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Original research
Early specialised palliative care: interventions, symptoms, problems
  1. Nete Skjoedt1,
  2. Anna Thit Johnsen1,2,
  3. Per Sjøgren3,
  4. Mette Asbjoern Neergaard4,
  5. Anette Damkier5,
  6. Christian Gluud6,
  7. Jane Lindschou6,
  8. Peter Fayers7,8,
  9. Irene J Higginson9,
  10. Annette S Strömgren1 and
  11. Mogens Groenvold10,11
  1. 1Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
  2. 2Department of Psychology, University of Southern Denmark, Odense, Denmark
  3. 3Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
  4. 4The Palliative Care Team, Oncology Department, Aarhus Univ Hosp, Aarhus, Denmark
  5. 5Department of Psychiatry, Odense Universitetshospital, Odense, Denmark
  6. 6The Copenhagen Trial Unit, Copenhagen University Hospital, Copenhagen, Denmark
  7. 7Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  8. 8Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
  9. 9Palliative Care and Policy, Kings College London, London, UK
  10. 10The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
  11. 11Public Health, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Anna Thit Johnsen, Department of Psychology, University of Southern Denmark, 5230 Odense, Denmark; atjohnsen{at}health.sdu.dk

Abstract

Background Few studies have investigated the content of interventions provided in early specialised palliative care (SPC).

Objectives To characterise the content of interventions delivered in early SPC in the Danish Palliative Care Trial (DanPaCT), a multicentre trial with six participating sites.

Methods A retrospective qualitative and quantitative study coding all new interventions initiated by the palliative teams and documented in the medical records during the 8-week study period of DanPaCT. Interventions were categorised according to (a) symptom/problem prompting the intervention, (b) type of intervention and (c) professional(s) providing the intervention.

Results In total, 145 patients were randomised to the SPC teams. According to the medical records, patients received a median of 3.5 (range 0–22) new interventions in the 8-week intervention-period from the palliative teams. For 24 (18%) of the patients there was no documented interventions in the medical records. The most frequent symptom/problems treated were pain, (100 interventions; 20% of interventions given) and impaired physical function (62; 13% of interventions given). The most frequent type of intervention was pharmacological (232; 42% of interventions given).

Conclusions This is one of the first studies to meticulously investigate the content of interventions documented in the medical records for patients receiving early SPC. Diverse symptoms were treated with many different interventions. However, a relatively low number of interventions were documented. This may explain the lack of effect in DanPaCT but also questions whether all interventions were adequately documented

Trial registration number NCT01348048

  • cancer
  • drug administration
  • pain
  • pharmacology
  • service evaluation
  • symptoms and symptom management

https://doi.org/10.1136/bmjspcare-2019-002043

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    Footnotes

    • Contributors ATJ, PS, MAN, AD, CG, JL, PF, IJH, ASS and MG took part in designing DanPaCT. ATJ was the postdoc on DanPaCT, project coordinator and data manager. MG was the coordinating investigator and the funding beneficiary. MG and NS developed the system for coding of the medical records. NS was the primary coder of the medical records. NS and ATJ did the analyses. NS and ATJ drafted the paper and all authors read, amended and approved the final manuscript.

    • Funding This work was funded by the Tryg Foundation (journal numbers 7-10-0838A and 7-12-0754) and the Danish Cancer Society (journal numbers R16-A695 and R114-A7232-14-S3).

    • Disclaimer The funding bodies had no role in the design, conduct, analysis, or reporting of the trial.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The protocol was approved by the Ethics Committee for the Capital Region, Denmark (journal number H-3-2010-144), the Danish Data protection agency (journal number BBH-2011–05), and registered at www.clinicaltrials.gov.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request and if it is in accordance with Danish law. If so, the dataset can be made available if requested from the second or last author (ATJ (atjohnsen@health.sdu.dk) and MG (mold@sund.ku.dk)).