Palliative care needs of cancer outpatients receiving chemotherapy: an audit of a clinical screening project.
OBJECTIVE
Although more and more cancer patients are receiving chemotherapy in outpatient settings in their advanced stage and could have a broad range of palliative care needs, referral to the specialized palliative care service is often delayed. The primary aim of this study is to explore the usefulness of a combined intervention for cancer patients in identifying patients with under-recognized palliative care needs and referring them to the specialized palliative care service. The intervention consisted of (1) introducing the specialized palliative care service when starting chemotherapy, (2) using screening tools, and (3) providing on-demand specialized palliative care service.


METHODS
All cancer patients newly starting chemotherapy with primary tumor sites of the lung, gastrointestine, pancreas, bile duct, breast, ovary, and uterus were included. As routine practice, at the first instruction about chemotherapy, pharmacists provided information about the role of the specialized palliative care service using a pamphlet and handed out screening questionnaires. Screening questionnaires were distributed at every hospital visit. Treating physicians and/or nurses checked the questionnaire before examining the patients. The patients were referred to the palliative care team, if (1) the patients voluntarily wished for the specialized palliative care service or (2) the treating physicians clinically determined that, on the basis of the screening results, the patients had physical or psychological needs appropriate for referral to the specialized palliative care service. The screening questionnaire included an open-ended question about their greatest concerns, the severity of 11 physical symptoms, overall quality-of-life, the distress thermometer, help for information about the treatment and decision-making, economic problems, nutrition, daily activities, and wish for help from the specialized palliative care service.


RESULTS
Of 211 patients who newly started chemotherapy, 5 patients refused to complete the questionnaire (compliance rate, 98%). We obtained 1,000 questionnaires from 206 patients. The percentages of missing values ranged from 2.7% to 7.0%. Of 206 patients, 38 (18%) were referred to the palliative care team due to newly recognized problems, in addition to 10 patients with problems well-recognized by primary physicians. The total percentage of patients receiving specialized palliative care service was thus 23% of all patients. Frequently identified problems were oral problems (20%), insomnia (20%), help with information and decision-making (16%), psychological distress defined as the distress thermometer (14%), severe fatigue (9.0%), and severe appetite loss (8.8%). As a whole, problems were identified in half of all questionnaires.


CONCLUSIONS
The combined intervention of introducing the specialized palliative care service, using screening tools and providing on-demand specialized palliative care service, was feasible as part of the routine clinical practice for all cancer patients starting chemotherapy. It might be useful in identifying patients with under-recognized palliative care needs and referring them to the specialized palliative care service at the appropriate time.
Morita
Tatsuya
T
Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, 3453 Mikatabara-cho, Hamamatsu, Shizuoka, Japan. tmorita@sis.seirei.or.jp
Fujimoto
Koji
K
Namba
Miki
M
Sasaki
Naoko
N
Ito
Tomoko
T
Yamada
Chika
C
Ohba
Arisa
A
Hiroyoshi
Motoki
M
Niwa
Hiroshi
H
Yamada
Takeshi
T
Noda
Tsuneo
T
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000534:rehabilitation; D010045:Outpatients; D010166:Palliative Care / Q000379:methods*; D010348:Patient Care Team; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012017:Referral and Consultation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D000970:Antineoplastic Agents