Palliative care phases (PCP) in clients with cancer receiving home care: A mixed methods study
02.2020 – 06.2022
Background: Existing casemix classifications in Switzerland are based on medical diagnoses and interventions. In palliative care however, where improving the quality of life is one of the main goals, diagnoses are poorly suited for the comprehensive assessment of patient needs as well as resource consumption. In Australia, this aspect has been addressed by establishing a casemix classification with five case types in subacute and non-acute health care settings, one of which is palliative care. The palliative care case type includes the domains: problem severity, functional status, a person’s age and the Palliative Care Phases (PCP). The latter comprises five empirically tested phases of illness that have been established in Australia for more than 20 years: stable phase, unstable phase, deteriorating phase, terminal phase and bereaved phase. PCP have been proven to be an important component in the assessment of complex needs of palliative care patients and are effective in determining resource consumption necessary to meet these needs. In that sense, studies have shown that applying PCP can lead to symptom improvement. However, in Switzerland, no data are yet available on the PCP of people with advanced cancer, who are being cared for by specialised outpatient palliative care services.
Aim: The present study aims to contribute to needs-based care, quality improvement and efficiency promotion in specialised outpatient palliative care by determining PCP-specific symptoms and needs, family members' burden and corresponding resource consumption.
Methods: A convergent mixed-methods design will be applied. We aim to enrol 150 adult clients with cancer, who are being cared for by one of the two participating mobile palliative care services. Clients will be assigned to one of the PCP by their responsible nurses. Quantitative data will be collected through questionnaires filled in by clients, relatives and nurses to assess the needs of the client from different perspectives, the burden of the caring relatives and the resource consumption in the respective PCP. Focus group interviews with the nursing staff as well as semi-structured, individual interviews with clients and their caring relatives, will be conducted for further exploration of the PCP. Analysis of data from the questionnaires will involve a multinomial regression and repeated measures ANOVA. Interview transcripts will be analysed using qualitative content analysis.
Relevance: We expect the results of the study to reveal important insights concerning the PCP clients of specialised outpatient palliative care services are in. Gaining information on PCP-specific symptom burden, - needs and - resource consumption from different perspectives, shows potential in significantly improving specialised palliative care in Switzerland.
Dr. phil. Andrea Kobleder
Spitex Zürich Sihl, Fachdienst Palliative Care; Spitex Zürich Limmat, Fachstelle Palliative Care
Zürcher Versorgungsforschungspreis, further funding proposals are pending
Palliative Care, End-of-Life Care, Phase of Illness