ORIGINAL ARTICLE

Criteria for palliative care referral in oncology practice: An instrument development

Maria A Witjaksono, Christantie Effendy, Sri Mulatsih, Iwan Dwiprahasto, Adi Utarini

Maria A Witjaksono
Department of Palliative Care, Dharmais National Cancer Center Hospital, West Jakarta, Jakarta, Indonesia

Christantie Effendy
Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sleman, Yogyakarta, Indonesia;

Sri Mulatsih
Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sleman, Yogyakarta, Indonesia;

Iwan Dwiprahasto
Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sleman, Yogyakarta, Indonesia

Adi Utarini
Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sleman, Yogyakarta, Indonesia. Email: adiutarini@ugm.ac.id
Online First: April 30, 2021 | Cite this Article
Witjaksono, M., Effendy, C., Mulatsih, S., Dwiprahasto, I., Utarini, A. 2021. Criteria for palliative care referral in oncology practice: An instrument development. Bali Medical Journal 10(1): 281-290. DOI:10.15562/bmj.v10i1.2120


Introduction: Cancer patients experience significant physical symptoms and psychosocial problems during cancer treatment that negatively impact on quality of life which can be intervened by palliative care. However, the referral of cancer patients to palliative care is still low. Therefore, this study aimed to explore the need of palliative care among doctors working in oncology in order to develop an instrument of criteria for palliative care referral in oncology practice.

Methods: A mixed method research with a sequential variant exploratory, quantitative dominant design was used. Using phenomenology orientation, the qualitative study exploring the needs of palliative care referral was conducted and data were obtained through in-depth interviews with 32 oncologic care doctors. Identified dimensions, criteria, sub-criteria and indicators were then used to develop the instrument. In the quantitative study, validity of the instrument was tested through expert judgement and Aiken’s V content-validity coefficient was calculated.

Results: The study found that palliative referral criteria consisted of 20 indicators, i.e., 15 medical indicators of the aspects related to disease stage, patient’s condition, treatment status, and status of care; and 5 non-medical indicators, included the aspects associated with psychological, social, spiritual, communication and decision making. The validity of the instrument was confirmed through the expert panel, in which the Aiken’s V coefficient of all indicators ranged high from 0.825 to 0.975.

Conclusion: The instrument of palliative care referral criteria was developed which consist of 20 indicators and had good validity.

References

World Health Organization. WHO definition of Palliative Care [Internet]. 2020 [cited 2020 Oct 20]. Available from: http://www.who.int/cancer/palliative/definition/en/

Davis MP, Temel JS, Balboni T, Glare P. A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Ann Palliat Med. 2015;4(3):99–121. doi:10.3978/j.issn.2224-5820.2015.04.04

Zhi WI ri., Smith TJ. Early integration of palliative care into oncology: evidence, challenges and barriers. Ann Palliat Med. 2015;4(3):122–31. doi:10.3978/j.issn.2224-5820.2015.07.03

Schenker Y, Park SY, Maciasz R, Arnold RM. Do patients with advanced cancer and unmet palliative care needs have an interest in receiving palliative care services? J Palliat Med. 2014;17(6):667–72. doi:10.1089/jpm.2013.0537

Kaasa S, Knudsen AK, Lundeby T, Loge JH. Integration between oncology and palliatve care: A plan for the next decade? Tumori. 2017;103(1):1–8. doi:10.5301/tj.5000602

Hui D, Bruera E. Models of integration of oncology and palliative care. Ann Palliat Med. 2015;4(3):89–98. doi:10.3978/j.issn.2224-5820.2015.04.01

Hui D, Kim YJ, Park JC, Zhang Y, Strasser F, Cherny N, et al. Integration of Oncology and Palliative Care: A Systematic Review. Oncologist. 2015;20(1):77–83. doi: 10.1634/theoncologist.2014-0312

Vanbutsele G, Van Belle S, De Laat M, Surmont V, Geboes K, Eecloo K, et al. The systematic early integration of palliative care into multidisciplinary oncology care in the hospital setting (IPAC), a randomized controlled trial: The study protocol. BMC Health Serv Res [Internet]. 2015;15(1):1–8. doi:10.1186/s12913-015-1207-3

Smith T, Temin S, Alesi E, Abernethy A, Balboni T, Basch E, et al. American Society of Clinical Oncology Provisional Clinical Oponion: The Integration of Palliative care into standard oncology care. J Clincal Oncol. 2012;30:880–7.

Hawley P. Barriers to Access to Palliative Care. Palliat Care. 2017;10.

Von Roenn JH. Optimal cancer care: Concurrent oncology and palliative care. JNCCN J Natl Compr Cancer Netw. 2013;11(SUPPL.1):1–2. doi:10.6004/jnccn.2013.0208

Wachterman MW, Pilver C, Smith D, Ersek M, Lipsitz SR, Keating NL. Quality of end-of-life care provided to patients with different serious illnesses. JAMA Intern Med. 2016;176(8):1095–105. doi:10.1001/jamainternmed.2016.1200

Hui D, Kilgore K, Park M, Liu D, Kim YJ, Park JC, et al. Pattern and Predictors of Outpatient Palliative Care Referral Among Thoracic Medical Oncologists. Oncologist. 2018;23(10):1230–5. doi:10.1634/theoncologist.2018-0094

Ogle KS, Mavis B, Wyatt GK. Physicians and hospice care: Attitudes, knowledge, and referrals. J Palliat Med. 2002;5(1):85–92. doi:10.1089/10966210252785042

Fischer SM, Gozansky WS, Kutner JS, Chomiak A, Kramer A. Palliative care education: An intervention to improve medical residents’ knowledge and attitudes. J Palliat Med. 2003;6(3):391–9. doi:10.1089/109662103322144709

Snow CE, Varela BR, Pardi DA, Adelman RD, Said S, Reid MC. Idetifying factors affecting utilization of an inpatient palliative care service: a physician survey. J Palliat Med. 2009;12(1):231–7. doi:10.1016/s0165-0114(97)90015-4

Khan SA, Gomes B, Higginson IJ. End-of-life care - What do cancer patients want. Nat Rev Clin Oncol. 2014;11(2):100–8. doi:10.1038/nrclinonc.2013.217

Hui D, Mori M, Watanabe SM, Caraceni A, Strasser F, Saarto T, et al. Referral criteria for outpatient specialty palliative cancer care: an international consensus. Lancet Oncol. 2016;17(12):e552–9. doi:10.1016/S1470-2045(16)30577-0

Azwar S. Penyusunan Skala Psikologi. 2nd ed. Yogyakarta: Pustaka Belajar; 1995.

Bennett M, Adam J, Alison D, Hicks F, Stockton M. Leeds eligibility criteria for specialist palliative care services. Palliat Med. 2000;14(2):157–8. doi:10.1191/026921600669491513

Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care. J Palliat Med. 2011;14(1):17–23. doi:10.1089/jpm.2010.0347

Cohen SR, Sawatzky R, Russell LB, Shahidi J, Heyland DK, Gadermann AM. Measuring the quality of life of people at the end of life: The McGill Quality of Life Questionnaire-Revised. Palliat Med. 2017;31(2):120–9. doi:10.1177/0269216316659603

Hui D, Santos R, Chisholm G, Bansal S, Silva TB, Kilgore K, et al. Clinical Signs of Impending Death in Cancer Patients. Oncologist. 2014;19(6):681–7. doi:10.1634/theoncologist.2013-0457


No Supplementary Material available for this article.
Article Views      : 0
PDF Downloads : 0