Friday, April 9, 2010

Cancer Centers and Palliative Care.

Oncology Times has an in-depth look at a recent study of palliative care in the US that was published by JAMA on March 17. Here's a clip, or read the entire article here.

“The state of palliative care in the United States is not very well known,” said lead author David Hui, MD, MSc, a medical oncologist currently completing a two-year clinical research fellowship in supportive and palliative oncology at the University of Texas M. D. Anderson Cancer Center. “Palliative care referral remains limited, and there remains much heterogeneity in the infrastructure and delivery of care.”

Speaking here at an AMA news briefing at the National Press Club, he noted that by the end of 2010 cancer is expected to be the number one cause of death worldwide and that about half of cancer patients die of their disease or related complications. “In about 10 years we should have palliative care for all cancer patients; more palliative care needs to be integrated into cancer care.”

The American Society of Clinical Oncology has recommended that palliative care be integrated into cancer care as a routine part of comprehensive cancer care by the year 2020.


“Almost all NCI-designated centers have palliative care programs,” said Dr. Hui. In fact, 98% of these NCI center centers said they have a palliative care program, 92% said they have at least one palliative care physician, and 92% said they have an inpatient palliative care consultation team. Figures were much lower for non-NCI centers.

But even NCI-designated cancer centers had a much lower rate for an outpatient palliative care clinic (59%) and relatively few centers—NCI-designated or not—had an institution-operated hospice or dedicated palliative care beds, he said.

The relative lack of available outpatient palliative care clinics can be a particularly high barrier to cancer patients receiving palliative care, since many who could benefit from such care are being treated as outpatients, Dr. Hui added.

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British Nurses Report on Advanced Care Planning (ACP)

The entire article, below, on a new survey done in Britain of nurses regarding advanced care planning:

Advance care planning (ACP) is a process of discussion about goals of care and a means of setting on record preferences for care of patients who may lose capacity or communication ability in the future. Implementation of ACP is widely promoted by policy makers.

This study examined how community palliative care nurses in England understand ACP and their roles within ACP. It sought to identify factors surrounding community nurses'implementation of ACP and nurses'educational needs.

Methods: An action research strategy was employed.

23 community nurses from two cancer networks in England were recruited to 6 focus group discussions and three follow up workshops. Data were analysed using a constant comparison approach.FindingsNurses understood ACP to be an important part of practice and to have the potential to be a celebration of good nursing care.

Nurses saw their roles in ACP as engaging with patients to elicit care preferences, facilitate family communication and enable a shift of care focus towards palliative care. They perceived challenges to ACP including: timing, how to effect team working in ACP, the policy focus on instructional directives which related poorly to patients'concerns; managing differences in patients'and families'views.

Perceived barriers included: lack of resources to; lack of public awareness about ACP; difficulties in talking about death. Nurses recommended the following to be included in education programmes: design of realistic scenarios; design of a flow chart; practical advice about communication and documentation; insights into the need for clinical supervision for ACP practice.

Conclusions: Nurses working in the community are centrally involved with patients with palliative care needs who may wish to set on record their views about future care and treatment.

This study reveals some important areas for practice and educational development to enhance nurses'use and understanding of ACP.

Author: Jane SeymourKathryn AlmackSheila Kennedy
Credits/Source: BMC Palliative Care 2010, 9:4

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Slovenia Institutes National Palliative Care Program.

On Thursday the Slovenian government passed a bill that commences a national program on palliative care. From the article by Michael Roberts at

At present, Slovenia has no palliative care system or specific policy dealing with the issue. As a result of longer life-expectancy and the increasing number of chronic diseases (among the most common being cardiovascular conditions, cancer, chronic pulmonary diseases and diabetes) there is a pressing need for organised palliative care. Research shows that as many as 60 per cent of people at the end of life and 80 per cent of patients with advanced cancer require palliative care. On average, two family members per patient require certain treatment that is encompassed by the palliative care definition.

The main goals of establishing a system of organised comprehensive palliative care in Slovenia include:

- ensuring high quality, equal and accessible palliative care for all who require it, anywhere and without delay;

- continuous palliative care, with a patient’s record that includes all aspects of palliative care;

- ensuring efficient and transparent use of funds for palliative care;

- providing well coordinated palliative care to patients at all levels of the healthcare system, with institutional care operators providing daily and 24-hour services;

- providing education for basic and specialist palliative care;

- raising public awareness of the principles of, and need for palliative care


I spent a few weeks in Slovenia during my travels around the world in 2006 - 7 and have since, when asked, suggested that Slovenia was perhaps my favorite place. It's a beautiful country with all the European charm and quaintness. The country's overcome a horrid history, reclaimed it's traditional languages, worked hard to boost education and the economy. I'm intrigued but not surprised to hear that, with it's progressive social policies and attention to human welfare, Slovenia has made this step toward improving end of life care for her citizens.

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