Establishment of a Palliative Care Consultation Service (PCCS) in an Acute Hospital Setting.

Peter Tom Engel, Tharshika Thavayogarajah, Dennis Görlich, Philipp Lenz
Author Information
  1. Peter Tom Engel: Department of Palliative Care, University of Muenster, 48149 Muenster, Germany.
  2. Tharshika Thavayogarajah: Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany.
  3. Dennis Görlich: Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany. ORCID
  4. Philipp Lenz: Department of Palliative Care, University of Muenster, 48149 Muenster, Germany.

Abstract

: Acute health service requires focused palliative care (PC). This study was performed to provide guidance for the establishment of a palliative care consultation service (PCCS). : This study was conceived as a retrospective single-center study for observing, analyzing and evaluating the initial setup of a PCCS from 1 May 2015 to 31 May 2018. Patients from Muenster University Hospital with advanced life-limiting diseases, identified to require PC, were included. : PCCS was requested from various departments, for between 20 and 80 patients per month, corresponding to a total of 2359 for the study period. Requests were highest in internal medicine (27.3%), gynecology (18.1%) and radiotherapy (17.6%). Time to referral was significantly shorter in departments with special PCCS ward rounds (6 ± 9 vs. 12 ± 22 days, < 0.001). The most frequently reported symptoms were fatigue, pain and loss of appetite. Pain was frequently localized in the stomach (20.4%), back (17.1%), or in the head and neck area (14.9%). After the first PCCS consultation, 254 patients (90%) reported sufficient pain relief after 48 h. An introduction/modification of painkiller medication, which was recommended for 142 inpatients, was implemented in 57.0% of cases by the respective departments. Overall, the direct realization of PCCS recommendations reached only 50% on average. : Besides an analysis of the ability to address the symptoms of the referred patients by the PCCS, this study highlights the importance of the interaction between PCCS and other departments. It further elucidates the role and possibilities of this service both in regular ward rounds and individual staff contacts.

Keywords

References

  1. J Palliat Med. 2013 Jul;16(7):786-9 [PMID: 23510168]
  2. Oncologist. 2016 Jan;21(1):110-8 [PMID: 26614711]
  3. J Palliat Med. 2007 Dec;10(6):1347-55 [PMID: 18095814]
  4. J Pain Symptom Manage. 2011 Nov;42(5):680-90 [PMID: 21620646]
  5. J Clin Oncol. 2012 Dec 10;30(35):4380-6 [PMID: 23109708]
  6. Oncologist. 2011;16(1):105-11 [PMID: 21212438]
  7. J Pain Symptom Manage. 2009 May;37(5):873-83 [PMID: 18804945]
  8. J Palliat Med. 2008 Mar;11(2):180-90 [PMID: 18333732]
  9. Palliat Med. 2011 Mar;25(2):148-52 [PMID: 20937612]
  10. Arch Intern Med. 2008 May 12;168(9):912-8 [PMID: 18474754]
  11. Cancer Nurs. 1978 Oct;1(5):373-8 [PMID: 250445]
  12. PLoS One. 2018 Aug 23;13(8):e0201191 [PMID: 30138316]
  13. J Pain Symptom Manage. 2013 Feb;45(2):261-71 [PMID: 22889857]
  14. Am J Clin Oncol. 1982 Dec;5(6):649-55 [PMID: 7165009]
  15. Am J Hosp Palliat Care. 2017 Feb;34(1):47-52 [PMID: 26543069]
  16. Medicine (Baltimore). 2016 Mar;95(10):e2981 [PMID: 26962805]
  17. PLoS One. 2017 Apr 6;12(4):e0175124 [PMID: 28384214]
  18. CMAJ. 2006 Feb 28;174(5):627-33 [PMID: 16505458]
  19. Palliat Med. 2017 May;31(5):406-418 [PMID: 27492160]
  20. J Palliat Med. 2009 Dec;12(12):1137-42 [PMID: 19708839]
  21. Cancer J. 2010 Sep-Oct;16(5):423-35 [PMID: 20890138]
  22. J Palliat Med. 2009 Mar;12(3):231-7 [PMID: 19254200]
  23. J Pain Symptom Manage. 2007 Jul;34(1):94-104 [PMID: 17509812]
  24. Dtsch Arztebl Int. 2015 Dec 11;112(50):863-70 [PMID: 26763381]
  25. J Palliat Med. 2016 Jan;19(1):69-75 [PMID: 26618636]
  26. Support Care Cancer. 2016 May;24(5):2287-2295 [PMID: 26590844]
  27. Br J Cancer. 2002 Sep 23;87(7):733-9 [PMID: 12232756]
  28. N Engl J Med. 2010 Aug 19;363(8):733-42 [PMID: 20818875]
  29. J Clin Oncol. 2011 Feb 20;29(6):646-50 [PMID: 21263094]
  30. J Palliat Med. 2008 Mar;11(2):191-7 [PMID: 18333733]
  31. J Oncol Pract. 2014 Mar;10(2):e37-44 [PMID: 24301842]
  32. J Pain Symptom Manage. 2009 Sep;38(3):327-40 [PMID: 19559564]

MeSH Term

Female
Hospitals
Humans
Male
Pain Management
Palliative Care
Referral and Consultation
Retrospective Studies

Word Cloud

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