Prognosis discussion and referral to community palliative care services in patients with advanced pancreatic cancer treated in a tertiary cancer entre
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Clelland, Nutall, Stott health ...
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Authors
Clelland, SarahNuttall, Christina L
Stott, Helen E
Cope, Joseph
Barratt, Natalie L
Farrell, Kelly
Eyong, Manyi V
Gleeson, Jack P
Lamarca, Angela
Hubner, Richard A
Valle, Juan W
McNamara, Mairéad G
Affiliation
The Christie NHS Foundation Trust, Manchester M20 4BX, UK. Division of Cancer Sciences, University of Manchester, Manchester M20 4BX, UK.Issue Date
2023
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Advanced pancreatic cancer is associated with a poor prognosis, often less than 1 year. Honest prognosis discussions guide early community palliative care services input, facilitating timely advance care planning and improving quality of life. The aims were to assess if patients were offered prognosis discussions and community palliative care services referral. A retrospective analysis of consecutive case-notes of new advanced pancreatic cancer patients was conducted. Chi-squared test assessed the association with prognosis discussion and community palliative care services referral. In total, 365 cases (60%) had a documented prognosis discussion at any time-point in the treatment pathway; 54.4% during the first appointment. The frequency of prognosis discussion was greater with nurse clinician review at first appointment (p < 0.001). In total, 171 patients (28.1%) were known to community palliative care services at the first appointment. Of those not known, 171 (39.1%) and 143 (32.7%) were referred at this initial time-point or later, respectively. There was a significant association between the referral to community palliative care services at first appointment and the reviewing professional (this was greatest for nurse clinicians (frequency 65.2%)) (p < 0.001), and also if reviewed by clinical nurse specialist at first visit or not (47.8% vs. 35.6%) (p < 0.01). Prognosis discussions were documented in approximately two-thirds of cases, highlighting missed opportunities. Prognosis discussion was associated with clinician review and was most frequent for nurse clinician, as was referral to community palliative care services. Clinical nurse specialist review increased referral to community palliative care services if seen at the initial visit. Multi-disciplinary review, specifically nursing, therefore, during the first consultation is imperative and additive. It should be considered best practice to offer and negotiate the content and timing of prognosis discussions with cancer patients, and revisit this offer throughout their treatment pathway. Greater attention to prognosis discussion documentation is recommended.Citation
Clelland S, Nuttall CL, Stott HE, Cope J, Barratt NL, Farrell K, et al. Prognosis Discussion and Referral to Community Palliative Care Services in Patients with Advanced Pancreatic Cancer Treated in a Tertiary Cancer Centre. Healthcare (Basel, Switzerland). 2023 Oct 23;11(20). PubMed PMID: 37893876. Pubmed Central PMCID: PMC10606359. Epub 2023/10/28. eng.Journal
Healthcare (Basel)DOI
10.3390/healthcare11202802PubMed ID
37893876Additional Links
https://dx.doi.org/10.3390/healthcare11202802Type
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.3390/healthcare11202802