May 2007
Dear Readers Here's the Article for this Month:
Carla Ripamonti, MD
(Italy)
Consultation in palliative care:
The relevance of clarification of problems
Author(s): Vernooij-Dassen M J.F.J, Groot M.M., van den Berg J, Kuin A,
van der Linder B.A, van Zuylen L, Crul B J.P., Grol R P.T.M.
Journal: European Journal of Cancer 2007; Jan 43 (2): 316-22
Palliative Care Consultation (PCC) teams have been primarily organized by palliative care professionals using a multidisciplinary approach with the aim to advise and support medical professionals who have less experience in the care of patients with symptoms due to an advanced, or terminal, stage of their disease. Some teams are based in hospitals, others in primary care settings. The patient’s problems are presented to the PCC team by a medical professional. During this meeting other problems may then emerge. The PCC team’s consultation may be performed by phone with no contact with the patient or at the bedside in the presence of the consulting professional.
The aim of this study is to verify the type and frequency of newly identified problems during the consultation with a PCC team using a process of clarification and exploration of the problems described by the professionals.
A theory states that new problems identified by the PCC team were frequently psychosocial or spiritual and were not considered problems by the professionals.
During the period between 1st March 2001 and 1st March 2003, twenty-three PCC teams participated in this descriptive study.
The following data were collected:
- the characteristics of the medical professional and the patients;
- the initial list of problems of the patients for whom the consultation was requested;
- the newly identified list of problems.
There were 3,416 patients in the study. Because of the different geographical regions involved in the study, bedside consultations varied from 4% to 44%. General practitioners required more frequent consultations (83% in region 5 compared to 48% in region 2).
The initial number of patient-related problems was 6001 and was increased by 7854 after clarification and investigation by the experts resulting in a total number of 13855 identified problems. Fifty-seven percent of these problems were newly identified.
Of the new problems, 53% had to do with physical problems, 70% had to do with the psychosocial sphere and 52% were connected with management problems. Most of the new problems (69.5%) were identified at the bedside consultation through clarification and 47.4 % were recognized by telephone consultation.
Pain and constipation were the most frequent identified new physical problems and were related to the dosage of medication.
Acceptance of illness (75.1%) and grief (79.5%) were the newly identified problems in the psychosocial and spiritual realm.
Why I chose this article
The authors describe a new way of taking care of patients and their individual needs independent of the setting of origin. It is interesting to note how many new physical and pharmacological problems were identified and, above all, how psychosocial and spiritual problems were identified in 70% of cases by means of clarification. Thorough communication between patients and caregivers has once again proven to be a fundamental feature of good palliative care.
Regards,
Carla Ripamonti, MD
Member of the Board of Directors, IAHPC
Please visit the following link to read past Articles Of The Month:
http://www.hospicecare.com/AOM/
