful patient outcomes considered.”
References
1 Nottelmann L, Groenvold M, Vejlgaard TB, Petersen MA, Jensen LH. Early, integrated palliative rehabilitation improves quality of life of patients with newly diagnosed advanced cancer: The Pal-Rehab randomized controlled trial. Palliative Medicine. 2021;35(7):1344-1355.
2 Hospice UK report, Tiberini R et al. Rehabilitative Palliative Care: enabling people to live fully until they die. 2015.
3 Nottelmann L, Jensen LH, Vejlgaard TB, Groenvold M. A new model of early, integrated palliative care: palliative rehabilitation for newly diagnosed patients with non-resectable cancer. Support Care Cancer. 2019;27(9):3291-3300.
Dr. Lise Nottelmann MD, PhD, Specialist registrar Public Health Medicine. She is currently training at Rigshospitalet, Copenhagen, Palliative team. Twitter: @LiseNottelmann. ORCID ID: 0000-0002-2900-3091.
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