Implementation of early palliative care in an oncologic outpatient clinic – an observational study of the first year

Abstract

Background

As earlier studies found that early onset specialized palliative care (ESPC) results in better quality of life (QoL), less hospitalization and chemotherapy toward end-of life, we implemented ESPC in our oncology outpatient clinic. The aim of this study was to describe reasons for referral, interventions performed and the satisfaction among the oncologic staff.

Material and Methods

The outpatient ESPC clinic was established in the department of oncology. Prespecified selected data was obtained from the patients records. All patients were asked to fill in a questionnaire concerning their symptoms and QOL. A survey among the oncologic personnel concerning their perception of the clinic was conducted. All data were consecutively collected in a share point database.

Results

We included 134 patients. The primary referral symptoms were pain (69%) or psychological/existential challenges (23%). 55% of patients filled in an EORTC questionnaire and rated a median (QoL) of 3.4. Interventions initiated were on based on the following symptoms: pain (70%), constipation (53%), nausea (15%), dyspnea (10%) and depression (7%). Median waiting time was 13 days. Of the 134 patients referred to the ESPC clinic 101 was admitted. Symptoms and problems were resolved in the ESPC clinic for 81 of the 101 admitted patients (80%), i.e., after one consultation for 25 patients and after a follow up course in the clinic for 56 patients. A survey among the staff at the Department of Oncology demonstrated a high degree of satisfaction with the ESPC clinic.

Conclusions

We report experiences from implementation of ESPC in our outpatient oncologic clinic, where 81 (80%) of the admitted patients could be finished after one or a few follow up contacts, as their symptoms had been resolved. There was a high degree of satisfaction with the clinic among the oncologic staff.

Keywords:

• Early palliative care
• integrated palliative care
• implementation
• quality of life

Acknowledgements

We are grateful for the enthusiastic contribution of our oncologic nurses Anja Ranum Broenserud, Christina Lykke Buhl, Mette Adelgaard, Ida Oerum Vestergaard, Helle Lyzet Hansen and Susanne Sejersen during the implementation process. Furthermore, we would like to thank the two reviewers for their helpful and constructive feedback in the publication process.

Author contribution

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Katrine R Schønnemann, Sabine UA Gill and Stine Hollegaard. The first draft of the manuscript was written by Sabine U Gill and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).