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The effect of palliative care team intervention and symptom improvement using patient-reported outcomes: a multicenter prospective observational study

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Abstract

Purpose

Hospital-based palliative care teams (HPCTs) are widespread internationally, but multicenter studies about their effectiveness, using patient-reported outcomes (PROs), are limited to Australia and a few other countries. We conducted a multicenter, prospective observational study in Japan to explore the effectiveness of the HPCTs using PROs.

Methods

Nationwide, eight hospitals participated in the study. We included newly referred patients for one month in 2021 and followed them for one month. We asked the patients to complete the Integrated Palliative Care Outcome Scale or the Edmonton Symptom Assessment System as PROs at the time of the intervention, three days later, and weekly after the intervention.

Results

A total of 318 participants were enrolled, of whom 86% were patients with cancer, 56% were undergoing cancer treatment, and 20% received the Best Supportive Care. After one week, the following 12 symptoms showed more than a 60% improvement from severe to moderate or less: vomiting (100%), shortness of breath (86%), nausea (83%), practical problems (80%), drowsiness (76%), pain (72%), poor sharing of feelings with family or friends (72%), weakness (71%), constipation (69%), not feeling at peace (64%), lack of information (63%), and sore or dry mouth (61%). Symptoms with improvement from severe/moderate to mild or less were vomiting (71%) and practical problems (68%).

Conclusion

This multicenter study showed that HPCTs effectively improved symptoms in several severe conditions, as assessed by PROs. This study also demonstrated the difficulty of relieving symptoms in patients in palliative care and the need for improved care.

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Data availability

The dataset generated and analyzed during the current study is fully anonymous and available from the corresponding author on reasonable request.

References

  1. Higginson IJ, Evans CJ (2010) What is the evidence that palliative care teams improve outcomes for cancer patients and their families? Cancer J 16:423–435. https://doi.org/10.1097/PPO.0b013e3181f684e5

    Article  PubMed  Google Scholar 

  2. Bajwah S, Oluyase AO, Yi D et al (2020) The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 9:CD012780. https://doi.org/10.1002/14651858.CD012780.pub2

    Article  PubMed  Google Scholar 

  3. Miyashita M, Matoba K, Sasahara T et al (2004) Reliability and validity of the Japanese version of the Support Team Assessment Schedule (STAS-J). Palliat Support Care 2:379–385. https://doi.org/10.1017/s1478951504040507

    Article  PubMed  Google Scholar 

  4. Atkinson TM, Ryan SJ, Bennett AV et al (2016) The association between clinician-based Common Terminology Criteria for Adverse Events (CTCAE) and Patient-Reported Outcomes (PRO): a systematic review. Support Care Cancer 24:3669–3676. https://doi.org/10.1007/s00520-016-3297-9

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hanson LC, Usher B, Spragens L, Bernard S (2008) Clinical and economic impact of palliative care consultation. J Pain Symptom Man 35:340–346. https://doi.org/10.1016/j.jpainsymman.2007.06.008

    Article  Google Scholar 

  6. De Santiago A, Portela MA, Ramos L et al (2012) A new palliative care consultation team at the oncology department of a university hospital: an assessment of initial efficiency and effectiveness. Support Care Cancer 20:2199–2203. https://doi.org/10.1007/s00520-012-1476-x

    Article  PubMed  Google Scholar 

  7. Silva MADS, Diniz MA, de Carvalho RT et al (2020) Palliative care consultation team: symptom relief in first 48 hours of hospitalization. Rev Bras Enferm 73:e20190391. https://doi.org/10.1590/0034-7167-2019-0391

    Article  PubMed  Google Scholar 

  8. Eagar K, Watters P, Currow DC et al (2010) The Australian Palliative Care Outcomes Collaboration (PCOC)–measuring the quality and outcomes of palliative care on a routine basis. Aust Health Rev 34:186–192. https://doi.org/10.1071/AH08718

    Article  PubMed  Google Scholar 

  9. Nakazawa Y (2019) Palliative care system and nursing in Japan. In: Shima Y, Hosokawa T, Tsuneto A (eds) Hospice Palliative Care White Paper. Seikaisya, Tokyo, pp 2–6 (in Japanese)

    Google Scholar 

  10. Hirayama H, Masukawa K, Miyashita M (2021) Current status of palliative care in Japan in data. In: Shima Y, Takamiya Y, Tsuneto A (eds) Hospice Palliative Care White Paper. Seikaisya, Tokyo, pp 56–97 (in Japanese)

