Invasive palliative interventions: when are they worth it and when are they not?
In palliative cancer care situations, invasive palliative interventions are frequently considered. The perception of invasiveness has a wide range and is subjective. A structured palliative care approach can guide decisional processes. It may contain 6 key elements: (1) multidimensional and multiprofessional assessment patients current priorities, (2) quality of current symptom management for the potential target intervention, (3) documentation of potential reasons to reduce symptomatic medications, (4) cautious judgment if patients' potential clinical benefit can be extrapolated from published evidence, (5) a decisional process for the considered intervention (e.g., the 7 P's model: priority, price, probability, prognosis, progression, prevention, preferences), and (6) agreement on the goal of the intervention before the invasive intervention. The examples of pleural effusion and parenteral nutrition are briefly emphasized. Oncologists may be competent to foster patients' participation in decision making and to use available specialist palliative care competencies and those of other professions.
Strasser
Florian
F
Oncological Palliative Medicine, Division of Oncology/Hematology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, St Gallen, Switzerland. florian.strasser@kssg.ch
Blum
David
D
Bueche
Daniel
D
D003657:Decision Making; D018450:Disease Progression; D004322:Drainage; D006801:Humans; D009369:Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care; D010358:Patient Participation; D010996:Pleural Effusion / Q000628:therapy; D011379:Prognosis