Content area
Full Text
Introduction
WHO defines palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness". Palliative care is mainly provided in a primary care setting or hospice and mostly concerns cancer patients. However, as cancer treatment options are increasing and cancer care becomes more and more complicated, there is an growing need for hospital-based palliative care. Hospital-based oncological palliative care may be provided in specialised palliative care units (PCUs). Multidisciplinary palliative care teams (PCTs), mostly working on a consultation basis, may offer alternative or additional care to that provided in PCUs. PCTs may work on an inpatient or outpatient basis. Originating in the 1980s, PCTs are now increasingly employed in countries such as Canada, 1 Italy, 2 the UK, 3 Australia, 4 the USA, 5 Japan 6 and the Netherlands. 7
While cost savings with both outpatient 8 and hospital-based PCTs 9 have been demonstrated and some prospective studies 10 - 12 have demonstrated improvements in symptoms, quality of life and mood in outpatient cancer patients, relatively few studies have prospectively assessed the clinical efficacy of inpatient PCTs using validated and clinically relevant outcome measures. 13 - 16
In 2007 a multidisciplinary PCT, consisting of palliative care nurses, a medical oncologist, a neurologist and a team of anaesthesiologists, was set up in Erasmus MC. The team does not have beds at their disposal, but can be consulted for palliative care for cancer patients. Our aim was to deliver rapid symptom control and accelerated transfer to an out-of-hospital setting. From the outset, we set out to evaluate clinical effectiveness by recording all relevant clinical data, including duration of admission, on a structured data sheet, as part of routine medical practice. We used a group of cancer pain patients from 2006 as a historical control to evaluate whether the effectiveness of our multidisciplinary team surpassed that of routine oncological care including pain control.
Methods
Patients and interventions
Our 769 bed general university hospital did not have a palliative care facility until 2007, although symptomatic cancer pain relief was provided by palliative care nurses and consulting anaesthesiologists, the latter as a 24/7 service. This service, which may be considered a predecessor of the multidisciplinary PCT, included...