    Google Scholar 

  11. Sasahara T, Watakabe A, Aruga E et al (2014) Assessment of reasons for referral and activities of hospital palliative care teams using a standard format: a multicenter 1000 case description. J Pain Symptom Man 47:579-587.e6. https://doi.org/10.1016/j.jpainsymman.2013.04.009

    Article  Google Scholar 

  12. Morita T, Fujimoto K, Tei Y (2005) Palliative care team: the first year audit in Japan. J Pain Symptom Man 29:458–465. https://doi.org/10.1016/j.jpainsymman.2004.08.013

    Article  Google Scholar 

  13. Iwase S, Murakami T, Saito Y, Nakagawa K (2007) Preliminary statistical assessment of intervention by a palliative care team working in a Japanese general inpatient unit. Am J Hosp Palliat Care 24:29–35. https://doi.org/10.1177/104990910629530214

    Article  PubMed  Google Scholar 

  14. Sakashita A, Kizawa Y, Kato M et al (2018) Development of a standard for hospital-based palliative care consultation teams in Japan using a modified Delphi method. J Pain Symptom Manage 56:746-751.e5. https://doi.org/10.1016/j.jpainsymman.2018.08.013

    Article  PubMed  Google Scholar 

  15. Murtagh FE, Ramsenthaler C, Firth A et al (2019) A brief, patient- and proxy-reported outcome measure in advanced illness: validity, reliability and responsiveness of the Integrated Palliative care Outcome Scale (IPOS). Palliat Med 33:1045–1057. https://doi.org/10.1177/0269216319854264

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sakurai H, Miyashita M, Imai K et al (2019) Validation of the Integrated Palliative care Outcome Scale (IPOS) – Japanese Version. Jpn J Clin Oncol - Japanese version 49:257–262. https://doi.org/10.1093/jjco/hyy203

    Article  Google Scholar 

  17. Sakurai H, Miyashita M, Morita T et al (2021) Comparison between patient-reported and clinician-reported outcomes: validation of the Japanese version of the Integrated Palliative care Outcome Scale for staff. Palliat Support Care 19:1–7. https://doi.org/10.1017/S1478951521000018

    Article  Google Scholar 

  18. Bruera E, Kuehn N, Miller MJ et al (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9

    Article  CAS  PubMed  Google Scholar 

  19. Yokomichi N, Morita T, Nitto A et al (2015) Validation of the Japanese version of the Edmonton symptom assessment system-revised. J Pain Symptom Man 50:718–723. https://doi.org/10.1016/j.jpainsymman.2015.05.014

    Article  Google Scholar 

  20. Abernethy AP, Shelby-James T, Fazekas BS et al (2005) The Australia-modified Karnofsky Performance Status (AKPS) scale: a revised scale for contemporary palliative care clinical practice [ISRCTN81117481]. BMC Palliat Care 4:7. https://doi.org/10.1186/1472-684X-4-7

    Article  PubMed  PubMed Central  Google Scholar 

  21. Masso M, Allingham SF, Banfield M et al (2015) Palliative Care Phase: inter-rater reliability and acceptability in a national study. Palliat Med 29:22–30. https://doi.org/10.1177/0269216314551814

    Article  PubMed  Google Scholar 

  22. Morita T, Tsunoda J, Inoue S et al (2001) Communication Capacity Scale and Agitation Distress Scale to measure the severity of delirium in terminally ill cancer patients: a validation study. Palliat Med 15:197–206. https://doi.org/10.1191/026921601678576185

    Article  CAS  PubMed  Google Scholar 

  23. Hamano J, Morita T, Inoue S et al (2015) Surprise questions for survival prediction in patients with advanced cancer: A multicenter prospective cohort study. Oncologist 20:839–844. https://doi.org/10.1634/theoncologist.2015-0015

    Article  PubMed  PubMed Central  Google Scholar 

  24. PCOC Patient outcomes in Palliative Care Australian National report January to June 2021 [Internet]. Accessed 2021 Dec 10. Available at: https://www.uow.edu.au/ahsri/pcoc/reports/

  25. Hui D, Bruera E (2017) The Edmonton symptom assessment system 25 years later: past, present, and future developments. J Pain Symptom Man 53:630–643. https://doi.org/10.1016/j.jpainsymman.2016.10.370

    Article  Google Scholar 

  26. Hui D, Shamieh O, Paiva CE et al (2015) Minimal clinically important differences in the Edmonton Symptom Assessment Scale in cancer patients: A prospective, multicenter study. Cancer 121:3027–3035. https://doi.org/10.1002/cncr.29437

