Palliative Care Hospital Support Teams

WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques

Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams

Albert Tuca, MD, PhDAlbert Tuca, MD, PhD

Palliative Care Hospital Support Team Palliative Care Hospital Support Team ICMHOICMHOHospital Clínic UniversitariHospital Clínic UniversitariBarcelona, SpainBarcelona, Spain



Definition of Palliative Care Hospital Support Teams

“Multidisciplinary specialist palliative care team which functions in an advisory and supportive capacity within a general hospital. The patients’ care remains the primary responsibility of the physician or surgeon but they are supported and advised by specialist palliative care personnel.”

Recommendation Rec (2003) 24 of the Committee of Ministers to member states on the organisation of palliative care.

Committee of Ministers on 12 November 2003 European Council.



Main characteristics of a Palliative Care Hospital Support Team

• Specialist multidisciplinary Palliative Care team

• Function: Consultant team

• Setting: General Hospital (acute hospitals)

• Accessibility to any clinical service of hospital

• No own hospital beds

• Intervention based on shared care

• Intensity of Intervention according to specific complexity of every case (intervention levels)



Professionals (usual structure)

• Doctors: 1-2 / team

• Nurses: 1-2 / team

• Social Worker: 1 or part time

• Psychologist: 1 or part time


Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams Objectives of a Palliative Care Hospital Support Team

• Assess the patient from a multidimensional approach

• Physical symptoms• Psychological symptoms• Family and Social needs• Spiritual needs

• To agree the level of shared care with referral service according to clinical complexity

• Establish a therapeutic comprehensive plan

• Patient follow up during episode of hospital admission and control of response to palliative measures (pharmacological and non-pharmacological)

• Establish the liaison with community palliative resources at hospital discharge (case management)



Clinical complexity Intervention level

Low complexityI: Advice to other professionals (clinical session)

II: Evaluation and proposal but no follow up

Medium complexity III: Shared care with intermittent or periodical interventions (+/-72 hours)

High complexityIV: Shared care with regular interventions (48 hours)

V: Intensive shared care with daily interventions or full responsibility of case



Usually, Palliative Care Hospital Support Teams are the first specialized palliative unit in a general hospital

The natural development of Palliative Care in a general hospital is to create first a consultant team, after an out-patients clinic, and finally a Palliative Care Unit (Palliative Care Service)

Palliative Care Support Team

Out-patients clinic

Palliative Care Unit



Strong Points

• Intervention centred in patient’s needs• Flexibility and accessibility (intervention according palliative

complexity)• Effectiveness in clinical outcomes• High capacity of influence in clinical services

Weaknesses

• Small teams• Usually, part-time psychosocial professionals• Brief intervention• No possibility of patients follow up at discharge if the Hospital Support

Team has not an out-patients clinic



Characteristics of Palliative Care Hospital Support Teams (PCHST) in Spain

• N PCHST in Spain: 96

• 50% were based in University Hospitals

• Mean structure (n/ PCHST) 1.6 doctors / team1.9 nurses / team0.5 social workers / team0.7 psychologists / team

• Mean length of experience: 6.8 years (range: 1-20)

• Global workload (mean): 275 patients / year

• Diagnosis: 90 % advanced cancer

FISESH 2010 Study



Characteristics of patients attended by PCHST in Spain

• Gender Men 64% Women

36%

• Age (mean) 69 years

• Patients ≤ 65 years 36%

FISESH 2010 Study. N= 364

Age (%)



Characteristics of patients

• Etiologic treatment during episode of PCHST intervention or last 4 weeks

• 44% Cancer Chemotherapy 30%

• Performance Status (PPS)

• PPS ≤ 40% 72%• PPS 50-60% 15%• PPS ≥ 70% 13%







Effectiveness

Comparing the intensity of symptoms (VAS) from the baseline visit with the control at 72 hours after the intervention of PCHST:

Differences statistically significant (p<0.001)for all symptoms except: - Asthenia - Anorexia



Palliative Care Hospital Support TeamsPalliative Care Hospital Support Teams Mean stay from admission

to discharge:

13 days (DST: 9.3)

Mean time between admission and first PCHST consultation

6.9 days (DST: 7.8)

Mean time between PCHST consultation and discharge

6.5 days (DST: 7.1)


Admission Discharge



Clinical complexity

• Low 85 (23,5%)• Medium 159 (44%)• High 117 (32,4%)

PCHST level of intervention

• Basic advice - Level 1 or 2:74 (20,6%)

• Shared care - Level 3:136 (37,9%)

• Intensive shared care – Level 4 or 5:149

(41,5%)FISESH 2010 Study. N= 364



Hospital discharge

• Exitus 36 %

• Long or medium stay Palliative Care Unit 29 %

• Home discharge 35 %

• PC out-patients clinic 11 %• Home Support Team 14 %



ConclusionsConclusions

PCHST are hospital consultant teams in Palliative Care without own beds for admission

Intervention in any clinical service of a general hospital

Intervention based on shared care

Intensity of shared care is based on specific complexity of every case and needs of referent services (agreement of shared care)

High accessibility, flexibility and clinical effectiveness

Brief intervention and difficulties in the follow up if the team does not have an outpatients clinic

Important role in liaison of palliative resources available in their health area.


Equip de Suport Hospitalari i Cures Pal·liativesEquip de Suport Hospitalari i Cures Pal·liativesServei Oncologia MèdicaServei Oncologia Mèdica

ICMHOICMHOHospital Clínic Universitari de BarcelonaHospital Clínic Universitari de Barcelona

Documents

Palliative Care Hospital Support Teams