Palliative Care Hospital Support Teams

1. Palliative Care Hospital Support Teams Albert Tuca, MD, PhD Palliative Care Hospital Support Team ICMHO Hospital ClínicUniversitari Barcelona, Spain

2. Palliative Care Hospital Support Teams • 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.

3. Palliative Care Hospital Support Teams • 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)

4. Palliative Care Hospital Support Teams • Professionals (usual structure) • Doctors: 1-2 / team • Nurses: 1-2 / team • Social Worker: 1 or part time • Psychologist: 1 or part time

5. Palliative 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)

6. Palliative Care Hospital Support Teams

7. Palliative Care Hospital Support Teams • 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 Unit Out-patients clinic Palliative Care Support Team

8. Palliative Care Hospital Support Teams • 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

9. Palliative Care Hospital Support Teams • 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 / team 1.9 nurses / team 0.5 social workers / team 0.7 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

10. Palliative Care Hospital Support Teams • Characteristics of patients attended by PCHST in Spain • Gender Men 64% Women 36% • Age (mean) 69 years • Patients ≤ 65 years 36% Age (%) FISESH 2010 Study. N= 364

11. Palliative Care Hospital Support Teams • 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% FISESH 2010 Study. N= 364

12. Palliative Care Hospital Support Teams FISESH 2010 Study. N= 364

13. Palliative Care Hospital Support Teams • 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 FISESH 2010 Study. N= 364

14. Palliative 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 FISESH 2010 Study. N= 364

15. Palliative Care Hospital Support Teams • 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

16. Palliative Care Hospital Support Teams • Hospital discharge • Exitus 36 % • Long or medium stay Palliative Care Unit 29 % • Home discharge 35 % • PC out-patients clinic 11 % • Home Support Team 14 % FISESH 2010 Study. N= 364

17. Conclusions • 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.

18. Equip de Suport Hospitalari i Cures Pal·liatives Servei Oncologia Mèdica ICMHO Hospital Clínic Universitari de Barcelona