    Article  PubMed  Google Scholar 

  27. Brinkman-Stoppelenburg A, Polinder S, Meerum-Terwogt J et al (2020) The COMPASS study: A descriptive study on the characteristics of palliative care team consultation for cancer patients in hospitals. Eur J Cancer Care 29:e13172. https://doi.org/10.1111/ecc.13172

    Article  Google Scholar 

  28. Vinant P, Joffin I, Serresse L et al (2017) Integration and activity of hospital-based palliative care consultation teams: the Insight multicentric cohort study. BMC Palliat Care 16:36. https://doi.org/10.1186/s12904-017-0209-9

    Article  PubMed  PubMed Central  Google Scholar 

  29. Temel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742. https://doi.org/10.1056/NEJMoa1000678

    Article  CAS  PubMed  Google Scholar 

  30. Haun MW, Estel S, Rücker G et al (2017) Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 6:CD011129. https://doi.org/10.1002/14651858.CD011129.pub2

    Article  PubMed  Google Scholar 

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Acknowledgements

We pray for the repose of the soul of the late Dr. Masashi Kato, who chaired the Specialized Palliative Care Promotion Committee of the Japanese Society of Palliative Medicine at the time this study was initiated.

Funding

This work was supported by the Japanese Society of Palliative Medicine; the Doctoral Program for World-leading Innovative & Smart Education: Advanced Graduate Program for Future Medicine and Health Care, Tohoku University by the Ministry of Education, Culture, Sports, Science and Technology and the Japan Society for the Promotion of Science; and the Support for Pioneering Research Initiated by the Next Generation program, by the Japan Science and Technology Agency (Grant number JPMJSP2114).

Author information

Authors and Affiliations

  1. Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8575, Japan

    Hideyuki Hirayama & Mitsunori Miyashita

  2. Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan

    Eriko Satomi

  3. Institute of Medicine, University of Tsukuba, Tsukuba, Japan

    Yoshiyuki Kizawa & Jun Hamano

  4. Iizuka Hospital, Iizuka, Japan

    Mayuko Miyazaki

  5. Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

    Keita Tagami

  6. Kameda Medical Center, Kamogawa, Japan

    Ryuichi Sekine

  7. Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Kozue Suzuki

  8. Division of Palliative Medicine, National Center for Child Health and Development, Tokyo, Japan

    Nobuyuki Yotani

  9. Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan

    Koji Sugano

  10. Rokkou Hospital, Kobe, Japan

    Hirofumi Abo

  11. Working Practitioner Group of Palliative Care Quality Evaluation, Committee On Specialized and Cross-Sectional Palliative Care Promotion, Japanese Society for Palliative Medicine, Osaka, Japan

    Hirofumi Abo, Akihiro Sakashita, Kazuki Sato, Sari Nakagawa, Yoko Nakazawa, Jun Hamano & Mitsunori Miyashita

  12. Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan

    Akihiro Sakashita

  13. Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Kazuki Sato

  14. Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Kobe, Japan

    Sari Nakagawa

  15. Institute for Cancer Control, National Cancer Center, Tokyo, Japan

    Yoko Nakazawa

Authors
  1. Hideyuki Hirayama
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  2. Eriko Satomi
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  15. Jun Hamano
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  16. Mitsunori Miyashita
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Contributions

All authors have contributed to the critical revision of the manuscript. Hideyuki Hirayama also managed the data, ran the statistical analyses, and drafted the manuscript. Eriko Satomi, Yoshiyuki Kizawa, Mayuko Miyazaki, Keita Tagami, Ryuichi Sekine, Kozue Suzuki, Nobuyuki Yotani, and Koji Sugeno also collected the data. Hideyuki Hirayama, Hirofumi Abo, Meidai Sakashita, Kazuki Sato, Sari Nakagawa, Yoko Nakazawa, Jun Hamano, and Mitsunori Miyashita also contributed to conception and design of the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hideyuki Hirayama.

Ethics declarations

Ethics approval

We conducted this study with the approval of the Ethics Review Committee of the Tohoku University Graduate School of Medicine (No. 2020–1-944).

Competing interest

Eriko Satomi has accepted speaking fees from Terumo Corporation and Shionogi & Co. Other authors have no conflicts of interest to disclose.

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Hirayama, H., Satomi, E., Kizawa, Y. et al. The effect of palliative care team intervention and symptom improvement using patient-reported outcomes: a multicenter prospective observational study. Support Care Cancer 31, 439 (2023). https://doi.org/10.1007/s00520-023-07912-2

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