Home palliative care team effectiveness in Switzerland:Preliminary results of a 2-years pilot study
K. Vanderlinden1, M. Bernard1, F. Diawara1, G. D. Borasio1 (1Lausanne)
In Switzerland, home palliative care teams (HPCTs) provide specialized palliative care counselling at the request of general practitioners (GPs) and home nursing teams.
This study aims to assess the type of requests addressed to a HPCT and the impact of HPCT before and after the implementation of a 24/7 telephone helpline, by considering patients, caregivers, and professionals opinions. Patient and professional perspectives from the pre implementation phase are reported.
Patients were evaluated pre/post intervention. When not possible, they were assessed retrospectively 15-20 days post-intervention. Outcome measures for patients were quality of palliative care (Palliative Outcome Scale -POS; total ‘0’ best quality - ‘40’ worst quality; single items ‘0’ best quality - ‘4’ worst quality). Professionals received a questionnaire 3 months following the end of the intervention. Outcomes were: satisfaction regarding the HPCT intervention, professionals’ attitudes and needs regarding palliative care (range 0-10 for each item). Descriptive analyses, Wilcoxon test and independent samples T test were used.
32 patients were recruited (mean age=74.4; 62.5% women, 78% with cancer diagnosis). Total quality of palliative care did not improve significantly between T1 and T2 (11.3 vs 10.4, p>.05). but time wasted on medical tests decreased; (1.6 vs 0.3; p<.05), information received was less clear (0.3 vs 1.2; p <.05) and patients reported feeling worse as a person (0.3 vs 1.1; p<.05). Considering professionals, nurses evaluated HPCT interventions as more useful than GPs for “advanced directives”, “patients psycho-social / spiritual supports”, and “transmitting specific knowledge” areas (7.2 vs 5.3; 7.3 vs 6.1; 7.1 vs 4.7; 7.6 vs 6.8, p<.05 respectively). Compared to nurses, GPs felt more confident regarding “ethical” and “legal” issues (6.7 vs 5.8; 6.1 vs 4.8, p<.05 respectively) and reported less need for palliative training (6.8 vs 7.8, p<.05). The main request addressed to the HPCT was “pain management” (28.4%).
Limited improvement in global palliative care quality may be due to low baseline scores (selection bias). Nurses, who have a regular follow-up with patients, reported more benefits from HPCT interventions. A second phase is important to evaluate whether a telephone helpline will result in an enhancement of HPCT performance, compared to current functioning.