Annals of palliative medicine
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Review
Early palliative care and its translation into oncology practice in Canada: barriers and challenges.
This article reviews the progress Canada has made integrating palliative care into oncologic practice. Key clinical practice guidelines (CPGs) have influenced and have been translated into Canadian oncology policy and operations. ⋯ As a result, eight made-in-Canada innovations emerged and are described. Lessons learned and recommendations describe a plan for action.
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The concept of early palliative care (ePC) has received enormous recognition in the field of cancer care. Increasing evidence supports this approach, but outside the research arena, the implementation of sustainable clinical concepts rely on solutions for practical problems such as funding issues. Therefore, the article presented here discusses economic considerations associated with different concepts of ePC. ⋯ Researchers, health care providers and policy makers need to distinguish the different concepts behind ePC before providing cost estimates. Detailed information is provided in this article. From our view, it is evident that neither of the two approaches (general vs. specialist) can be a one-or-the-other choice. Successful ePC will most likely rely on a joint effort of all medical disciplines and profession in close cooperation and early integration of specialist PC services. For such an approach, additional resources may be necessary, but from the public health perspective, cost-savings can also be assumed.
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Palliative care has emerged as care that specifically aims to address gaps inherent in disease-centered approaches in order to enhance care quality in serious illness, both for patients and families and for health care systems. Late palliative care for patients with serious illness mitigates benefits to patients, families, and health care systems. Efforts have been made by investigators to define the impact of earlier palliative care interventions on patient, family and health care systems outcomes. We conducted a systematic review of randomized trials of outpatient and home palliative care, two locations where earlier palliative care do occur, to examine the evidence for palliative care benefits. ⋯ Multiple studies have demonstrated several benefits to early outpatient palliative care for patients with newly diagnosed metastatic cancer. However, better designed and executed studies are needed to determine the best time to intervene and the best model of care.
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Palliative care aims to improve cancer patients' quality of life through expert symptom management, psychosocial and spiritual care, patient-clinician communication, facilitation of complex decision making, and end-of-life care planning. Over the past few years, there has been increasing interest and evidence to support integration of oncology and palliative care. However, it remains unclear how best to promote integration. The goal of this review is to examine contemporary conceptual models and clinical approaches to integrate oncology and palliative care. ⋯ There are multiple conceptual models and clinical models to promote integration. Further research is needed to inform best practices for integration at different healthcare settings.
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The importance of early integration of palliative care (PC) into oncology treatment is increasingly being recognized. However, there is no consensus on what is the optimal way of integration. This article describes a unique model in Hong Kong where clinical oncology and palliative medicine (PM) is integrated through the development of PM as a subspecialty under clinical oncology.